THE DYNAMIC ENVIRONMENT OF HEALTH CARE
Chapter 1
Objectives
Describe the present healthcare environment.
Examine megatrends in the environment.
Address organizational survival.
Identify the role of the healthcare practitioner as manager.
Review the classic functions of the manager.
Define and differentiate between management as an art and a science.
Conceptualize the characteristics of an effective manager.
2
Megatrends
Client characteristics
Professional practitioners and caregivers
The healthcare marketplace and settings
Applicable laws, regulations, and standards
The impact of technology
Privacy and security considerations
Financing of health care
Social and cultural factors
Healthcare Regulation
State licensure laws for facilities
State licensure laws for professions
State-mandated healthcare planning
State laws governing reimbursement and insurance
Healthcare Regulation
Federal laws governing reimbursement
Federal laws regarding privacy and security of information
Patient Protection and Affordable Care Act
American Recovery and Reinvestment Act
5
Reimbursement and Payment
Charitable roots and the not-for-profit model
Fee-for-service
Health insurance: Non-profit and commercial
Managed care
Current legislation: Healthcare reform
The Managed Care Era
Providing access to quality care at affordable cost
Primary care physician as “gatekeeper”
Premium costs by limits on services
Arrangements between managed care groups and hospitals
Issues about denial of service or payment
Capitation
Reimbursement system under which provider is paid specific amount of money to look after all the healthcare needs of a given population
Literally, reimbursement based on so much “per head”
Reasons for Restructuring
Desire to achieve greater negotiating clout
Desire to penetrate new markets
Need for improved efficiencies
Desire to express an overall value of promoting comprehensive, readily accessible care
Mergers and Affiliations
MERGER: Two or more corporate entities blend to create one new organization
AFFILIATION: Formal agreement between facilities to coordinate and share activities while remaining separate corporate entities
Range of Service
Note the variety of services and levels of care
Examples:
Adult day care center
Hospice
Urgent care clinic
Impact of Technology
“eVisits” and “digital doctors”
Translational medicine
Data warehousing
Data mining
“Real-time” interventions
Common language and standards: Standard vocabulary and classification systems
National information infrastructure: To capture, access, use, exchange, and store data
Increased use by patients of alternative therapies and interventions
The embedded nurse representative on patient care teams
Rationing; quality-adjusted remaining years
Social and Ethical Factors
Unit supervisor; project manager; department head
Specialized division head
Manager of independent practice
Role of Healthcare Practitioner as Manager
Management Functions
Typ.
The ethics of performance monitoring-private sector perspectiveDavid Quek
Increasingly medical practice is coming under intense scrutiny as to what is appropriate and affordable care, including serious considerations of patient safety issues and protection. Medical professionalism must be consciously adhered to as we try and find the best health care for our patients at the best value and outcomes for our patients themselves, and also for society at large. In view of escalating health care costs, physician autonomy to practice as he or she likes or deems fit has now come under siege with more and more performance monitoring, not just for appropriateness, but also for outcomes, necessity and cost-effectiveness. Physician' vested interests must be tempered with evidence-based benefits or at least be associated with no increase in harm or incur affordability issues. Fraudulent physician malfeasance are now being uncovered via whistle-blowers, or through greater more meticulous audit of various validated performance measures, and those physicians found to have flouted these due to pecuniary self-interests, overuse of tests or procedures have been found guilty and sanctioned with heavy fines, return of reimbursements as well as imprisonment, and erasure from medical registries and the removal of license to practice.
community health center are based on health care where Healthcare for Communities are designed to offer information on how the healthcare system is functioning in order to take care of their own health.
Peer response’s # 2Rules Please try not to make the responses s.docxdanhaley45372
Peer response’s # 2
Rules: Please try not to make the responses super lengthy, contribute one fact AND include references
HMGT 420
· Wk#3
Talar posted Jun 4, 2016 11:57 PM
Patients who have complex health needs require not only medical. But also social services and support from a variety of caregivers and providers. Facility managers who are part of care coordination could assist patient in receiving optimal care by addressing the challenges in coordinating care for these patients, and offer programmatic changes and policies that help deliver the best services to all patients.
Facility managers can come up with strategic plans based on prior data and make necessary changes based on preexisting conditions. “Patient- centered, comprehensive, coordinated, and accessible care that continuously improved through a systems-based approach to quality and safety” (AHRQ, 2012) are what’s needed to achieve the highest quality care possible in any health care facility.
Patient centered care can’t be achieved with providers only. It requires team work and collaboration among all stakeholders. To improve the quality and safety of patients, health care facility managers can work hand and hand with the coordinated team to provide a system based approach by drawing on decision-support tools, taking into account patient experience, and using population health management approach. Patient preference and needs on what aspects of care to be improved.
Respond to Talar here:
· Vanscoy, Week 3
Sarah posted Jun 5, 2016 11:07 AM
As a facility manager, and part of the care coordination team, I would look into models of care that would assist our situation. With the Affordable Care Act in place, there are accountable care organizations (ACOs), which provide models of care (“Promise,” 2013). There are many different definitions and perspectives on care coordination, but all lead to the goal of meeting patient needs and providing adequate healthcare (“Care,” 2014).
Care coordination is essential because each patient can interact with a variety of professionals each visit. For example, for a routine physical appointment, the patient could meet with the scheduling staff, medical assistants, nurses, doctors, pharmacists, and the billing staff. If each one of these member fails to coordinate as a whole, the patient could be harmed or neglected. As a care coordinator, I would be responsible for discussing an individualized care plan with each patient and ensuring that they understand their responsibilities. All barriers should be identified, such as financial, social (language), psychological, and anything that would effect the patient from following their correct plan of care and interacting with the staff (“Promise,” 2013). Another key point is to ensure the medical staff has reviewed the patient’s medical records and ensure that everyone is on the same page. These are just a few examples, because each case is different and each patient will have different needs. .
S28 September-October 2016HASTINGS CENTER REPORTUndispu.docxWilheminaRossi174
S28 September-October 2016/HASTINGS CENTER REPORT
Undisputedly, the United States’ health care sys-
tem is in the midst of unprecedented complexi-
ty and transformation. In 2014 alone there were
well over thirty-five million admissions to hospitals in
the nation,1 indicating that there was an extraordinary
number of very sick and frail people requiring highly
skilled clinicians to manage and coordinate their com-
plex care across multiple care settings. Medical advances
give us the ability to send patients home more efficiently
than ever before and simultaneously create ethical ques-
tions about the balance of benefits and burdens associ-
ated with these advances. New treatments for cancer or
complex heart disease may prolong life until the disease
becomes irreversible while causing significant morbidity
that undermines functional status, independence, and
quality of life in ways that patients find unacceptable.
Some patients and families voice concerns about access
to treatments and about the quality and safety of the care
they or their loved ones receive.
Every day on every shift, nurses at the bedside feel
these pressures and the intense array of ethical issues that
they raise. A staggering 17.5 percent of trained nurses are
leaving their roles or the profession after less than one
year of service,2 and increasing levels of moral distress
and burnout contribute to their decisions.3 Meanwhile,
research supports the common-sense understanding that
patients and health care organizations fare better when
nurses are not harried, are supported in their work en-
vironments, and are able to practice high-quality, ethical
care.
At the same time, administrators, policy-makers, and
regulators struggle to balance commitments to patients,
families, staff members, and governing boards. Health
care organizations are compelled by laws, regulations,
and accrediting bodies to pursue externally reported
measures of effectiveness that can put their mission and
values at risk. While health care systems declare their
commitment to core ethical values, many clinicians
struggle to understand institutional priorities, budgets,
policies, and decisions seemingly inconsistent with their
values as professionals.
Increasingly clinicians find their ability to provide
compassionate care at odds with the intensifying focus
on matters such as clinical pathways aimed at standard-
izing care, cost-cutting efficiencies, electronic medical
records, and hospital policies and procedures.4 Arguably,
each of these have merit in the current system, but what
is not accounted for are the unintended consequences
of diverting attention from the core ethical values of the
professions. For example, the advent of the EMR requires
clinicians to focus on documentation rather than being
fully present during patient encounters. An emphasis on
clinical pathways increases the risk of reducing patient
symptoms and diseases to what fits a rote app.
Creating adaptable communities summary from Empowering Adaptable Communities ...Innovations2Solutions
Sodexo was honored to be a featured presenter at the 2nd Annual Atlantic Center for Population Health Sciences Empowering Adaptable Communities Summit. The Summit was held on October 21 and 22, 2015, in Morristown, New Jersey, at the College of Saint Elizabeth. The event was devoted to providing new insights, information, inspiration, and personal connections in our united efforts to empower communities to be more adaptable.
The ethics of performance monitoring-private sector perspectiveDavid Quek
Increasingly medical practice is coming under intense scrutiny as to what is appropriate and affordable care, including serious considerations of patient safety issues and protection. Medical professionalism must be consciously adhered to as we try and find the best health care for our patients at the best value and outcomes for our patients themselves, and also for society at large. In view of escalating health care costs, physician autonomy to practice as he or she likes or deems fit has now come under siege with more and more performance monitoring, not just for appropriateness, but also for outcomes, necessity and cost-effectiveness. Physician' vested interests must be tempered with evidence-based benefits or at least be associated with no increase in harm or incur affordability issues. Fraudulent physician malfeasance are now being uncovered via whistle-blowers, or through greater more meticulous audit of various validated performance measures, and those physicians found to have flouted these due to pecuniary self-interests, overuse of tests or procedures have been found guilty and sanctioned with heavy fines, return of reimbursements as well as imprisonment, and erasure from medical registries and the removal of license to practice.
community health center are based on health care where Healthcare for Communities are designed to offer information on how the healthcare system is functioning in order to take care of their own health.
Peer response’s # 2Rules Please try not to make the responses s.docxdanhaley45372
Peer response’s # 2
Rules: Please try not to make the responses super lengthy, contribute one fact AND include references
HMGT 420
· Wk#3
Talar posted Jun 4, 2016 11:57 PM
Patients who have complex health needs require not only medical. But also social services and support from a variety of caregivers and providers. Facility managers who are part of care coordination could assist patient in receiving optimal care by addressing the challenges in coordinating care for these patients, and offer programmatic changes and policies that help deliver the best services to all patients.
Facility managers can come up with strategic plans based on prior data and make necessary changes based on preexisting conditions. “Patient- centered, comprehensive, coordinated, and accessible care that continuously improved through a systems-based approach to quality and safety” (AHRQ, 2012) are what’s needed to achieve the highest quality care possible in any health care facility.
Patient centered care can’t be achieved with providers only. It requires team work and collaboration among all stakeholders. To improve the quality and safety of patients, health care facility managers can work hand and hand with the coordinated team to provide a system based approach by drawing on decision-support tools, taking into account patient experience, and using population health management approach. Patient preference and needs on what aspects of care to be improved.
Respond to Talar here:
· Vanscoy, Week 3
Sarah posted Jun 5, 2016 11:07 AM
As a facility manager, and part of the care coordination team, I would look into models of care that would assist our situation. With the Affordable Care Act in place, there are accountable care organizations (ACOs), which provide models of care (“Promise,” 2013). There are many different definitions and perspectives on care coordination, but all lead to the goal of meeting patient needs and providing adequate healthcare (“Care,” 2014).
Care coordination is essential because each patient can interact with a variety of professionals each visit. For example, for a routine physical appointment, the patient could meet with the scheduling staff, medical assistants, nurses, doctors, pharmacists, and the billing staff. If each one of these member fails to coordinate as a whole, the patient could be harmed or neglected. As a care coordinator, I would be responsible for discussing an individualized care plan with each patient and ensuring that they understand their responsibilities. All barriers should be identified, such as financial, social (language), psychological, and anything that would effect the patient from following their correct plan of care and interacting with the staff (“Promise,” 2013). Another key point is to ensure the medical staff has reviewed the patient’s medical records and ensure that everyone is on the same page. These are just a few examples, because each case is different and each patient will have different needs. .
S28 September-October 2016HASTINGS CENTER REPORTUndispu.docxWilheminaRossi174
S28 September-October 2016/HASTINGS CENTER REPORT
Undisputedly, the United States’ health care sys-
tem is in the midst of unprecedented complexi-
ty and transformation. In 2014 alone there were
well over thirty-five million admissions to hospitals in
the nation,1 indicating that there was an extraordinary
number of very sick and frail people requiring highly
skilled clinicians to manage and coordinate their com-
plex care across multiple care settings. Medical advances
give us the ability to send patients home more efficiently
than ever before and simultaneously create ethical ques-
tions about the balance of benefits and burdens associ-
ated with these advances. New treatments for cancer or
complex heart disease may prolong life until the disease
becomes irreversible while causing significant morbidity
that undermines functional status, independence, and
quality of life in ways that patients find unacceptable.
Some patients and families voice concerns about access
to treatments and about the quality and safety of the care
they or their loved ones receive.
Every day on every shift, nurses at the bedside feel
these pressures and the intense array of ethical issues that
they raise. A staggering 17.5 percent of trained nurses are
leaving their roles or the profession after less than one
year of service,2 and increasing levels of moral distress
and burnout contribute to their decisions.3 Meanwhile,
research supports the common-sense understanding that
patients and health care organizations fare better when
nurses are not harried, are supported in their work en-
vironments, and are able to practice high-quality, ethical
care.
At the same time, administrators, policy-makers, and
regulators struggle to balance commitments to patients,
families, staff members, and governing boards. Health
care organizations are compelled by laws, regulations,
and accrediting bodies to pursue externally reported
measures of effectiveness that can put their mission and
values at risk. While health care systems declare their
commitment to core ethical values, many clinicians
struggle to understand institutional priorities, budgets,
policies, and decisions seemingly inconsistent with their
values as professionals.
Increasingly clinicians find their ability to provide
compassionate care at odds with the intensifying focus
on matters such as clinical pathways aimed at standard-
izing care, cost-cutting efficiencies, electronic medical
records, and hospital policies and procedures.4 Arguably,
each of these have merit in the current system, but what
is not accounted for are the unintended consequences
of diverting attention from the core ethical values of the
professions. For example, the advent of the EMR requires
clinicians to focus on documentation rather than being
fully present during patient encounters. An emphasis on
clinical pathways increases the risk of reducing patient
symptoms and diseases to what fits a rote app.
Creating adaptable communities summary from Empowering Adaptable Communities ...Innovations2Solutions
Sodexo was honored to be a featured presenter at the 2nd Annual Atlantic Center for Population Health Sciences Empowering Adaptable Communities Summit. The Summit was held on October 21 and 22, 2015, in Morristown, New Jersey, at the College of Saint Elizabeth. The event was devoted to providing new insights, information, inspiration, and personal connections in our united efforts to empower communities to be more adaptable.
Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, gave the Ian Webster Health for All Oration to the annual forum of the Centre for Primary Health Care and Equity on 13 August 2015.
This e-book focuses on Health Management Solutions the value it adds alongside other systems that are already in place throughout the care lifecycle...
Heritage Healthcare:-
Legacy healthcare refers to the traditional model of healthcare that has been in vogue for many years. It is characterized by a fee-for-service payment model, where healthcare providers are reimbursed for each service they provide to patients. This model has been a foundation of the US healthcare system for many years, but it has faced increasing criticism for its high costs and inefficiencies. In this essay, we'll explore the history, challenges, and possible solutions to legacy healthcare.
History of Legacy Healthcare
Legacy healthcare emerged in the United States in the early 20th century. At the time, health care was largely provided by individual physicians and hospitals, and patients paid for services out of pocket. However, with the rise of employer-sponsored health insurance during World War II, a new payment model emerged. This model was based on a fee-for-service system, where healthcare providers were reimbursed for each service they provided to patients. The system was designed to encourage healthcare providers to provide more services, with the assumption that more services would lead to better health outcomes.
Over the past few years, the fee-for-service model has become deeply ingrained in the US healthcare system. It has been the foundation of the Medicare and Medicaid programs, which provide healthcare for millions of Americans. However, as the cost of health care continues to rise, the limits of this model are becoming increasingly apparent.
Challenges of Legacy Healthcare
One of the main challenges of legacy healthcare is its high cost. The fee-for-service model incentivizes healthcare providers to provide more services, whether those services are truly needed or not. This has given rise to a phenomenon known as overuse, where patients receive more tests, procedures and treatments than they actually need. This not only increases the cost of health care but can also cause harm to patients. For example, unnecessary tests and procedures can expose patients to radiation and other risks.
Another challenge of legacy healthcare is its fragmentation. The fee-for-service model encourages healthcare providers to work independently of each other, rather than collaborating to provide coordinated care. This can lead to a lack of communication between healthcare providers, resulting in duplication of services and missed opportunities to meet the health needs of patients. Fragmentation also makes it difficult for patients to navigate the health care system, as they may need to see multiple providers for different health problems.
Finally, legacy health care is often criticized for its lack of focus on prevention and population health. The fee-for-service model incentivizes healthcare providers to treat serious illnesses and injuries instead of addressing the underlying causes of poor health. more details
Point of Care CNA The Heart of Healthcare.pdfArticles Reader
Point of Care CNAs are the backbone of healthcare. As we continue to navigate the complexities of modern healthcare, let’s remember to acknowledge and appreciate the invaluable contributions of Point of Care CNAs who tirelessly work to enhance the quality of patient care.
1.Write an essay discussing the various causes and solutions for aBenitoSumpter862
1.Write an essay discussing the various causes and solutions for a patient’s inability to pay for medications (prescriptions).
Your response should be at least 200 words in length
2. “Front desk syndrome” is a particularly troublesome aspect of patients visiting their healthcare provider. Write an essay describing this phenomena and methods to prevent or decrease its occurrence.
Your response should be at least 200 words in length.
Inmate Manipulation and Boundaries
Nicole Jones, Dionne Russell, Francisco Villegas, Lupe Silva
University of Phoenix
CPSS/430
Dr. Debra McCoy
May 16, 2022
What to Expect from This Presentation
Summary of manipulation scenario
Development of a plan for how to maintain boundaries in this situation
Possible obstacles in setting and maintaining these boundaries
Identifying ethical and legal consequences to not maintaining boundaries in this situation
Manipulation Scenario
Patricia Wilkes works as a correctional officer at Corcoran California state prison. Corcoran is a high security institution that houses some of the most violent male offenders. Patricia has worked at the institution for four years and has encountered two attacks against her from two separate inmates over a year span. Patricia is freshly returned back to work after being off for a week due to her injuries from her latest attack. The attack involved her being pushed down by an inmate, causing a sprain arm. Feeling vulnerable Patricia became friends with an inmate who witnessed the attack and promised to issue protection if she sneaks in contraband for him. She is conflicted but, because she is afraid; she agrees to do it.
How to Maintain Boundaries in this Situation
How to Maintain Boundaries in this Situation (continued)
How to Maintain Boundaries in this Situation (continued)
Possible Obstacles in Setting and Maintaining these Boundaries
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Questions
References
HCA 4303, Comparative Health Systems 1
Course Learning Outcomes for Unit I
Upon completion of this unit, students should be able to:
1. Identify and explain how demographics, such as age and race, impact true access to quality care.
Reading Assignment
Chapter 1: Introduction
Chapter 2: Disparities in Health Care: Race and Age Matters
Unit Lesson
Many Americans find it difficult to even comprehend being denied access to medical care. When we are sick,
we want to see a physician, promptly receive a diagnosis, and procure the necessary treatment that will
restore us to our previous level of health. T ...
1.Write an essay discussing the various causes and solutions for aSantosConleyha
1.Write an essay discussing the various causes and solutions for a patient’s inability to pay for medications (prescriptions).
Your response should be at least 200 words in length
2. “Front desk syndrome” is a particularly troublesome aspect of patients visiting their healthcare provider. Write an essay describing this phenomena and methods to prevent or decrease its occurrence.
Your response should be at least 200 words in length.
Inmate Manipulation and Boundaries
Nicole Jones, Dionne Russell, Francisco Villegas, Lupe Silva
University of Phoenix
CPSS/430
Dr. Debra McCoy
May 16, 2022
What to Expect from This Presentation
Summary of manipulation scenario
Development of a plan for how to maintain boundaries in this situation
Possible obstacles in setting and maintaining these boundaries
Identifying ethical and legal consequences to not maintaining boundaries in this situation
Manipulation Scenario
Patricia Wilkes works as a correctional officer at Corcoran California state prison. Corcoran is a high security institution that houses some of the most violent male offenders. Patricia has worked at the institution for four years and has encountered two attacks against her from two separate inmates over a year span. Patricia is freshly returned back to work after being off for a week due to her injuries from her latest attack. The attack involved her being pushed down by an inmate, causing a sprain arm. Feeling vulnerable Patricia became friends with an inmate who witnessed the attack and promised to issue protection if she sneaks in contraband for him. She is conflicted but, because she is afraid; she agrees to do it.
How to Maintain Boundaries in this Situation
How to Maintain Boundaries in this Situation (continued)
How to Maintain Boundaries in this Situation (continued)
Possible Obstacles in Setting and Maintaining these Boundaries
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Questions
References
HCA 4303, Comparative Health Systems 1
Course Learning Outcomes for Unit I
Upon completion of this unit, students should be able to:
1. Identify and explain how demographics, such as age and race, impact true access to quality care.
Reading Assignment
Chapter 1: Introduction
Chapter 2: Disparities in Health Care: Race and Age Matters
Unit Lesson
Many Americans find it difficult to even comprehend being denied access to medical care. When we are sick,
we want to see a physician, promptly receive a diagnosis, and procure the necessary treatment that will
restore us to our previous level of health. T ...
Discover Why Maxwell Hospital is the Best in Varanasi - Healthcare in VaranasiMaxwellHospital
Are you looking for top-quality healthcare in Varanasi? Look no further than Maxwell Hospital. In this video, we take a tour of the hospital and showcase its state-of-the-art facilities and equipment. From advanced diagnostic services to cutting-edge treatments, Maxwell Hospital has it all. We also introduce you to the dedicated team of doctors and nurses who work tirelessly to provide the best care possible. From general medicine to specialized care, Maxwell Hospital is committed to providing the highest level of service. Join us as we explore why this hospital is the best in Varanasi and how it's impacting the lives of the community.
https://www.maxwellhospital.in/
Presentation given at Service Science Factory, Cafe october 2013. The presentation mainly deals with data/information from a user experience point of view in the healthcare settings. And suggests patient centric services based on key meta trends in the sector.
The employee life cycle is a foundational framework for robust and h.docxtodd701
The employee life cycle is a foundational framework for robust and healthy employee experience and is a major contributor to the success of the organization. It is also a powerful mechanism that can, when well-designed and properly used, make a company a workplace that employees want to be at every day of the week and creativity and innovation show up even when leaders are just hoping for it. Learners are asked to respond to the following question for this last discussion in the course: Which parts of the employment life cycle do you consider most important and why?
Resources
Employee Life Cycle Impact on Engagement
(2018, Feb 28).
Report details how moments that matter & employee value propositions impact worker engagement.
PR Newswire.
"Among the most critical components shaping (the organization's engagement) ecosystem is the employee value proposition, the tangible and intangible deal that organizations provide in exchange for employee effort, commitment and performance."
Bradison, P. (2019).
HR Matters: From recruiting to onboarding the importance of quality new hire work flows.
Alaska Business Monthly,
35
(4), 83.
This article describes how "employees from multiple generations are seeking employment with a consumer’s approach" when they consider more than the pay structure before applying for a position.
Working in HRM
Justin, T. C. (2018).
Addressing the top HR challenges in 2019.
HR Strategy and Planning Excellence Essentials.
This preview to the year in HRM in Canada considers these hot topics: "catering to a multi-generational workforce, employee engagement, increasing feedback, attracting and keeping the right employees, and now marijuana in the workplace."
Sato, Y., Kobayashi, N., & Shirasaka, S. (2020).
An analysis of human resource management for knowledge workers: Using the three axes of target employee, lifecycle stage, and human resource flow.
Review of Integrative Business and Economics Research, 9
(1), 140–156.
This study considers human resource flow management and how to foster that along with two other HRM initiatives with knowledge workers.
Tyler, K. (2019).
10 steps to unlocking innovation at your organization.
HRMagazine, 64
(1), 1.
Innovation is a key component for the longevity of an organization and "HR can't expect to foster an innovative company culture if it does not have an innovative culture within its own function." This resource is inspiring to help HR professionals find a purpose for their efforts to improve all steps in the employee life cycle and embrace the HR platforms and tools that will help them towards this goal.
Case Study
Saurombe, M., Barkhuizen, E. N., & Schutte, N. E. (2017).
Management perceptions of a higher educational brand for the attraction of talented academic staff.
SA Journal of Human Resource Management
, 15.
This study gives a great example of how managers think about branding in higher education and how a.
The economy is driven by data ~ Data sustains an organization’s .docxtodd701
The economy is driven by data ~ Data sustains an organization’s business processes and enables it to deliver products and services. Stop the flow of data, and for many companies, business comes quickly to a halt. Those who understand its value and have the ability to manage related risks will have a competitive advantage. If the loss of data lasts long enough, the viability of an organization to survive may come into question.
What is the significant difference between quality assurance & quality control? Explain
Why is there a relationship between QA/QC and risk management? Explain
Why are policies needed to govern data both in transit and at rest (not being used - accessed)? Explain
.
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Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, gave the Ian Webster Health for All Oration to the annual forum of the Centre for Primary Health Care and Equity on 13 August 2015.
This e-book focuses on Health Management Solutions the value it adds alongside other systems that are already in place throughout the care lifecycle...
Heritage Healthcare:-
Legacy healthcare refers to the traditional model of healthcare that has been in vogue for many years. It is characterized by a fee-for-service payment model, where healthcare providers are reimbursed for each service they provide to patients. This model has been a foundation of the US healthcare system for many years, but it has faced increasing criticism for its high costs and inefficiencies. In this essay, we'll explore the history, challenges, and possible solutions to legacy healthcare.
History of Legacy Healthcare
Legacy healthcare emerged in the United States in the early 20th century. At the time, health care was largely provided by individual physicians and hospitals, and patients paid for services out of pocket. However, with the rise of employer-sponsored health insurance during World War II, a new payment model emerged. This model was based on a fee-for-service system, where healthcare providers were reimbursed for each service they provided to patients. The system was designed to encourage healthcare providers to provide more services, with the assumption that more services would lead to better health outcomes.
Over the past few years, the fee-for-service model has become deeply ingrained in the US healthcare system. It has been the foundation of the Medicare and Medicaid programs, which provide healthcare for millions of Americans. However, as the cost of health care continues to rise, the limits of this model are becoming increasingly apparent.
Challenges of Legacy Healthcare
One of the main challenges of legacy healthcare is its high cost. The fee-for-service model incentivizes healthcare providers to provide more services, whether those services are truly needed or not. This has given rise to a phenomenon known as overuse, where patients receive more tests, procedures and treatments than they actually need. This not only increases the cost of health care but can also cause harm to patients. For example, unnecessary tests and procedures can expose patients to radiation and other risks.
Another challenge of legacy healthcare is its fragmentation. The fee-for-service model encourages healthcare providers to work independently of each other, rather than collaborating to provide coordinated care. This can lead to a lack of communication between healthcare providers, resulting in duplication of services and missed opportunities to meet the health needs of patients. Fragmentation also makes it difficult for patients to navigate the health care system, as they may need to see multiple providers for different health problems.
Finally, legacy health care is often criticized for its lack of focus on prevention and population health. The fee-for-service model incentivizes healthcare providers to treat serious illnesses and injuries instead of addressing the underlying causes of poor health. more details
Point of Care CNA The Heart of Healthcare.pdfArticles Reader
Point of Care CNAs are the backbone of healthcare. As we continue to navigate the complexities of modern healthcare, let’s remember to acknowledge and appreciate the invaluable contributions of Point of Care CNAs who tirelessly work to enhance the quality of patient care.
1.Write an essay discussing the various causes and solutions for aBenitoSumpter862
1.Write an essay discussing the various causes and solutions for a patient’s inability to pay for medications (prescriptions).
Your response should be at least 200 words in length
2. “Front desk syndrome” is a particularly troublesome aspect of patients visiting their healthcare provider. Write an essay describing this phenomena and methods to prevent or decrease its occurrence.
Your response should be at least 200 words in length.
Inmate Manipulation and Boundaries
Nicole Jones, Dionne Russell, Francisco Villegas, Lupe Silva
University of Phoenix
CPSS/430
Dr. Debra McCoy
May 16, 2022
What to Expect from This Presentation
Summary of manipulation scenario
Development of a plan for how to maintain boundaries in this situation
Possible obstacles in setting and maintaining these boundaries
Identifying ethical and legal consequences to not maintaining boundaries in this situation
Manipulation Scenario
Patricia Wilkes works as a correctional officer at Corcoran California state prison. Corcoran is a high security institution that houses some of the most violent male offenders. Patricia has worked at the institution for four years and has encountered two attacks against her from two separate inmates over a year span. Patricia is freshly returned back to work after being off for a week due to her injuries from her latest attack. The attack involved her being pushed down by an inmate, causing a sprain arm. Feeling vulnerable Patricia became friends with an inmate who witnessed the attack and promised to issue protection if she sneaks in contraband for him. She is conflicted but, because she is afraid; she agrees to do it.
How to Maintain Boundaries in this Situation
How to Maintain Boundaries in this Situation (continued)
How to Maintain Boundaries in this Situation (continued)
Possible Obstacles in Setting and Maintaining these Boundaries
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Questions
References
HCA 4303, Comparative Health Systems 1
Course Learning Outcomes for Unit I
Upon completion of this unit, students should be able to:
1. Identify and explain how demographics, such as age and race, impact true access to quality care.
Reading Assignment
Chapter 1: Introduction
Chapter 2: Disparities in Health Care: Race and Age Matters
Unit Lesson
Many Americans find it difficult to even comprehend being denied access to medical care. When we are sick,
we want to see a physician, promptly receive a diagnosis, and procure the necessary treatment that will
restore us to our previous level of health. T ...
1.Write an essay discussing the various causes and solutions for aSantosConleyha
1.Write an essay discussing the various causes and solutions for a patient’s inability to pay for medications (prescriptions).
Your response should be at least 200 words in length
2. “Front desk syndrome” is a particularly troublesome aspect of patients visiting their healthcare provider. Write an essay describing this phenomena and methods to prevent or decrease its occurrence.
Your response should be at least 200 words in length.
Inmate Manipulation and Boundaries
Nicole Jones, Dionne Russell, Francisco Villegas, Lupe Silva
University of Phoenix
CPSS/430
Dr. Debra McCoy
May 16, 2022
What to Expect from This Presentation
Summary of manipulation scenario
Development of a plan for how to maintain boundaries in this situation
Possible obstacles in setting and maintaining these boundaries
Identifying ethical and legal consequences to not maintaining boundaries in this situation
Manipulation Scenario
Patricia Wilkes works as a correctional officer at Corcoran California state prison. Corcoran is a high security institution that houses some of the most violent male offenders. Patricia has worked at the institution for four years and has encountered two attacks against her from two separate inmates over a year span. Patricia is freshly returned back to work after being off for a week due to her injuries from her latest attack. The attack involved her being pushed down by an inmate, causing a sprain arm. Feeling vulnerable Patricia became friends with an inmate who witnessed the attack and promised to issue protection if she sneaks in contraband for him. She is conflicted but, because she is afraid; she agrees to do it.
How to Maintain Boundaries in this Situation
How to Maintain Boundaries in this Situation (continued)
How to Maintain Boundaries in this Situation (continued)
Possible Obstacles in Setting and Maintaining these Boundaries
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Possible Obstacles in Setting and Maintaining these Boundaries (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Ethical and Legal Consequences to not Maintaining Boundaries in this Situation (continued)
Questions
References
HCA 4303, Comparative Health Systems 1
Course Learning Outcomes for Unit I
Upon completion of this unit, students should be able to:
1. Identify and explain how demographics, such as age and race, impact true access to quality care.
Reading Assignment
Chapter 1: Introduction
Chapter 2: Disparities in Health Care: Race and Age Matters
Unit Lesson
Many Americans find it difficult to even comprehend being denied access to medical care. When we are sick,
we want to see a physician, promptly receive a diagnosis, and procure the necessary treatment that will
restore us to our previous level of health. T ...
Discover Why Maxwell Hospital is the Best in Varanasi - Healthcare in VaranasiMaxwellHospital
Are you looking for top-quality healthcare in Varanasi? Look no further than Maxwell Hospital. In this video, we take a tour of the hospital and showcase its state-of-the-art facilities and equipment. From advanced diagnostic services to cutting-edge treatments, Maxwell Hospital has it all. We also introduce you to the dedicated team of doctors and nurses who work tirelessly to provide the best care possible. From general medicine to specialized care, Maxwell Hospital is committed to providing the highest level of service. Join us as we explore why this hospital is the best in Varanasi and how it's impacting the lives of the community.
https://www.maxwellhospital.in/
Presentation given at Service Science Factory, Cafe october 2013. The presentation mainly deals with data/information from a user experience point of view in the healthcare settings. And suggests patient centric services based on key meta trends in the sector.
Similar to THE DYNAMIC ENVIRONMENT OF HEALTH CAREChapter 1Objecti.docx (20)
The employee life cycle is a foundational framework for robust and h.docxtodd701
The employee life cycle is a foundational framework for robust and healthy employee experience and is a major contributor to the success of the organization. It is also a powerful mechanism that can, when well-designed and properly used, make a company a workplace that employees want to be at every day of the week and creativity and innovation show up even when leaders are just hoping for it. Learners are asked to respond to the following question for this last discussion in the course: Which parts of the employment life cycle do you consider most important and why?
Resources
Employee Life Cycle Impact on Engagement
(2018, Feb 28).
Report details how moments that matter & employee value propositions impact worker engagement.
PR Newswire.
"Among the most critical components shaping (the organization's engagement) ecosystem is the employee value proposition, the tangible and intangible deal that organizations provide in exchange for employee effort, commitment and performance."
Bradison, P. (2019).
HR Matters: From recruiting to onboarding the importance of quality new hire work flows.
Alaska Business Monthly,
35
(4), 83.
This article describes how "employees from multiple generations are seeking employment with a consumer’s approach" when they consider more than the pay structure before applying for a position.
Working in HRM
Justin, T. C. (2018).
Addressing the top HR challenges in 2019.
HR Strategy and Planning Excellence Essentials.
This preview to the year in HRM in Canada considers these hot topics: "catering to a multi-generational workforce, employee engagement, increasing feedback, attracting and keeping the right employees, and now marijuana in the workplace."
Sato, Y., Kobayashi, N., & Shirasaka, S. (2020).
An analysis of human resource management for knowledge workers: Using the three axes of target employee, lifecycle stage, and human resource flow.
Review of Integrative Business and Economics Research, 9
(1), 140–156.
This study considers human resource flow management and how to foster that along with two other HRM initiatives with knowledge workers.
Tyler, K. (2019).
10 steps to unlocking innovation at your organization.
HRMagazine, 64
(1), 1.
Innovation is a key component for the longevity of an organization and "HR can't expect to foster an innovative company culture if it does not have an innovative culture within its own function." This resource is inspiring to help HR professionals find a purpose for their efforts to improve all steps in the employee life cycle and embrace the HR platforms and tools that will help them towards this goal.
Case Study
Saurombe, M., Barkhuizen, E. N., & Schutte, N. E. (2017).
Management perceptions of a higher educational brand for the attraction of talented academic staff.
SA Journal of Human Resource Management
, 15.
This study gives a great example of how managers think about branding in higher education and how a.
The economy is driven by data ~ Data sustains an organization’s .docxtodd701
The economy is driven by data ~ Data sustains an organization’s business processes and enables it to deliver products and services. Stop the flow of data, and for many companies, business comes quickly to a halt. Those who understand its value and have the ability to manage related risks will have a competitive advantage. If the loss of data lasts long enough, the viability of an organization to survive may come into question.
What is the significant difference between quality assurance & quality control? Explain
Why is there a relationship between QA/QC and risk management? Explain
Why are policies needed to govern data both in transit and at rest (not being used - accessed)? Explain
.
THE EMERGENCY DEPARTMENT AND VICTIMS OF SEXUAL VIOLENCE AN .docxtodd701
THE EMERGENCY DEPARTMENT AND
VICTIMS OF SEXUAL VIOLENCE: AN
ASSESSMENT OF PREPAREDNESS TO HELP
STACEY BETH PLICHTA, SC.D.
TANCY VANDECAR-BURDIN, M.A.
Old Dominion University, Norfolk, VA
REBECCA K ODOR, M.S.W.
Virginia Department of Health, Richmond, VA
SHANI REAMS, A.A.S.
Virginia Sexual and Domestic Violence Action Alliance,
Richmond, VA
YAN ZHANG, M.S.
Old Dominion University, Norfolk, VA
ABSTRACT
The Emergency Department (ED) is a key source of care for
victims of sexual violence but there is little information available about
the extent to which EDs are prepared to provide this care. This study
examines the structural and process factors that the ED has in place to
assist victims. A survey of all 82 publicly accessible EDs in the
Commonwealth of Virginia was conducted (RR 76%). In general, the
EDs provide the recommended medical care to victims. However, at
least half do not have the needed resources in place to effectively assist
victims and most (80%) do not provide regular training to their medical
staff about sexual violence. Further, almost one-quarter do not have a
relationship with a local rape crisis center. It is recommended that each
ED partner with local rape crisis centers to provide training to their
staff and to ensure continuity of support for victims. It is also
suggested that the state government explore ways in which a forensic
(SANE) nurse be made available to every victim of sexual violence that
presents to the ED for medical assistance. Ideally, each ED would
become part of a community-wide Sexual Assault Response Team
286 JHHSA WINTER 2006
(SART) in order to provide comprehensive care to victims and
thorough evidence collection and information to law enforcement.
INTRODUCTION
This study seeks to examine the extent to which
Emergency Departments (EDs) in the Commonwealth of
Virginia are prepared to provide care for victims of sexual
violence through an examination of both structural and
process factors that are currently in place. Many studies
indicate that sexual violence victimization has both long-
term and short-term health consequences (Plichta and Falik,
2001; see also Rentoul and Applebloom 1997; Cloutier,
Martin and Poole, 2002; Bohn and Holz, 1996). The ED is
a key source of care for victims of sexual assault. It is one
of the first points of entry to care. Competent care by
professionals trained in treating sexual assault victims is
critical to the timely recovery of physical and mental
health. The ED also plays a critical role in the collection of
evidence that may lead to the conviction of the perpetrator
and a recent study found that specially trained (forensic)
nurses perform this function significantly better than do
other staff (Sievers, Murphy and Miller, 2003). Forensic
nurses are registered nurses (R.N.’s) who have advanced
training in the examination of sexual assault victims; this
includes training on legal aspe.
The emergence of HRM in the UK in the 1980s represented a new fo.docxtodd701
The emergence of HRM in the UK in the 1980s represented a new form of managerialism and was instrumental in increases in work intensification’. Discuss.
Word count: 2,000 words (excluding references) and the 10% convention applies
· Minimum use of 15 academic journal articles/ research reports.
· It must be single-sided with size 12 font, 1.5 spacing with the pages numbered and stapled.
Structure – a clear logical format with linked points and arguments.
Broadly, your essay should be structured in the following manner (subheadings are not necessary)
1. Introduction – summary of your ideas and the structure
2. Review of the literature – critical discussion
3. Conclusions
4. References
Background material – evidence of the background research drawing from literature sources. This should include enough descriptive content and factual information from which to derive arguments and assessment of key themes, issues and problems addressed.
Accuracy – in the presentation and description of theories used in the argument
Argumentation – the main argument of the report should relate to the objectives you have initially stated. They should be supported by evidence, both from a variety of sources in the literature.
Presentation – the answers should be well planned – clear, coherent and well constructed. Remember- never write in the first person.
Relevant references and sources must be cited using the Harvard style of referencing. Marks will be removed for wrong or poor referencing.
Useful tips on essay writing
http://www.reading.ac.uk/internal/studyadvice/studyresources/essays/stadevelopessay.aspx
.
The elimination patterns of our patients are very important to know .docxtodd701
The elimination patterns of our patients are very important to know as we continue to assess and do our care plans. How can impaired elimination affect the integumentary system?
Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.
.
The Elements and Principles of Design A Guide to Design Term.docxtodd701
The Elements and Principles of Design
A Guide to Design Terminology
The elements of design are some of the basic building blocks that make up the design or artwork.
Understanding and using this terminology can help the designer articulate what works and what doesn’t
work in a design, and to think critically about a design on a more conscious level. Combined, the elements
and principles of design can make for a strong, complete and well-established composition. The principles
of Gestalt, which arise from the elements of design, are included at the end of this document. Learning to
use these elements and principles will be the focus of Beginning Design.
The elements of design are: Point, Line, Form, Value, Texture, Shape, Space, Color
(Color is covered in Art 110; we will be focusing on black, white, and gray scale values.)
DEFINITIONS:
A Point is a position in space.
A Line is the path of a moving point. Two points connected make a line. Lines often imply motion, and can
be rendered in a variety of ways. Contour lines or outlines, define the boundary between shapes. Lines can
create texture or value when used in crosshatching. In addition to these types of actual lines, our eyes can
invent implied lines, such as in dotted lines, or where area boundaries describe lines that may not be there.
Shape is a two dimensional form. The variety of possible shapes is endless. Several common ones are as
follows:
• Simple Geometric: circles, squares, triangles are some of the examples.
• Complex Geometric: straight and curved shapes that have more sides and angles.
• Curvilinear: French curves, ellipses, circles and ovals used in combination.
• Accidental: an example of this might be a coffee ring or paint splatters.
Form is a shape with dimension, an object existing in three dimensional space physically or implied.
Value is the tone created by black, white and shades of gray. The value or tone of an element can create
mass, dimension, emphasis or volume.
Texture can be actual or visual.
• Actual texture is tactile: you can feel it by touching it.
• Visual texture are the markings of a two dimensional artwork that imply actual texture.
Space is an illusion or feeling of 3-dimensionality, which can be created in a two-dimensional design in
several ways, for example:
• Overlapping one object in front of another;
• Using differences in value, amount of detail, etc. between elements;
• Using techniques related to linear perspective, such as differences in size or height on page between
elements
The principles of design are: Unity, Variety, Movement, Balance, Emphasis, Contrast, Proportion,
and Pattern.
DEFINITIONS:
Unity or harmony is the quality of wholeness or oneness that is achieved through the effective use of the
elements and principles of design. The most basic quality of a design or artwork, unity gives a piece the
feeling of being an integrated human expression. The princi.
The emergence of HRM in the UK in the 1980s represented a new form o.docxtodd701
The emergence of HRM in the UK in the 1980s represented a new form of managerialism and was instrumental in increases in work intensification’. Discuss.
Word count: 2,000 words (excluding references) and the 10% convention applies
· Minimum use of 15 academic journal articles/ research reports.
· It must be single-sided with size 12 font, 1.5 spacing with the pages numbered and stapled.
Structure – a clear logical format with linked points and arguments.
Broadly, your essay should be structured in the following manner (subheadings are not necessary)
1. Introduction – summary of your ideas and the structure
2. Review of the literature – critical discussion
3. Conclusions
4. References
Background material – evidence of the background research drawing from literature sources. This should include enough descriptive content and factual information from which to derive arguments and assessment of key themes, issues and problems addressed.
Accuracy – in the presentation and description of theories used in the argument
Argumentation – the main argument of the report should relate to the objectives you have initially stated. They should be supported by evidence, both from a variety of sources in the literature.
Presentation – the answers should be well planned – clear, coherent and well constructed. Remember- never write in the first person.
Relevant references and sources must be cited using the Harvard style of referencing. Marks will be removed for wrong or poor referencing.
Useful tips on essay writing
http://www.reading.ac.uk/internal/studyadvice/studyresources/essays/stadevelopessay.aspx
.
The eligibility requirements to become a family nurse practition.docxtodd701
The eligibility requirements to become a family nurse practitioner include completion of “APRN core (advance physical assessment, advanced pharmacology, and advanced pathophysiology), supervised clinical hours, completion of an accredited graduate program with evidence of an academic transcript, and an active nurse license” (American Academy of Nurse Practitioners, 2021).
The value associated with certification as an FNP is very personal to me. Along with providing higher quality care to clientele, I will have a more fulfilled inner sense of purpose and also be able to provide for my family in a higher capacity than I was previously able to, with an estimated average nurse practitioner salary being over $100,000 annually in the state of Wisconsin. Achieving both my master's and nurse practitioner certification would allow my employer, fellow professional comrades, and most of all; my clients, to have a higher sense of security knowing I’ve worked and studied hard to bring them the highest quality care available. Staying up to date on my continuing education and state-of-the-art processes and pathology will also instill confidence in my clientele to not only continue coming to me with their individual and family healthcare needs but likely will ensure referrals into my practice.
Any time a nurse genuinely takes on a holistic approach towards the practical application of nursing theory, a client is in a better position for patient-centered care, maintaining anonymity, and ensuring positive effective communication during the care process. In the nursing profession, nurses need to not only advocate for their clients, but themselves by participating in associations that work towards advancing the field through by working towards lower nurse-to-client ratios to decrease burnout, leadership education, and opportunity, and also grants to advance continuing education.
.
The Electoral College was created to protect US citizens against.docxtodd701
The Electoral College was created to protect US citizens against mob rule. Mob rule is the control of a lawful government system by a mass of people through violence and intimidation. However, some Americans question the legitimacy of this process. Pick one election where the outcome of the popular vote and the electoral college vote differed to create an argument in favor of or opposed to the use of the electoral college. List at least three valid points to support your argument. Present you argument in a PowerPoint presentation.
As you complete your presentation, be sure to:
Use speaker's notes to expand upon the bullet point main ideas on your slides, making references to research and theory with citation.
Proof your work
Use visuals (pictures, video, narration, graphs, etc.) to compliment the text in your presentation and to reinforce your content.
Do not just write a paper and copy chunks of it into each slide. Treat this as if you were going to give this presentation live.
Presentation Requirements (APA format)
Length: 8-10 substantive slides (excluding cover and references slides)
Font should not be smaller than size 16-point
Parenthetical in-text citations included and formatted in APA style
References slide ( 3 scholarly sources)
.
The Emerging Role of Data Scientists on Software Developmen.docxtodd701
The Emerging Role of Data Scientists
on Software Development Teams
Miryung Kim
UCLA
Los Angeles, CA, USA
[email protected]
Thomas Zimmermann Robert DeLine Andrew Begel
Microsoft Research
Redmond, WA, USA
{tzimmer, rdeline, andrew.begel}@microsoft.com
ABSTRACT
Creating and running software produces large amounts of raw data
about the development process and the customer usage, which can
be turned into actionable insight with the help of skilled data scien-
tists. Unfortunately, data scientists with the analytical and software
engineering skills to analyze these large data sets have been hard to
come by; only recently have software companies started to develop
competencies in software-oriented data analytics. To understand
this emerging role, we interviewed data scientists across several
product groups at Microsoft. In this paper, we describe their educa-
tion and training background, their missions in software engineer-
ing contexts, and the type of problems on which they work. We
identify five distinct working styles of data scientists: (1) Insight
Providers, who work with engineers to collect the data needed to
inform decisions that managers make; (2) Modeling Specialists,
who use their machine learning expertise to build predictive mod-
els; (3) Platform Builders, who create data platforms, balancing
both engineering and data analysis concerns; (4) Polymaths, who
do all data science activities themselves; and (5) Team Leaders,
who run teams of data scientists and spread best practices. We fur-
ther describe a set of strategies that they employ to increase the im-
pact and actionability of their work.
Categories and Subject Descriptors:
D.2.9 [Management]
General Terms:
Management, Measurement, Human Factors.
1. INTRODUCTION
Software teams are increasingly using data analysis to inform their
engineering and business decisions [1] and to build data solutions
that utilize data in software products [2]. The people who do col-
lection and analysis are called data scientists, a term coined by DJ
Patil and Jeff Hammerbacher in 2008 to define their jobs at
LinkedIn and Facebook [3]. The mission of a data scientist is to
transform data into insight, providing guidance for leaders to take
action [4]. One example is the use of user telemetry data to redesign
Windows Explorer (a tool for file management) for Windows 8.
Data scientists on the Windows team discovered that the top ten
most frequent commands accounted for 81.2% of all of invoked
commands, but only two of these were easily accessible from the
command bar in the user interface 8 [5]. Based on this insight, the
team redesigned the user experience to make these hidden com-
mands more prominent.
Until recently, data scientists were found mostly on software teams
whose products were data-intensive, like internet search and adver-
tising. Today, we have reached an inflection point where many.
The Earths largest phylum is Arthropoda, including centipedes, mill.docxtodd701
The Earth's largest phylum is Arthropoda, including centipedes, millipedes, crustaceans, and insects. The insects have shown to be a particularly successful class within the phylum. What biological characteristics have contributed to the success of insects? I'm many science fiction scenarios, post-apocalyptic Earth is mainly populated with giant insects. Why don't we see giant insects today?
250-500 words done by 12:40pm today which is about two hours from now. Cite work.
.
The economic and financial crisis from 2008 to 2009, also known .docxtodd701
The economic and financial crisis from 2008 to 2009, also known as the global financial crisis, was considered to be the worst financial crisis since the Great Depression. The general situation of financial markets has been additionally complicated by the introduction of new financial products as well as other modes of operations including globalization. The global financial market seems to be playing a different function in our economy and it has been working because of new regulations. The introduction of new trade platforms, online access to information, integration and globalization of the market have caused some revisions of finance theories.
What are reliable predictors of economic and financial crises (list at least 3 of them)?
Describe some achievements and some pending issues in context of a global crisis.
Are we still in danger of economic and financial crises today (please refer to current Covid-19 situation)?
Instructions:
Conduct research from viable and credible sources such as and not limited to economic journals, periodicals, books, data base, and websites. This assignment should be submitted/uploaded via D2L on the date the assignment is due. Any late assignments will be subject to a letter grade reduction unless an extension has been negotiated with the professor prior to the due date.
In this written assignment, the quality of your writing and the application of APA format will be evaluated in addition to your content. Evaluation based on these criteria is designed to help prepare you for completing your college projects, which must be well written and follow APA guidelines. Each written assignment should contain a minimum of 800 words, but no more than 900 words. Make sure that you use correct spelling, grammar, and punctuation.
.
The Economic Development Case Study is a two-part assign.docxtodd701
The Economic Development Case Study is a two-part assignment – the written paper and video
presentation. Economic Development Case studies must be posted prior to April 19th to
receive approval. Case studies are approved on first posted basis – case studies must be unique,
and students are required to review previously posted case studies to alleviate duplicate case
studies.
The first part of the assignment is to write a paper on a local (San Bernardino or Riverside counties)
economic development. You may identify a case as reported from a city’s website, local
newspapers, or other quality source. Remember, a low-quality source, or insufficient information
from your sources, will affect the quality of your grade for this assignment. The Economic
Development project cannot have been completed.
Your case study should be approximately 750~1000 words long. In your case study paper, you
should briefly describe the following:
• Introduction to the economic development case
• Identify the role government played
• Identify the role of the public, if any
• Economic impact to the community – What is the economic impact to the community? How will it
benefit or not benefit the community?
• Analysis – What is your analysis of the project?
• Conclusion – Where is the project currently?
Instructions for the case study: go to Economic Development Case Study – Submit Here
Scoring Rubric for Economic Development Case Study Paper
Criteria Exceptional
(15 - 13 points)
Very Good
(13 – 11.25 points)
Acceptable
(11.25 – 9 points)
Unacceptable
(8 points or less)
Content
Provides an accurate and
complete description of the
case. All sources of facts
and examples are fully
documented. The case is
original. Case was approved.
For the most part,
description of the case
accurate and complete.
Most sources of facts and
examples are documented.
The case is original and
case was approved.
Description of the case is
inaccurate or incomplete.
Some sources of facts and
examples are
documented. The case is
original and was approved.
Very little reference was
made to the case. Case
is not supported by
evidence. Case is not
original and was not
approved.
Organization
Writer presents information in
logical, interesting sequence,
which reader can follow
Writer presents information
in logical sequence which
reader can follow.
Reader has difficulty
following case study
Reader cannot follow the
case organization.
Economic Development Case Study Paper & Presentation:
Analysis
Writer provides excellent
analysis of the role of
government and the
economic impact of the case
supported by information
provided
Writer provides good
analysis of the role of
government and the
economic impact of the
case.
Writer provides analysis of
either the role of
gov.
The Eighties, Part OneFrom the following list, choose five.docxtodd701
The Eighties,
P
art
One
From the following list, choose five
events
during the 1980s.
I
dentify
the basic facts, dates, and purpose of the event in 2 to 3 sentences in the Identify column. Include why the event is significant in the Significance column, and add a reference for your material in the Reference column.
·
The Sunbelt
·
Suburban Conservatism
·
The Tax Revolt
·
Corporate Elites
·
Neoconservatives
·
Populist Conservatives
·
Deregulation
·
The Federal Reserve Board
·
The Energy Glut
·
The 1981 Tax Cuts
·
Spending Cuts
·
Military Spending
·
Technology
Event
Identify
Significance
Reference
The Eighties,
P
art
Two
From the following list, choose five
events
during the 1980s.
I
dentify
the basic facts, dates, and purpose of the event in 2 to 3 sentences in the Identify column. Include why the event is significant in the Significance column, and add a reference for your material in the Reference column.
·
Feminism
·
Homelessness
·
Republicans and the environment
·
Malls
·
Alternative rock
·
Madonna
·
Michael Jackson
·
AIDS
·
The Cosby Show
·
Sandra Day O’Connor
·
We Are the World
·
Global Warming
·
Geraldine Ferraro
Event
Identify
Significance
Reference
.
The Election of 1860Democrats split· Northern Democrats run .docxtodd701
The Election of 1860
Democrats split
· Northern Democrats run Stephen Douglas
· Southern Democrats run John C. Breckinridge
Republicans decide for moderate
· Republicans nominate Lincoln
· Lincoln opposes slavery in territories
· Republican platform comprehensive
Fourth party enters race
· Constitutional Unionists
· Run John Bell
Republican Victory
· Lincoln gains 40% popular vote
· Lincoln wins in electoral college
· Most Americans want settlement
South Carolina fire-eaters demand secession
· South Carolina secedes December 20, 1680
· Deep South follows
· Buchanan unable to shape compromise
Crittenden Compromise
· Proposed extension of 36º 30’
· John Tyler proposed constitutional amendment
· Lincoln cannot accept slavery in territories
· Compromises fail
Confederate States of America
· Seven states of deep South
· Montgomery original capital
· Constitution similar to that of U.S.
· Constitution protects slavery
President Jefferson of CSA
· Model slave owner; not fire-eater
· Cold personality, irritable, inflexible
· Lacks self-confidence
· Surrounds himself with yes-men
President Abraham Lincoln of United States
· Knows value of unity, competency
· Appoints rivals to cabinet
· Brunt of jokes, criticism
· Sharp native intelligence, humble
Border states
· Virginia, North Carolina, Tennessee, Arkansas join CSA
· Maryland, Kentucky, Missouri stay with Union
· West Virginia secedes from Virginia
A war of nerves
· Two Southern forts in U.S. hands
· Davis willing to let status quo stand for moment
· Lincoln decides to re-supply forts without force
· Confederates fire, beginning April 12, 1861
Art of War influences commanders
· Focus on occupying high ground
· Focus on taking enemy cities
· Retreat when necessary
· Jomini’s 12 models of war
The Armies
· Calvary: for reconnaissance
· Artillery: weakens enemy
· Infantry: backbone of army
· Also support units
Infantry
· Brigades of 2,000–3,000
· Form double lines of 1,000 yards
· Advance into enemy fire
· Then fight hand-to-hand
· Most battles in dense woods
Yanks and Rebs
· Most between 17 and 25
· From all states, social classes
· Draft exempts upper class
· Anti-draft riots in New York City
· Draft dodgers in South
· Some bounty hunters
· High desertion rates
· Shirking duty not common
First Battle of Manassas (Bull Run)
· Both sides thought war would be short
· First battle 20 miles from Washington
· South wins, Union forces flee in panic
First Battle of Manassas (Bull Run)
· South fails to attack Washington
· South celebrates victory
· Stonewall Jackson hero for South
· South disorganized even in victory
Consequences of Manassas (Bull Run)
· South becomes overconfident
· North prepares for long fight
· George McClellan given command of Army of Potomac
Northern strategy
· Defend Washington; take Richmond
· Split Confederacy by taking Mississippi River
· Blockade southern coastline
Mismatch
· North had population advantage of 22 to 9 million
· Industry in north
· Railroads mainl.
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THE DYNAMIC ENVIRONMENT OF HEALTH CAREChapter 1Objecti.docx
1. THE DYNAMIC ENVIRONMENT OF HEALTH CARE
Chapter 1
Objectives
Describe the present healthcare environment.
Examine megatrends in the environment.
Address organizational survival.
Identify the role of the healthcare practitioner as manager.
Review the classic functions of the manager.
Define and differentiate between management as an art and a
science.
Conceptualize the characteristics of an effective manager.
2
Megatrends
Client characteristics
Professional practitioners and caregivers
The healthcare marketplace and settings
Applicable laws, regulations, and standards
The impact of technology
Privacy and security considerations
Financing of health care
Social and cultural factors
2. Healthcare Regulation
State licensure laws for facilities
State licensure laws for professions
State-mandated healthcare planning
State laws governing reimbursement and insurance
Healthcare Regulation
Federal laws governing reimbursement
Federal laws regarding privacy and security of information
Patient Protection and Affordable Care Act
American Recovery and Reinvestment Act
5
Reimbursement and Payment
Charitable roots and the not-for-profit model
Fee-for-service
Health insurance: Non-profit and commercial
Managed care
Current legislation: Healthcare reform
The Managed Care Era
Providing access to quality care at affordable cost
Primary care physician as “gatekeeper”
Premium costs by limits on services
Arrangements between managed care groups and hospitals
Issues about denial of service or payment
3. Capitation
Reimbursement system under which provider is paid specific
amount of money to look after all the healthcare needs of a
given population
Literally, reimbursement based on so much “per head”
Reasons for Restructuring
Desire to achieve greater negotiating clout
Desire to penetrate new markets
Need for improved efficiencies
Desire to express an overall value of promoting comprehensive,
readily accessible care
Mergers and Affiliations
MERGER: Two or more corporate entities blend to create one
new organization
AFFILIATION: Formal agreement between facilities to
coordinate and share activities while remaining separate
corporate entities
Range of Service
Note the variety of services and levels of care
Examples:
Adult day care center
Hospice
Urgent care clinic
4. Impact of Technology
“eVisits” and “digital doctors”
Translational medicine
Data warehousing
Data mining
“Real-time” interventions
Common language and standards: Standard vocabulary and
classification systems
National information infrastructure: To capture, access, use,
exchange, and store data
Increased use by patients of alternative therapies and
interventions
The embedded nurse representative on patient care teams
Rationing; quality-adjusted remaining years
Social and Ethical Factors
Unit supervisor; project manager; department head
Specialized division head
Manager of independent practice
Role of Healthcare Practitioner as Manager
Management Functions
Typical management functions include:
Planning
Decision making
Organizing
Staffing
5. Directing or actuating (motivating)
Controlling
Effective Managers
Characteristics of effective managers include:
Knowledge of the internal structure and characteristics of their
organization
Knowledge of the internal and external dynamics of their
organization
Leading and motivating the workforce
Engaged in continuous search for excellence
Aware of and responsive to trends and challenges
16
CHAPTER 1
The Dynamic Environment of Health Care
CHAPTER OBJECTIVES
• Describe the healthcare environment as it has evolved since
the middle to late 1960s with attention to the dynamic interplay
of key factors.
• Examine megatrends in the healthcare environment with
attention to:
○ Client characteristics
○ Professional practitioners and caregivers
○ Healthcare marketplace and settings
○ Applicable laws, regulations, and standards
○ Impact of technology
○ Privacy and security considerations
○ Financing of health care
6. ○ Social and cultural factors
• Identify the role set of the healthcare practitioner as manager.
• Review the classic functions of the manager.
• Define and differentiate between management as an art and a
science.
• Conceptualize the characteristics of an effective manager.
THE DYNAMIC ENVIRONMENT OF HEALTH CARE
The contemporary healthcare environment is a dynamic one,
combining enduring patterns of practice with evolving ones to
meet challenges and opportunities of changing times. The
healthcare organization is a highly visible one in most
communities. It is a fixture with deep roots in the social,
religious, fraternal, and civic fabric of the society. It is a major
economic force, accounting for approximately one-sixth of the
national economy. In some local settings, the healthcare
organization is one of the major employers, with the local
economy tied to this sector. The image of the hospital is
anchored in personal lives: it is the place of major life events,
including birth and death, and episodes of care throughout one’s
life. Families recount the stories of “remember the time when
we all rushed to the hospital ...” and similar recollections. The
hospital is anchored in the popular culture as a common frame
of reference. People express, in ordinary terms, their stereotypic
reference to the healthcare setting: “He works up at the
hospital,” “Oh yes, we made another trip to the emergency
room,” or “I have a doctor’s appointment.” Popular media also
uses similar references; television shows regularly feature
dramatic scenes in the acute care hospital, with the physician as
an almost universally visible presence. Care is often depicted as
happening in the emergency department.
On closer examination, one recognizes that, in fact, many
changes have occurred in the healthcare environment. The
traditional hospital remains an important hub of care but with
many levels of care and physical locations. The physician
continues to hold a major place on the healthcare team, but
there has been a steady increase in the development and use of
7. other practitioners (e.g., nurse midwife, physical therapist as
independent agent, physician assistant) to complement and
augment the physician’s role. A casual conversation reflects
such change; a person is just as likely to go to the mall to get a
brief physical examination at a walk-in, franchised clinic as he
or she would be to go to the traditional physician’s office. One
might get an annual “flu” shot at the grocery store or smoking
cessation counseling from the pharmacist at a commercial drug
store. One might have an appointment for care with a nurse
practitioner instead of a physician. Instead of using an
emergency service at a hospital, one might receive health care
at an urgent care service or clinic.
Although the setting and practitioners have developed and
changed, the underlying theme remains: how to provide health
care that is the best, most effective, accessible, and affordable,
in a stable yet flexible delivery system. This is the enduring
goal.
Those who manage healthcare organizations monitor trends and
issues associated with the healthcare delivery system in order to
reach this goal. Thus, a manager seeks to have thorough
awareness and knowledge of the interplay of the dynamic
forces. It is useful, therefore, to follow a systematic approach to
identify, monitor, and respond to changes in the healthcare
environment. The following template provides such a systematic
approach. The starting point is the client/patient/recipient of
care. This is followed in turn by considerations of the
professional practitioners and caregivers; healthcare market
place and settings; applicable laws, regulations, and standards;
impact of technology; privacy and security considerations;
financing; and social-cultural factors.
CLIENT/PATIENT CHARACTERISTICS
The demographic patterns of the overall population have a
direct impact on the healthcare organization. For example, the
increase in the number of older people requires more facilities
and personnel specializing in care of this group, such as
continuing care, skilled nursing care, and home care. Clinical
8. conditions associated with aging also lead to the development of
specialty programs such as Alzheimer’s disease and memory
care, cardiac and stroke rehabilitation, and wellness programs to
promote healthy aging. At the other end of the age spectrum,
attention to neonatal care, healthy growth and development, and
preventive care are points of focus. Particular attention is given
to adolescents and young adults who engage in contact sports,
where concussion, permanent brain injury, fractures, and
sprains are common. In all age groups, there is a rising rate of
obesity; type 2 diabetes; and addictions to substances, such as
heroin, opioids, methadone, and assorted “street drugs.”
Diseases and illnesses are, of course, an ever-present
consideration. Some diseases seem to have been conquered and
eliminated through timely intervention. Some recur after long
periods of absence. Tuberculosis, polio, smallpox, and pertussis
are examples of successes in disease management and
prevention. Sometimes, however, new strains may develop or
compliance with immunization mandates may decrease so that
these types of communicable diseases reappear.
Decades of use of antibacterial medicines has given rise to
superbugs, resistant to the usual treatment. Another element of
concern is the appearance of an almost unknown disease entity
(e.g., Ebola or a pandemic agent). New clinical conditions may
also arise within certain age groups, necessitating fresh
approaches to their care. By way of example, consider the rise
in autism and childhood obesity.
Other characteristics of the client/patient population reflect
patterns of usage and the associated costs of care. The
identification of superusers—patients who have high
readmission rates and/or longer than average lengths of stay or
more complications—gives providers an insight into practices
needing improvement (e.g., better discharge planning or
increased patient education). The geographic region that
constitutes the general catchment area of the facility should be
analyzed to identify health conditions common to the area.
Examples include rural farm regions, with associated injuries
9. and illnesses; heavy industry, with work-related injuries; and
winter resort areas, with injuries resulting from strenuous
outdoor activity (e.g., fractures from skiing injuries).
TRENDS RELATING TO PRACTITIONERS AND
CAREGIVERS
The trends and issues relating to practitioners and caregivers
cluster around the continuing expansion of scope of practice,
with the related increase in education and credentialing. The
traditional attending physician role has given way to the
inpatient physician, the hospitalist. The one-to-one physician–
patient role set continues to shift from solo practice to group
practice and team coverage. Licensed, credentialed
nonphysician practitioners continue to augment the care
provided by the physician. These physician-extenders often
specialize—for example, the physical therapist in sports-related
care, the occupational therapist in autism programs, the nurse
practitioner in wellness care for the frail elderly, the nurse
midwife, the nurse case manager in transition care, and the
physician assistant in emergency care. Educational requirements
include advanced degrees in the designated field.
There is a related shift in the practice settings for these various
practitioners. The move away from inpatient-based care leads to
an increase in independent practice. Sometimes the franchise
model is favored over self-employment. Regional and national
franchises provide a turnkey practice environment with the
additional benefits of a management support division.
The Family as Caregiver
Although the provision of care by family members is a practice
that long predates formal healthcare models, these caregivers
are the focus of renewed attention. As shorter stays for inpatient
care, or subacute care to reduce inpatient care, become the
norm, the role of the family caretaker intensifies. The patient
care plan, with emphasis on the discharge plan, necessarily
includes instruction to family members about such elements as
medication regimen, wound care, infection prevention, and
injection processes. If the patient does not have a family
10. member who is able to assist in these ways, or if the patient
(often a frail, elderly person) lives alone, coordination of
services with a community agency or commercial company is
needed. This gives rise to related issues. Can family members
be reimbursed by insurance providers? If so, what is needed by
way of documentation and billing? And there is yet another
related issue: how can employers assist workers to meet the
demands of work as well as help the family member? Practices
such as flexible work hours and unpaid leave become both
desirable and necessary elements.
Changes in Management Support Services
Behind the scenes, there is the wide network of management
support services within the healthcare organization. The trend
toward specialization increases within these ranks, with new job
categories being developed in response to related trends. With
regard to finances and reimbursement, chief financial officers
(or similar administrators) augment their teams with clinical
reimbursement auditors, coding and billing compliance officers,
physician coder-educators, and certified medical coders. The
regulatory standards manager specializes in coordinating the
many compliance factors flowing from laws, regulations, and
standards. The chief information officer augments that role with
specialized teams, including nurse informaticians, clinical
information specialists, and information technology experts.
Patterns of Care
Improvements in patient care services, the utilization of
advanced technologies such as telemedicine, and the financial
pressures to reduce the length of stay for inpatient care have
resulted in shorter stays, more transitional care, and (possibly) a
higher readmission rate. To offset a high readmission rate,
additional attention is given to the discharge plan. The
increased use of the observation unit in the emergency
department also helps reduce admission and readmission rate.
These issues and trends lead to a discussion of the healthcare
setting.
THE HEALTHCARE SETTING: FORMAL
11. ORGANIZATIONAL PATTERNS AND LEVELS OF CARE
Each healthcare setting has a distinct pattern of organization
and offers specific levels of care. Characteristics include
ownership and sponsorship, nonprofit or for-profit corporate
status, and distinct levels of care. These elements are specified
in the license to operate as well as in the corporate charter.
Ownership and sponsorship often reflect deep ties to the
immediate community. A sector of the community, such as a
fraternal organization, a religious association, or an academic
institution, developed and funded the original hospital or clinic,
almost always as nonprofit because of their own nonprofit
status. These organizations purchased the land, had the
buildings erected and equipped, and provided continued
supplemental funding for the enterprise. Federal, state, city, and
county units of government also own and sponsor certain
facilities (e.g., facilities for veterans, state behavioral care
facilities, county residential programs for the intellectually
disabled). For-profit ownership and sponsorship include owner-
investor hospital and clinic chains; long-term care facilities;
franchise operations for specialty care (e.g., eye care,
rehabilitation centers, retail clinics in drugstores and big-box
retailer stores). Over the past several decades, sponsorship by
religious or fraternal organizations has diminished, with the
resulting sale of these healthcare facilities to other entities. The
original name is often retained because it is a familiar and
respected designation in the community.
Provider Growth: Mergers, Joint Ventures, and Collaborative
Partnerships
Healthcare organizations periodically change or augment their
service offerings, with a resulting change in corporate structure.
This restructuring may take the form of a merger, a joint
venture, or a collaborative partnership. Why do healthcare
organizations seek restructuring? The reasons are several:
• The desire to express an overall value of promoting
comprehensive, readily accessible care by shoring up smaller
community-based facilities, keeping them from closure
12. • The need for improved efficiencies resulting from centralized
administrative practices such as financial and health
information resource streamlining or public relations and
marketing intensification
• The desire and/or need to penetrate new markets to attract
additional clients
• The desire and/or need to increase size so as to have greater
clout in negotiations with managed care providers who tend to
bypass smaller entities
As cost-containment pressure began to grow, providers—
primarily hospitals—initially moved into mergers mostly to
secure economies of scale and other operating efficiencies and
sometimes for reasons as basic as survival. The growth and
expansion of managed care plans provided further incentive to
merge among hospitals, which seems to have inspired health
plan mergers in return. Each time a significant merger occurs,
one side gains more leverage in negotiating contracts. The
larger the managed care plan, the greater the clout in
negotiating with hospitals and physicians and vice versa.
Clarification of Terms
The term merger is used to describe the blending of two or more
corporate entities to create one new organization with one
licensure and one provider number for reimbursement purposes.
One central board of trustees or directors is created, usually
with representation from each of the merged facilities. Debts
and assets are combined. For example, suppose a university
medical center buys a smaller community-based hospital.
Ownership and control is now shifted to the new organization.
Sometimes the names of the original facilities are retained as
part of public relations and marketing, as when a community
group or religious-affiliated group has great loyalty and ties to
the organization. Alternatively, a combined name is used, such
as Mayfair Hospital of the University Medical System.
The joint venture differs from a merger in that each
organization retains its own standing as a specific
legal/corporate entity. A joint venture or affiliation is a formal
13. agreement between or among member facilities to officially
coordinate and share one or more activities. Ownership and
control of each party remains distinct, but binding agreements,
beneficial to all parties, are developed. Shared activities
typically include managed care negotiations, group purchasing
discounts, staff development and education offerings, and
shared management services. Each organization keeps its own
name with the addition of some reference to its affiliated status,
as in the title: Port Martin Hospital, an affiliate of Vincent
Medical Center.
A collaborative partnership is another interorganizational
arrangement. As with the joint venture, each organization
retains its own standing as a specific legal–corporate entity. The
purpose of the collaborative partnership is to draw on the
mutually beneficial resources of each party for a specific time
period associated with the completion of agreed-on projects. An
example from research illustrates this point: a university’s
neuroscience and psychology departments and a hospital
pediatric service combine research efforts in the area of autism.
A formal letter of agreement or mutual understanding is
exchanged, outlining the essential aspects of the cooperative
arrangement.
Such restructuring efforts, especially the formal merger, are
preceded by mutual due diligence reviews in which operational,
financial, and legal issues are assessed. Federal regulations and
state licensing requirements must be followed. Details of the
impact of the restructuring on operational levels are considered,
with each manager providing reports; statistics; contractual
information, leases (as of equipment); and staffing
arrangements, including independent contractors and outsourced
work.
In the instance of a full merger, practical considerations
constitute major points of focus. Examples include redesigning
forms, merging the master patient index and record system into
one new system, merging finance and billing processes, and
officially discharging and readmitting patients when the legally
14. binding merger has taken place.
Present-day mergers and joint ventures can have a pronounced
effect on the health professional entering a management
position. Consider the example of a laboratory manager who
must now oversee a geographically divided service because a
two-hospital merger results in this person’s having
responsibility in two sites that are miles apart. There is far more
to consider in managing a split department than in managing a
single-site operation. The manager’s job is made all the more
difficult. Overall, however, mergers, joint ventures, and
collaborative partnerships are an opportunity for the
professional-as-manager with greatly increased responsibility
and accountability and a role of increasing complexity.
Range of Service and Levels of Care
One of the most distinguishing features of a specific healthcare
organization is the range of service, along with levels of care.
This feature identifies the organization as a particular kind of
organization, explicitly defined in its license to operate (e.g., an
acute care hospital, an adult day care center, a hospice). An
organization may offer many different services, both inpatient
and outpatient. The range of service and levels of care are part
of the overall definition of the organization; the specific types
of care are delineated. Groups such as the American Hospital
Association (AHA), The Joint Commission (TJC) and similar
associations, and various designated federal and/or state
agencies, define types and levels of care. Thus, a hospital might
develop its range of services at an advanced level, with a
variety of specialty services, to meet the definition of tertiary
care. A small, rural hospital might seek to meet the basic
standards for a critical access facility, capitalizing on the
flexibility such designation permits.
Clinics vary in their range of service from the relatively small,
walk-in clinic, to more complex services such as an urgent care
clinic or specialty clinic associated with a hospital. In this latter
arrangement, the inpatient service coordinates care with its
companion outpatient clinic. Examples include surgery, cardiac
15. care, and prenatal and postnatal care.
Another way of noting the variety of care services is to group
organizations by client characteristics and treatment needs:
geriatric behavioral care, rapid treatment for drug-dependent
clients, women’s health, comprehensive cancer care, sports
medicine, hospice care, and intensive day treatment for at-risk
youth. Care of frail, elderly people has been and is a growth
industry because of the simple fact of demographics—the
increasing numbers of older individuals. The variety of levels of
care include independent living units; personal care assistance,
including secured units for dementia care; skilled nursing care;
and comprehensive continuing care facilities. Adult day care
programs augment residential care.
Further details about the range of care can be found by
identifying the organization’s place in the overall continuum of
care. For the purposes of this discussion, the acute care,
inpatient facility will be placed at the center, with the
continuum of care segmented as subacute and postacute,
although it should be noted that not all care involves inpatient
admission. Thus, an organization might tailor its services to
support transitional care, either temporary or permanent care,
with a postacute rehabilitation center, a long-term nursing care
center, and assisted living and secured personal care for frail
elderly people. The current emphasis on reducing readmission
rates for inpatient care gives new impetus to the development
and/or expansion of these types of services. A traditional
nursing home, specializing in “balance of life” care of frail,
elderly people, might restructure its programs to add
posthospitalization care, with the expectation that the length of
stay will be weeks or (a few) months—not indeterminate and
permanent. Home care programs have increased in prominence
because of their place in the sequence of care. Shortened
inpatient stays, outpatient same-day surgery, transitional care
from hospital to nursing home to the patient’s personal
residence intensify the need for home care by nurses, along with
a variety of other caregivers (e.g., health aides, homemaker
16. aides).
Hospice care represents a model of service that utilizes several
levels of care. Care of the terminally ill (regardless of age) is
rendered in the home, in the hospital when needed, and in a
nursing care facility. A hospice might be owned and sponsored
by an inpatient facility or operate as a stand-alone organization.
One way to describe hospice care is this: the hospice program
follows the patient and family as they move through the various
changes in location.
In the continuing search for the best care, with flexibility and
affordability, there has been renewed interest in domiciliary
care for the elderly or developmentally disabled. The underlying
idea is a return to home-like, individual care provided by paid
caregivers, often in a patient’s own homes. Some states have
active programs to increase the number and quality of such
arrangements, along with active plans to decrease the number of
nursing home beds.
The group home for adolescents or developmentally disabled
people continues to be an area of change. The movement is
away from large, institutional-based care to very small units
(e.g., four to six clients in a family-like group home).
LAWS, REGULATIONS, AND ACCREDITING STANDARDS
Laws, regulations, and accrediting standards are a major
consideration in the delivery of health care. They affect every
aspect of the healthcare system. The sheer volume of such
requirements, some of which are in contradiction to others, has
increased to the point that most organizations have a formally
designated compliance officer. This high-level manager,
assigned to the chief executive division, has the responsibility
of assessing compliance with current requirements, monitoring
proposed changes, and helping departments and services prepare
for upcoming changes. Other responsibilities of this officer
include the preparation of required reports and studies, the
coordination of site visits, and the preparation of any follow-up
action or plan of correction. In addition, this officer provides
liaison with the Board of Trustee’s corporate compliance
17. committee. Managers at the operational level work closely with
this office in order to comply—indeed excel—at meeting all
requirements.
The operational level managers, while assisted by the
compliance office, must take the initiative on their own to
ensure that day-to-day practices and systems are in order. A
systematic review of laws, regulations, and standards facilitates
this practice. A manager can sort through the thicket of
requirements by analyzing them in terms of several features:
• Setting. Licensure laws at the state level authorize the
owner/sponsors to offer specific types of care (e.g., acute care
hospital, behavioral care facility, rehabilitation center). The
definitions and requirements in this fundamental law are the
starting point, for without meeting this set of binding elements,
the organization would not be permitted to function. Changes in
program offerings, including expansion, termination, or sale,
trigger an update in licensure status.
• Patient/client group. Certain issues concerning definition of
the patient/client must be considered: when does the
relationship begin; who is eligible for certain programs of care;
what aspects of reimbursement for care apply; who may consent
for care; and what, if any, special provisions attach to certain
patient groups (e.g., any patients needing protective care).
• Professional practitioners and the support staff. Professional
practitioners are required to have a license to practice. Both the
individual and the organization’s officials must be mindful of
the necessity of meeting this set of rules. In addition to this
requirement, there are many laws and regulations governing
working conditions, hours and rates of pay, and
nondiscrimination.
• Systems requirements. Specific aspects of the administrative
and support systems are often laid out in detail, including time
frames; requirements for record development and retention; and
review processes relating to patient care, safety, and privacy.
Required documentation of care is delineated in terms of
content and time (e.g., development of plan of care, discharge
18. plan, medication profile, restraint usage).
The sources of law are both state and federal governments. In
addition to these, local units of government, such as counties
and cities, have laws that apply to most or all formal
organizations in their geographic jurisdiction. The usual ones
are fire and safety codes, zoning regulations, environmental
requirements, and traffic controls.
Regulations Stemming from Laws
The usual practice in lawmaking is this: the basic law is
developed and passed, with the lawmakers recognizing that
further details will be needed. The specific law usually
indicates which government department or agency is invested
with this rule making power. Healthcare providers are most
familiar with the Department of Health and Human Services
(DHHS) and its Centers for Medicare and Medicaid Services
(CMS—formerly the Health Care Financing Administration)
division that has the authority to develop Medicare rules and
regulations. Other current “headliner” laws and companion
regulations include the Health Information Technology for
Economic and Clinical Health Act (HITECH), the Health
Insurance Portability and Accountability Act (HIPAA) of 1996,
and the Patient Protection and Affordable Care Act (PPACA) of
2010.
Accrediting Standards
Although these standards or elements of performance are not
required as such, most healthcare facilities seek to meet them
and have official recognition by an appropriate accrediting
agency. Some of the usual nationwide accrediting bodies are
TJC, Continuing Care Accreditation Commission, and the
Accrediting Commission for Health Care.
Within the accrediting process for the overall facility, there are
additional criteria for certain programs, with the resulting
assurance of quality care. By way of example, TJC has a gold
seal of approval rating for rehabilitation services. It also has
disease-specific care certification.
Professional Association Standards and Guidelines
19. Professional associations develop standards of practice and
related guidelines in their area of expertise. These guidelines
reflect best practices and provide practical methods of
developing and implementing operational level systems. In
addition to the practical aspect of meeting such optional
standards, there is prestige value associated with gaining
recognition by outside groups. Receiving magnet designation
from the American Nurses’ Credentialing Center illustrates this
dual benefit.
Sources of Information about Requirements
Managers face a challenge in trying to keep up to date regarding
the many requirements. They must take a proactive stand,
especially for those aspects relating to their department or
service.
One’s professional association is a reliable source of timely and
thorough information. The umbrella organizations such as the
AHA monitor current and prospective issues and make the
information readily available. A useful practice for managers to
adopt is the regular monitoring of the Federal Register for
federal regulations, and the companion publication at state
level. These agencies publish agenda listings on a periodic basis
(e.g., annually, semiannually) to alert the public about probable
new regulations. This is augmented by an official Notice of
Proposed Rulemaking about a specific topic.
Government agencies, public and private “think tanks,” and
other associations prepare position papers; national, state, or
regional health initiatives proposals; and similar plans. Healthy
People 2020 or the DHHS’s national health goals or a state
governor’s long-range plan are examples of readily available
documents to alert managers of trends and issues.
THE IMPACT OF TECHNOLOGY
A survey of any health discipline would readily provide
examples of the impact of …