Determine the basic organization and operation of various types of hospitals and other healthcare organizations and services
Learning Objectives
Differentiate the roles of various healthcare providers throughout the healthcare delivery system
Determine the basic organization and operation of various types of hospitals and other healthcare organizations and services
Examine the use and functions of telehealth services in healthcare
Examine the influence of artificial intelligence in the delivery of healthcare
Identify the various policy making influences in the delivery of healthcare
Examine healthcare delivery in the United States
Key Terms
Accountable care organizations (ACOs)
Allied health professional
Ambulatory care
American Recovery and Reinvestment Act (ARRA)
Artificial intelligence (AI)
Average length of stay (ALOS)
Big data
Case management
Centers for Disease Control and Prevention (CDC)
Chief executive officer (CEO)
Chief financial officer (CFO)
Chief information officer (CIO)
Chief nursing officer (CNO)
Chief operating officer (COO)
Clinical privileges
Continuum of care
Critical access hospital (CAH)
Extended care facility
Health Information Technology for Economic and Clinical Health (HITECH) Act
Home healthcare
Hospice
Hospital
Hospitalist
Integrated delivery network (IDN)
Integrated delivery system (IDS)
Managed care organization (MCO)Medicaid
Medical home
Medical staff bylaws
Medical staff classification
Medicare
Patient Protection and Affordable Care Act (ACA)
Peer review organization (PRO)
Quality improvement organization (QIO)
Safety net hospital (SNH)
Skilled nursing facility (SNF)
Social determinants of health (SDOH)
Subacute care
Telehealth
Utilization review (UR)
Utilization Review Act
What are the advantages to all facilities of having a shared health record number
Assignment 3: (1) page assignment in a word document, Times New Roman Times in a font size of 12.
Real World Case 2.2
1. How is this situation complicated by not having all of the facilities linked into a common EHR?
- Whom would the HIM director have to work with to make an EMPI project successful?
- What are the advantages to all facilities of having a shared health record number
Real-World Case 2.2
A municipal medical center in a city of 100,000 residents decided that they needed to diversify if they were going to survive the ups and downs of the economy. The board of directors met with the chief of the medical staff to determine the best course of action. They mutually decided to emphasize a cradle-to-grave approach by acquiring a few select physician practices and a local nursing home, starting a home health agency, and creating a hospice unit within the medical center. The board then decided to link all new acquisitions to the medical center’s existing electronic health record (EHR) but ran into a problem with patient identification for health record purposes. The issue was that the same patient may have been or was going to be in multiple facilities within the new enterprise. However, at each of the present facilities (physician office, medical center, and nursing home), the same patient would have different health record numbers. A plan for an enterprise health record number was needed. The medical center administration decided to bring in the health information management director of the medical center to provide expertise and experience in resolving the problem.
What events in Steve’s life created a downward spiral into homelessness? Which events are related to social needs and which could healthcare have addressed?
Real World Case 2.1
What events in Steve’s life created a downward spiral into homelessness? Which events are related to social needs and which could healthcare have addressed?
What were some of the barriers Steve faced in accessing healthcare?
Why do you think the emergency department was the first place Steve thought to go for care? How might the emergency department improve care for patients like Steve?
What public health programs would be of the best utilization for Steve?
Real World Case 2.1
Steve is a 35-year-old, single male who lived in a one-bedroom apartment in a safe neighborhood. Steve worked as a maintenance technician for a local mill. Steve’s job provided health insurance and he rarely needed to use it. Steve smoked half a pack of cigarettes each day and drank socially a few times a month.
One afternoon, Steve’s company notified him that it was laying off more than one hundred employees, including him. Though he was devastated about losing his job, Steve was grateful that he had some savings that he could use for rent and other bills, in addition to the unemployment checks he would receive for a few months. For the next six months, Steve searched aggressively for a job but was unable to find one. With his savings depleted, he was not able to make ends meet, and he was evicted from his apartment. His self-esteem plummeted and he became depressed.
Steve stayed with various family members and friends and was able to pick up some odd jobs to make some money. However, his drinking and anger got worse and his hosts asked him to leave. When he ran out of people to call, he started sleeping at the park. One night when Steve was drunk, he fell and cut his shin. The injury became red and filled with pus. Steve was embarrassed about his situation and didn’t want anyone to see him. But when he developed a fever and pain, he decided to walk to the nearest emergency department. He saw a provider who diagnosed him with cellulitis, a common but potentially serious bacterial skin infection, and gave him a copy of the patient instructions that read “discharge to home” and a prescription for antibiotics. Steve could not afford the entire prescription, but he was able to purchase half the tablets.
Steve began staying at a shelter. Each morning he had to leave the shelter by 6 am, and he walked the streets during the day and panhandled for money to buy alcohol. One day two men jumped Steve, kicked him repeatedly, and stole his backpack. A bystander called 911 and he was taken to the same emergency department where he had sought treatment for the shin injury. Again, the providers didn’t screen him for homelessness, and he was discharged back to “home.”
A few days later, an outreach team from a local nonprofit organization introduced themselves to Steve and asked if he was ok. He did not engage in conversation with them. They offered him a sandwich, a drink, and a blanket, which he took without making eye contact. The outreach team visited him over the next several days and noticed his shortness of breath and the cut on his leg.
After a couple of weeks, Steve began to trust the outreach team and agreed to go to the organization’s medical clinic. The clinic provided primary care and behavioral health services through scheduled and walk-in appointments. Steve said the providers there treated him like a real person. He was able to have regular appointments with a therapist and began working on his depression and substance abuse. A year later, his health has improved. He is sober and working with a case manager to find housing.
What type of social skills /communication skills do you need to achieve your career goals?
Write a 1-2 page personal career development plan. Describe your short-term (after graduation) and long-term ( 5-10 years) career goals.
- What specific steps have you taken to prepare yourself for your career (i.e courses you took, additional workshops, training, volunteer work, internship or research you have undertaken)
- What specific steps do you plan to take in the near future to achieve your career goals?
- What specific technical skills do you need to achieve your career goals? Do you have these skills? How do you plan to improve these skills?
- What type of social skills /communication skills do you need to achieve your career goals? Do you have these skills? How do you plan to improve these skills?
Identify the price point you will sell your product at, including the pricing strategy and objectives.
Marketing Plan: Situation Analysis & New Product Development
Pretend you are introducing a new product in the same category as
your Step One research. Using the CityU Library:
1. Conduct a study of its consumer target market to include
demographics, geographics, and psychographics. Be sure to take
into account the target market of competing products, finding a
niche for yours.
2. Identify your points of difference and positioning strategy.
3. Analyze relevant category trends.
4. Analyze consumer trends.
5. Perform an environmental analysis including both a SWOT &
PEST.
Marketing Plan: Marketing Activities / Budget / Schedule / Pricing
Using the new product you identified in Step Two:
1. Identify the price point you will sell your product at, including the
pricing strategy and objectives.
2. Identify the marketing activities you will use to advertise your
product (minimum of 5; combination of both offline and
online marketing activities).
3. Develop a one-year calendar identifying when you'll execute each
of these marketing activities.
4. Develop a budget for the marketing activities identified above.
Topic: Yoga and tourism retreat
Explain how your academic and professional goals align with Walden’s vision, mission, social change message, social determinants of health, and university outcomes as well as and the AACN DNP Essentials.
- Explain how your academic and professional goals align with Walden’s vision, mission, social change message, social determinants of health, and university outcomes as well as and the AACN DNP Essentials. Be specific.
- Explain how you plan to incorporate social change throughout your program of study and in professional practice. Be sure to include how social change may contribute to your practicum/field experience and your role in professional practice.
What are the differences between a traditional metric and a KPI?
1. What are the differences between a traditional metric and a KPI?
2. What causes a lack of support for the use of metrics?
From a skills perspective, how would you describe the three managers, Kelly, Danielle, and Patrick? What does each of them need to do to improve their skills?
Case 3.2 Andy’s Recipe
Andy Garafallo owns an Italian restaurant that sits in the middle of a cornfield near a large midwestern city. On the restaurant’s far wall is an elaborate mural of the canals of Venice. A gondola hangs on the opposite wall, up by the ceiling. Along another wall is a row of real potted lemon trees. “My ancestors are from Sicily,” says Andy. “In fact, I can remember seeing my grandfather take a bite out of a lemon, just like the ones hanging on those trees.” Andy is very confident about his approach to this restaurant, and he should be, because the restaurant is celebrating its 25th anniversary. “I’m darned sure of what I want to do. I’m not trying different fads to get people to come here. People come here because they know they will get great food. They also want to support someone with whom they can connect. This is my approach. Nothing more, nothing less.” Although other restaurants have folded, Andy seems to have found a recipe for success. Since opening his restaurant, Andy has had a number of managers. Currently, he has three: Kelly, Danielle, and Patrick. Kelly is a kitchen (food prep) manager who is known as very honest and dependable. She loves her work, and is efficient, good with ordering, and good with preparation. Andy really likes Kelly but is frustrated with her because she has such difficulty getting along with the salespeople, delivery people, and waitstaff. Danielle, who works out front in the restaurant, has been with Andy the longest, six years. Danielle likes working at Garafallo’s—she lives and breathes the place. She fully buys into Andy’s approach of putting customers first. In fact, Andy says she has a knack for knowing what customers need even before they ask. Although she is very hospitable, Andy says she is lousy with numbers. She just doesn’t seem to catch on to that side of the business. Patrick, who has been with Andy for four years, usually works out front but can work in the kitchen as well. Although Patrick has a strong work ethic and is great with numbers, he is weak on the people side. For some reason, Patrick treats customers as if they are faceless, coming across as very unemotional. In addition, Patrick tends to approach problems with an either–or perspective. This has gotten him into trouble on more than one occasion. Andy wishes that Patrick would learn to lighten up. “He’s a good manager, but he needs to recognize that some things just aren’t that important,” says Andy. Andy’s approach to his managers is that of a teacher and coach. He is always trying to help them improve. He sees part of his responsibility as teaching them every aspect of the restaurant business. Andy’s stated goal is that he wants his managers to be “A” players when they leave his business to take on jobs elsewhere. Helping people to become the best they can be is Andy’s goal for his restaurant employees. Although Andy works 12 hours a day, he spends little time analyzing the numbers. He does not think about ways to improve his profit margin by cutting corners, raising an item price here, or cutting quality there. Andy says, “It’s like this: The other night I got a call from someone who said they wanted to come in with a group and wondered if they could bring along a cake. I said ‘yes’ with one stipulation. . . . I get a piece! Well, the people came and spent a lot of money. Then they told me that they had actually wanted to go to another restaurant, but the other place would not allow them to bring in their own cake.” Andy believes very strongly in his approach. “You get business by being what you should be.” Compared with other restaurants, his restaurant is doing quite well. Although many places are happy to net 5%–7% profit, Andy’s Italian restaurant nets 30% profit, year in and year out.
Questions
2. From a skills perspective, how would you describe the three managers, Kelly, Danielle, and Patrick? What does each of them need to do to improve their skills?
3. How would you describe Andy’s competencies? Does Andy’s leadership suggest that one does not need all three skills to be effective?
Does Dr. Wood have the skills necessary to be an effective leader of this research team?
Better answers will respond appropriately to the question using concepts from the chapter which the link is below and 2022 up to date outside sources and details from the case. Each question should be supposed with the chapter source and one outside source.
Case 3.1 A Strained Research Team
Dr. Adam Wood is the principal investigator on a three-year, $1 million federally funded research grant to study health education programs for older populations, called the Elder Care Project. Unlike previous projects, in which Dr. Wood worked alone or with one or two other investigators, on this project Dr. Wood has 11 colleagues. His project team is made up of two co-investigators (with PhDs), four intervention staff (with MAs), and five general staff members (with BAs). One year into the project, it has become apparent to Dr. Wood and the team that the project is underbudgeted and has too few resources. Team members are spending 20%–30% more time on the project than has been budgeted to pay them. Regardless of the resource strain, all team members are committed to the project; they believe in its goals and the importance of its outcomes. Dr. Wood is known throughout the country as the foremost scholar in this area of health education research. He is often asked to serve on national review and advisory boards. His publication record is second to none. In addition, his colleagues in the university know Dr. Wood as a very competent researcher. People come to Dr. Wood for advice on research design and methodology questions. They also come to him for questions about theoretical formulations. He has a reputation as someone who can see the big picture on research projects. Despite his research competence, there are problems on Dr. Wood’s research team. Dr. Wood worries there is a great deal of work to be done but that the members of the team are not devoting sufficient time to the Elder Care Project. He is frustrated because many of the day-to-day research tasks of the project are falling into his lap. He enters a research meeting, throws his notebook down on the table, and says, “I wish I’d never taken this project on. It’s taking way too much of my time. The rest of you aren’t pulling your fair share.” Team members feel exasperated at Dr. Wood’s comments. Although they respect his competence, they find his leadership style frustrating. His negative comments at staff meetings are having a demoralizing effect on the research team. Despite their hard work and devotion to the project, Dr. Wood seldom compliments or praises their efforts. Team members believe that they have spent more time than anticipated on the project and have received less pay or credit than expected. The project is sucking away a lot of staff energy, yet Dr. Wood does not seem to understand the pressures confronting his staff. The research staff is starting to feel burned out, but members realize they need to keep trying because they are under time constraints from the federal government to do the work promised. The team needs to develop a pamphlet for the participants in the Elder Care Project, but the pamphlet costs are significantly more than budgeted in the grant. Dr. Wood has been very adept at finding out where they might find small pockets of money to help cover those costs. Although team members are pleased that he is able to obtain the money, they are sure he will use this as just another example of how he was the one doing most of the work on the project.
Questions
1. Based on the skills approach, how would you assess Dr. Wood’s leadership and his relationship to the members of the Elder Care Project team? Will the project be successful?
2. Does Dr. Wood have the skills necessary to be an effective leader of this research team?
3. The skills model describes three important competencies for leaders: problem-solving skills, social judgment skills, and knowledge. If you were to coach Dr. Wood using this model, what competencies would you address with him? What changes would you suggest that he make in his leadership?
Propose improvements to a health services organization based on total quality management (TQM) concepts.
Assignment 2 – Case Study: Total Quality Management: The Patient Process at East-Southern Kentucky Community College Medical Clinic
Dr. William Jones has been the director of the health center clinic at East-Southern Kentucky Community College (ESKCC) for about six months. Having been a part of a much larger medical center in the past, he has seen the benefits of total quality management (TQM) and feels that it would help improve the operations at the ESKCC clinic. He has made some positive changes to the staffing of the clinic, but now feels that he must tackle making improvements to its operations. Consequently, he has created a TQM team (of which you are a part) and has made certain that they have received the necessary training to start examining the various processes within the health center’s operations. The ambulatory health service department of the ESKCC health center clinic has received increased complaints from the ESKCC student body and staff concerning the services it offers in its walk-in urgent care clinic. Dr. Jones feels that this center would be an excellent starting point for the TQM team.
The Data
The team is presented with the following data regarding student/staff complaints:
CHART IS ATTACHED
The Patient Review Process
The process for a patient (either a student or a staff member) coming in because of a problem is as follows:
- When a patient arrives at the clinic, the patient first sees the receptionist, who checks to see if the patient was seen before. If so, the receptionist pulls the medical record from the file. If the patient is new, the receptionist has the patient complete the necessary forms and creates a medical record.
- Patients are seen by the physician in the order they arrive. If one of the two examination rooms is empty, the nurse escorts the patient to the examination room and records the patient’s medical complaint. If no examination rooms are available, the nurse escorts the patient to a waiting area until an examination room is available.
- When the patient is in the examination room, the nurse performs routine tests. The nurse then writes the complaint and findings on a medical examination form, a form that will be subsequently filed with the patient’s medical record.
- The physician examines the patient and orders medical tests, if necessary. A diagnosis and treatment plan is presented to the patient by the physician; a written copy of this plan and any other appropriate instructions are written on the medical examination form.
- When the physician releases the patient, the patient returns to the receptionist, who prepares a bill. If the patient has health insurance, the bill is sent to the health insurance carrier.
- The patient leaves after either paying the bill (by cash, check, or credit card) or signing the forms to authorize payment by his or her health insurance company. If the health insurance company refuses to pay or partially pays the bill, the receptionist bills the patient by mail. Any patient with an unpaid bill or bad credit history is refused subsequent treatment until the old bill is paid.
Instructions
As a member of the ESKCC TQM team, you are asked to put together a report that recommends improvements to the overall patient process. Create a 4–6 page report in a Word document (copy and paste any charts created in Excel) addressing the following tasks:
- Construct a Pareto Chart for the data regarding complaints to the health center that is presented in Table 1. Describe two conclusions from examining this data.
- Develop a control chart for the waiting time complaint (complaint #2). Explain how the control chart is developed and show the calculation process.
- Illustrate the causes for Complaint #2 in a fishbone diagram. (Note: refer to the readings for examples.)
- Develop a flow chart for the process that the clinic uses for a patient who comes into the ambulatory center. Draw two conclusions from examining the flow chart regarding either or both of the following:
- How the process affects the patient.
- Potential sources of unnecessary complexity.
- Determine three improvements to streamline the patient process based on the insights that you gain from examining the process flow chart as well as your understanding of total quality management concepts from your course readings.
This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course. Check with your professor for any additional instructions.The specific course learning outcome associated with this assignment is:
- Propose improvements to a health services organization based on total quality management (TQM) concepts.
