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- 1. Organizational Structure Ana Jacobs HCS/325 Week 5 Professor E. Milo
- 2. Introduction • The effects of organizational structure on communication • Steps involved in planning and functions of management • Tracking outcomes and improving quality • Effects of financial and human resource management control • Influencing organizational change and minimizing conflict • Ethical issues that are important today in health care
- 3. Why communication is important • Organizational structure and communication • H.I.P.A.A. • P.H.I. • E.H.R. (Electronic Health Record) • How teams communicate
- 4. Planning and functions of management S.W.O.T. Analysis Strengths Weakness Opportunity Threats Threats Weakness Opportunity Strength
- 7. Tracking outcomes and improving quality Administration Quality Assurance Team Dietary Non – medical services Quality Assurance Team Nursing Department
- 8. Financial and human resource management controls Minimum Data Set • Accurate documentation • MDS coordinator ICD - 10 • Codes are accurate • Follow updated regulations Prevent Fraud Waste and Abuse • Prevent medication errors • Do not document ahead of time
- 9. Minimizing conflict & influencing change within Overall job satisfaction Perception of co-workers and leaders Opportunity for advancement Negative competition No motivation Burn out
- 10. Ethical issues in health care today • Beginning and end of life issues • Religious and cultural factors influence ethical decision making • Ethical reasoning requires critical thinking • Ethical decisions are made every day in health care
- 11. Q & A Discussion Forum 1) Is it motivating to the care giver or patient to go beyond the routine scope of practice in patient care – reaching out to patients in other areas such as providing emotional support? For example what if they have no family to visit them? Is it unprofessional or do you consider it caring to play chess/checkers with a patient on your day off, or on break? 2) Many feel that every person deserves or has the right to have quality health care. Others think that health care must be earned. What is your point of view and why? 3) Cosmetic surgery and aesthetic surgery is for the most part an industry that is not regulated. Why hasn’t health care reform formerly addressed any ethical or legal issues in the area of professionals and non - professionals who practice plastic/cosmetic surgery? What affect does repairing complicated and botched surgeries have on health care costs and on the health care industry as a whole? 4) What are some differences between legal and ethical behavior in the health care setting?
- 12. Q & A Discussion Forum 5) Health care reform – What type of lawmaking action instituted health care reform? a) Common law b) Legislative process c) Executive order 6) Will health care reform spawn new laws or will new laws be enacted to guide reform? 7) Is reporting child abuse or domestic violence a legal issue, ethical issue or both? Does it matter who reports such cases in a health care organization? If the law does not permit you to report such cases from an official patient record is there still an ethical obligation to do so? What are other methods of reporting such cases? 8) Should the decision to provide an organ to someone in need of a transplant be influenced by the availability of family support for the individual? Does demographics, culture, lifestyle choices play a part in choosing who is at the top of the list to receive a transplant and who is at the bottom of the list?
- 13. Summary At Above Basic Care (ABC) our Mission and Vision includes maintaining practices that reflect the highest standards of quality care in our chosen profession. We endeavor to commit ourselves to change from within, to be a positive influence on our vast network of associations professionally; never excluding those the are near and very dear to us, our patients and their families.
- 14. References Allen, J.E. (2007). Nursing Home Administration (5th ed.). Springer Publishing. Atiyeh, B. S., Rubeiz, M. T., & Hayek, S. N. (2008). Aesthetic/Cosmetic surgery and ethical challenges. Aesthetic Plastic Surgery, 32(6), 829-39; discussion 840-1. doi:http://dx.doi.org/10.1007/s00266-008-9246-3 Buchbinder, S. B., & Shanks, N. H. (2012). Introduction to health care management (2nd ed.). Burlington, MA: Jones & Bartlett Learning Rauch, S. A., & Lanphear, B. P. (2012). Prevention of disability in children: Elevating the role of environment. The Future of Children, 22(1) Retrieved from http://search.proquest.com/docview/1519298061?accountid=35812 Seeger, M. W., Cohen, Sproull (2006). Article. Best practices in communication: An expert panel process. Routledge Taylor & French Group. University of Phoenix website student materials.
- 15. References Wall, Sarah,B.ScN., M.H.S.A. (2007). Organizational ethics, change, and stakeholder involvement: A survey of physicians. HEC Forum, 19(3), 227-43. doi:http://dx.doi.org/10.1007/s10730-007-9042-5 Picture References https://www.bing.com/images/search?q=stethoscope&qs=IM&form=QBIR&pq=stethas&sc=8- 7&sp=1&sk=&undefined=undefined
Editor's Notes
- 1) Identify communication methods The importance of the methods of communication for the organization Consider internal and external relationships 2) Identify the steps to plan and implement change within the organization Explain the steps and how they apply to Quality Assurance and the Long Term Care addition to the facility 3) Analyze strategies that might be used to bring about change for the organization How are the strategies used to prevent and minimize conflict? What strategies can be applied should a conflict arise What is the managers role in resolving conflict 4) How ethical issues might alter the way change is conducted within an organization 5) How do financial and human resource control issues affect the decision making process 6) Environmental influences that are related to health care that may affect outcomes and quality within an organization-analysis How will implemented change be tracked and evaluated -analyze
- Communication flows from the top down or vertically when information regarding changes in health care policies, facility protocols, change in management or leadership is exchanged in a health care organization. The Administrator at Above Basic Care, a nursing home facility – has just been informed that the new Long Term Care addition is ready to open the doors and welcome new patients. Information regarding patient care may be exchanged horizontally- from one department (nursing to dietary) to another. Communication is always done with protecting patient information in mind. A nurse is required to log out of a screen displaying patient information when they are finished documenting notes electronically using any electronic health record, in compliance with H.I.P.A.A. Information that is P.H.I. such as the names and room # of patients can be de-identified for the purpose of doing rounds or giving report. Be careful not to disclose any P.H.I. unknowingly, at the nurses station giving a verbal report - other patients that are alert and oriented might hang around to get an update on the condition of other patients. The health care team can communicate in their meeting room away from the patients to be discreet and to keep patient information private. The Administrator, H.R. director, Director of Nursing; and Director of Social Services Administrator and patient care advocates – and volunteers (even you are included in the discussion) all are communicating face to face - the intricate details of the new Long Term Care addition to the facility.
- Planning is important to managing a health care organization. Above Basic Care Facility (ABC), Is utilizing a newly trained Quality Assurance team to do a S.W.O.T. analysis during the hiring process to staff a new Long Term Care unit added recently to the facility. During training, the Q&A team will define their goals and communicate expected outcomes to improve patient care to the new employees. Of the two S.W.O.T. Analysis structures above, which example is the ideal for any organization? The pink example is ideal because the threats are minimized and the strengths of the organization are greater than the weaknesses. In the second example on the far left: the threats to ABC are greater than the strengths of the organization. Threats are any influences externally, or internally that could have a negative impact on the success of the health care organization. Threats are usually seen as negative press, a bad reputation, or bad survey results from an unhappy or unhealthy community of patients. With negative survey results – the strengths of a facility are reduced, and the census or number of beds that are filled may decrease. In the second example the threats that are looming over DGT (Don’t Go There Facility) are targeting the weakened areas seeking the opportunity to ultimately smother the little strength that this example does have.
- Morning Schedule. During training the responsibility of the Q&A team will be to identify the current strengths of the newly hired healthcare team realistically. During that time Quality Assurance can also identify factors that can be improved upon. Quality Assurance will create and implement measures to be created adding changes to the facility protocol in accordance with recent changes in health care policies and regulation. Other training that is critical to the success of an organization is crisis intervention. As stated by Cohen and Sproull (1996), “Best practices are useful for packaging learned principles in a way that facilitates their communication both within and between organizations and ultimately their adoption.” Quality assurance communicates the needs of a health care facility internally and acquires resources externally, from other organizations to ensure quality patient care. For example, your patient at ABC facility ran out of colostomy supplies. Do you wait for the supplies to be delivered or would you call other facilities to see if some one else has any ostomy appliance that fits your patient? By calling another facility and finding that they do have the supplies that your patient desperately needs - you just prevented a major crisis for your patient. Be prepared to go and get the supplies - if the help that you found is not able to deliver it to you.
- Afternoon Schedule. The newly hired nurses and nurse aides, already have experience. During weeks four and five, Quality Assurance will assess skills on the floor for nurses and nurse aides and identify weakness. On the unit and during hands on patient care – Quality Assurance also checks for the new health care team to use ‘best practices’ in their delivery of care to patients. Best practices such as acknowledging patient rights, hand washing, don gloves and other PPE; and using sterile technique during treatments (if a procedure calls for the care-giver to do so).
- In health care facilities environmental influences are directly related to the health and wellness of patients. Environmental influences are the physical elements in the patient’s surroundings that can make a person better or keep some one very ill. Researchers examine the emergence of evidence that shows that many disabilities that affect children have their origins in the environment; polluted air, water, and soil; and marketing practices that promote unhealthy lifestyles or discourage healthy living. (Rauch & Lanphear, 2012). Interventions that are being put to use now can prevent disabilities and complicated pregnancies, or births in the future that would otherwise continue to afflict millions of children. Interventions to control environmental influence: (examples) residential areas being away from industrialized areas when zoning regulations are utilized; chemical testing for toxicity before products are put on the market; and restrictions on advertising unhealthy products like tobacco, alcohol, and junk foods to minors. (Rauche & Lanphear, 2012). In the hospital, everyone can have a responsibility or role in containing the environmental influences that are harmful by practicing something as simple as washing your hands frequently. Nurses use best practices containing environmental influences that are harmful by using a sharps container to dispose of needles and other sharps; or by putting a protective cover over catheter bags, by making sure the catheter bag does not touch the floor. A protective cover over a catheter bag not only prevents germs and harmful bacteria from entering the catheter tubing – it also gives a patient their dignity and privacy. Quality Assurance teams play an important role in tracking outcomes and improving quality for an organization. Quality Assurance teams are used to train, and assess – measuring the performance of the health care team as needed to ensure that patients are getting quality care. The Q&A team bases the assessments on state and federal regulations and health care laws.
- Finance does play a major role in the health and wellness of patients at any health care organization. The goal of an Administrator and H.R. is to save money, but not at the expense of the nurses not having the necessities needed to provide quality patient care. A long term care administrator has to have knowledge of a facilities financial performance in the past to prepare a realistic and reasonable budget; and to predict, planning for successful financial outcomes. For example, assessments that are not done correctly by the M.D.S. coordinator can cost a facility thousands of dollars in financial losses annually. Some Long Term Care facilities require that nurses do M.D.S. documentation under the guidance of an M.D.S coordinator. “The Administrator has to understand and monitor the manner of which the (M.D.S.) minimum data set is being completed to assure that the facility receives the highest reasonable and accurate resource utilization group (R.U.G.) score for each resident served.” (Allen, 2007). Billing for services not rendered includes a statement that has purchases for items that are not available to use for patient care. Preventing fraud, waste, and abuse; and accurate documentation have a direct impact on the financial stability of a health care organization. Do you know how new health care regulations and the Affordable Care Act affect your health care organization? Quality Assurance will implement a system of reviews to assess the health care team in the area of accurate documentation.
- Leaders and managers play an important role in minimizing conflict. The leaders in the health care industry also influence change, setting the pace or tone of the work environment. Managers as well as leaders may be confronted with insubordinate behavioralists (employees that have perfected the art of being insubordinate because the know you can’t afford to fire them if there is no one else to work), negative competitionists, and employees that are not motivated – even a little bit to complete the task at hand. Some employees may be experiencing ‘burn out’ emotionally, or physically. Managers must dissolve conflicts and dissimilate by disassociating employees that do not work well together from one another. Dissolve, Dissimilate & Disassociate. Job satisfaction can be increased by giving employees the opportunity to advance, and by changing any negative perceptions of the work environment including co-workers and management. Managers can prevent the vicious cycle that is all too common in the medical profession; poor quality of work life causes turnover, that causes a poor work environment - causing stress – and more turn over. When C.N.A.’s quit, the L.P.N.’s become stressed and quit causing upper management to either quit or be replaced. (Buchbinder, 2012).
- Ethical issues today are influenced by culture, religion, personal beliefs; and the law. Ethical committees in hospitals and other health care settings (mental health), are becoming much more prominent. Ethical topics are discussed at ABC facility during orientation. Ethics are weaved in to other discussions on patient rights and reporting patient abuse. An ethical committee can be established to decide on harder cases such as discussing end of life issues.
- There are definite right and wrong answers for some questions and for others there are no right or wrong answers.
- There are some definite right and wrong answers, however, many will not come to the same ethical conclusion depending on their religious, cultural, or personal beliefs.