Leadership, Operations Management, and the Impact of Fraud

An Executive Summary of Leadership, Operations Management, and the Impact of Fraud of D\’Wellington Healthcare Group (DWHCG)

D’Wellington Healthcare Group (DWHCG) is experiencing frauds and varying leadership issues. Due to this, a SWOT analysis conducted illustrates the strengths, weaknesses, threats, and opportunities. This identified leadership issues, operation management, and the impact of fraud.

Effective leadership in healthcare is vital in integrating and strengthening care delivery (Aronson, 2001). To start on a robust leadership in D’Wellington Healthcare Group (DWHCG), an autocratic leadership will be effective. The reason for choosing this form of leadership is because it relies on specific procedures, policies, and rules to govern all processes within DWHCG. Al-Sawai (2013) identifies that autocratic leadership allows fast decision making. DWHCG experiences fraud issues, which require fast decisions that will improve overall communication as there are fewer administration levels.

The benefit of autocratic leadership for DWHCG is that it handles crisis effectively (Van Vugt, Jepson, Hart, & De Cremer, 2004). The autocratic leader will be in charge of all aspects, from decision making to communication. This will help manage traffic in fraudulent activities efficiently than other forms of leadership styles like democratic. However, autocratic leadership faces challenges as it results in micromanagement, as the leader will supervise every small aspect of fraud. Other leadership styles include relationship-oriented, task-oriented, autocratic, transactional, and transformational leadership.
Transformational leadership boosts relationship with employees and long-term motivation of employees by boosting confidence, respect, and loyalty (Aronson, 2001). On the other hand, transactional leadership focuses on change, which improves productivity. Laissez-faire leadership style involves leaders who apply a hands-off approach and do not make decisions for employees. Lastly is task oriented that aims towards attaining visions and is relationship-oriented, which incorporates recognition, development, and support (Al-Sawai, 2013).

The Role of Operation Manager

The DWHCG operations manager will act as a liaison between the clinical staff and healthcare services recipients. The manager will manage the financial wellbeing of DWHCG, formulate policies, and manage all employees (both medical and non-medical staff). The operations manager communicates with personnel through the creation of an efficient work environment. The manager should have the skills and ability to express the expectation of the company. Langabeer and Helton (2015) explain that the operations manager communicates with employees and provides strong feedback for future operations.
One of the responsibilities of healthcare managers is technological proficiency. DWHCG requires operational managers who are proficient in information technology. Strategic planning is significant among health managers. Therefore, to ensure increased safety and reduced frauds, the operations manager will enforce rules and policies.

System to Detect and Prevent Fraud

Healthcare organizations’ managers should improve medical billing processes and implement comprehensive strategies to detect and prevent healthcare abuse and fraud (Fowman, 2004). One tool that DWHCG can employ is computer-assisted coding, which will detect fraudulent practices and coding errors. The managers can remain actively involved in local and national policy decisions that are related to the detection and prevention of fraud and abuse. A decision system also requires health leaders to remain up to date on new laws and regulations. As leaders, it is essential to educate consumers on ways to identify medical theft and safeguard health information.

The company should apply value-based purchasing models, which will assist in filling care gaps by forming business relationships with other companies. Through this, the company maximizes value-based reimbursement by monitoring patients’ outcomes. Nonetheless, this aspect is challenged by the Anti-Kickback Statute and Physician Self-Referral Law. Following such laws providers will not be paid based on outcome and value, but rather on service volume.

References

Al-Sawai, A. (2013). Leadership of Healthcare Professionals: Where Do We Stand? Oman Medical Journal, 28(4), 285-287. doi: 10.5001/omj.2013.79
Aronson, E. (2001). Integrating leadership styles and ethical perspectives. Canadian Journal of Administrative Sciences/Revue Canadienne des Sciences de l’Administration, 18(4), 244-256.
Forman, B. (2004). U.S. Patent No. 6,826,536. Washington, DC: U.S. Patent and Trademark Office.
Langabeer, J. R., & Helton, J. (2015). Health care operations management. Jones & Bartlett Publishers.
Van Vugt, M., Jepson, S. F., Hart, C. M., & De Cremer, D. (2004). Autocratic leadership in social dilemmas: A threat to group stability. Journal of experimental social psychology, 40(1), 1-13.