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The St. Clare Hospital was founded in 1988. In the past few years, the revenues have dropped steadily to a point where CEO James Edwards is considering cost control to improve the organization’s bottom line. Mr. Edwards understands physicians play a critical role in controlling cost, but they do not have a great interest in cooperating with him to sustain the viability of the hospital. Mr. Edwards decides to hire Wendy Jones as the chief operating officer and empower her to cut costs for the hospital. The first measure taken by Ms. Jones is to outsource the interpretation of imaging readings and fire the radiologist Dr. Harris. By doing so, the hospital would save $160,000 per year. However, after two weeks, the hospital sees 18% inaccuracy rates in outsourced reading reports. The hospital might face legal liabilities from inaccurate readings. Mr. Edwards and Ms. Jones want to stay with the plan to control costs, but the physicians are furious. The medical director, Dr. Wiseman, gathers all staff physicians to a call for action. Write a four-to six-page double-spaced paper (excluding title and reference pages), addressing the following: Describe types of conflict identified in this case. Explain conflict management styles evidenced in this case. Propose a conflict resolution strategy to be used. Recommend strategies to reduce cost and legal liabilities. Including an introduction and conclusion paragraph, your paper must be four to six double-spaced pages (excluding title and reference pages) and formatted according to APA style. Utilize a minimum of three scholarly and/or peer-reviewed sources, including the textbook, that were published within the last five years. .

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In order to successfully respond to circumstances in your healthcare organization, you must first be able to appraise your organization, its mission, its vision, and its values. To provide you with experience doing this, you will assess the situation as described in your selected case study. Read your case study carefully and develop a short paper that provides a summary of the case study. In the summary, be sure to address the following: A. Provide a brief summary of the circumstances and the problem(s) faced by the healthcare organization. Highlight details you believe to be of particular relevance. B. Provide an interpretation of the organization's mission, vision, and values. Consider how the industry, the organization, and/or the stakeholders define key terms within the organization's mission, vision, and values and how the definitions clarify the meaning. C. Discuss how the organization's interpretation of its mission, vision, and values impacts the circumstance it faces. Consider how the mission and vision relate to the situation outlined in the case study. Guidelines for Submission: This short paper should be between 1 and 3 pages, not including cover page and references. This paper should be in APA format. Use case study as a reference and any other scholarly article if relevant to the topic. case 13 emanuel medical center.pdf C A S E Emanuel Medical Center: Crisis in the Health Care Industry The Haley Eckman Story On Friday, four-year-old Haley Eckman stayed home from school because of a slight fever. She complained that she was feeling very tired. That night, Haley’s temperature increased to 104°F. At 3:15 A.M., Mr. and Mrs. Eckman took Haley to the emergency department (ED) of Emanuel Medical Center (EMC) in Turlock, California. They registered at the admissions desk and waited for someone to see them. After what seemed like forever to the Eckmans, a triage nurse came out to evaluate Haley. He asked several questions, but failed to take her temperature – a routine procedure in that situation. He then disappeared, leaving the Eckmans to wait yet again. While they waited, Haley vomited. She said she felt very weak. The family asked if Haley could lie down in a bed while they waited to see a doctor. A staff member told them that there were no available This case study was prepared by Randall Harris, Kevin Vogt, and Armand Gilinsky as a basis for class discussion rather than to illustrate either effective or ineffective handling of an administrative situation. © 2004 by Randall Harris, Kevin Vogt, and Armand Gilinsky. Used with permission from Randy Harris. 13 both13.indd 670both13.indd 670 11/11/08 12:04:27 PM11/11/08 12:04:27 PM M O R E P R O B L E M S T H A N T H E E D 6 7 1 beds, and that they would have to wait. The Eckmans saw several empty beds across the hall from where they sat as the staff member said this. At 4:35 A.M., the Eckmans were led to a room where a nurse took Ha.

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James I. Merlino is a colorectal surgeon and the chief experience officer at the Cleveland Clinic. Ananth Raman is the UPS Foundation Professor of Business Logistics at Harvard Business School. HEALTH CARE'S SERVICE FANATICS How the Cleveland Clinic leaped to the top of patient-satisfaction surveys by James I. Merlino and Ananth Raman THE CLEVELAND CLINIC has long had a reputation for medical excel- lence and for holding dov în costs. But in 2009 Delos "Toby" Cos- grove, the CEO, examined its performance relative to that of other hospitals and admitted to himself that inpatients did not think much of their experience at its flagship medical center or its eight community hospitals—and decided something had to be done. Over the next three years the Clinic transformed itself. Its overall ranking in the Centers for Medicare & Medicaid Services (CMS) sur- vey of patient satisfaction jumped from about average to among the top 8% of the roughly 4,600 hospitals included. Hospital executives from all over the world now flock to Cleveland to study the Clinic's practices and to leam how it changed. The Clinic's journey also holds lessons for organizations outside health care—ones that until now have not had to compete by creating a superior experience for customers. Such enterprises often have workforces that were not hired with customer satisfaction in mind. Can they improve the customer experience without jeopar- dizing their traditional strengths? The Clinic's success suggests that they can. The Cleveland Clinic's transformation involved actions any organization can take. Cosgrove made improving the patient experience a strategic priority, ultimately appointing James Merlino, a prominent colorectal surgeon (and a coauthor of this piece), to io8 Harvard Business Review May 2013 n HEALTH CARE'S SERVICE FANATICS lead the efiFort. By spelling out the problems in a sys- tematic, sustained fashion. Merlino got everyone in the enterprise—including physicians who thought that only medical outcomes mattered—to recognize that patient dissatisfaction was a significant issue and that all employees, even administrators and janitors, were "caregivers" who should play a role in fixing it. By conducting surveys and studies and so- liciting patients' input, the Clinic developed a deep understanding of patients' needs. It gave MerUno a dedicated staff and an ample budget with which to change mind-sets, develop and implement processes, create metrics, aind monitor performance so that the organization could continually improve. And it com- municated intensively with prospective patients to set realistic expectations for what their time in the hospital would be like. These steps were not rocket science, but they changed the organization very quickly. What's more, fears expressed by some physicians that the initiative might conflict with efforts to maintain high quality and safety standards and to further reduce costs turned out to be unfounded. Du ...

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362 Cases The Battle in Boise One would not expect Idaho, a state with fewer than 2 million residents, to be highlighted nationally as an example of heightened conflict among physicians and hospitals. Nevertheless, competitive pressures and the trend of physician employment have profoundly changed the state's healthcare market. In 2012 about half of the 1,400 doctors in southwestern Idaho were employed by the dominant St. Luke's Health System or its smaller competitor, Saint Alphonsus Health System. St. Luke's is a regional health system consisting of seven medical centers in southwestern Idaho. Its largest facility is a 399-bed hospital in Boise. The system has expanded in the recent past and controls hospitals in Twin Falls (228 beds), Jerome (25 beds), Ketchum (25 beds), and McCall (15 beds) (St. Luke's 2013). The system also has been aggressively preparing itself for the changes that will be instituted by the Affordable Care Act. Saint Alphonsus, on the other hand, belongs to Trinity Health, a large national system of approximately 30 hospitals. Saint Alphonsus has two facili- ties in southwestern Idaho: the 381-bed Saint Alphonsus Regional Medical Center in Boise and a 152-bed hospital in Nampa (Trinity Health 2013). By 2012, according to an article in the New York Times, many independent doctors were complaining that both hospitals in Boise, especially St. Luke's, had too much power and control over their medical practices (Cre- swell and Abelson 2012). The doctors accused St. Luke's of dictating which tests and procedures to perform, how much to charge, and which patients to admit. Independent specialists claimed that their referrals from the physicians employed by St. Luke's had dropped sharply and that patients frequently paid more for treatment at the hospital than they would pay at an independent physician's office. At the same time, employed physicians voiced growing pressures to meet the financial goals the hospitals had set for them, which in the physicians' opinions often entailed unnecessary tests, procedures, and hospital admissions. Although the two hospitals have competed for decades, their rivalry has intensified in the past few years. Saint Alphonsus, trying to slow St. Luke's perceived domination, even sought a court injunction to stop St. Luke's from buying physician practices. This legal maneuver claimed that St. Luke's market dominance allowed them to raise prices and to demand exclusive or preferential agreements with insurance companies. As an example, Saint Alphonsus claimed that the price of a colonoscopy had quadrupled and that St. Luke's charges for laboratory work were nearly three times the fees charged by others in the market. Saint Alphonsus argued that St. Luke's dominance was hurting Saint Alphonsus's business and creating steep declines in hospital admissions and referrals from physicians employed by St. Luke's. Cases 363 St. Luke's justified its ac ...

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April 28, 2017 Transparency is a relatively new concept to the world of health and health care, considering that just a few short decades ago we were still in the throes of a “doctor-knows-best” model. Today, however, transparency is found on almost every short list of solutions to a variety of health policy problems, ranging from conflicts of interest to rising drug costs to promoting efficient use of health care resources, and more. Doctors are now expected to be transparent about patient diagnoses and treatment options, hospitals are expected to be transparent about error rates, insurers about policy limitations, companies about prices, researchers about data, and policymakers about priorities and rationales for health policy intervention. But a number of important legal and ethical questions remain. For example, what exactly does transparency mean in the context of health, who has a responsibility to be transparent and to whom, what legal mechanisms are there to promote transparency, and what legal protections are needed for things like privacy, intellectual property, and the like? More specifically, when can transparency improve health and health care, and when is it likely to be nothing more than platitude? This conference aimed to: (1) identify the various thematic roles transparency has been called on to play in American health policy, and why it has emerged in these spaces; (2) understand when, where, how, and why transparency may be a useful policy tool in relation to health and health care, what it can realistically be expected to achieve, and when it is unlikely to be successful, including limits on how patients and consumers utilize information even when we have transparency; (3) assess the legal and ethical issues raised by transparency in health and health care, including obstacles and opportunities; (4) learn from comparative examples of transparency, both in other sectors and outside the United States. In sum, we hope to reach better understandings of this health policy buzzword so that transparency can be utilized as a solution to pressing health policy issues where appropriate, while recognizing its true limitations. Learn more on our website: http://petrieflom.law.harvard.edu/events/details/2017-annual-conference

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Ruling may up risk for ‘apparent authority’ Risk managers take some solace in knowingthat not every allegation of malpractice will fall on the hospital, that sometimes the individual physician or physician group will be responsible for defending the claim. But there is cause for con- cern with a recent court ruling that could increase the chance of the hospital being held responsible under the “apparent authority” concept. Also known as “ostensible authority,” “apparent authority” is the idea that the patient sometimes can reasonably assume the doctor was performing as a hospital employee even if that is not actually the case. The theory was confirmed recently by a New Jersey state appellate court, which held that a hospital may be vicariously liable for a staff doctor whom a patient reasonably believes is providing treatment on behalf of the hospital. In Estate of Cordero v. Christ Hospital, the plaintiffs asked the Superior Court of New Jersey to reconsider the trial court’s dismissal of vicarious liability claims against the hospital. (Editor’s note: The appellate ruling can be found on the web site: www.sitemason. com/files/hR0RBm/njmalpracticedecision.pdf.) The case involved Ramona Cordero, an insulin- dependent diabetic, who was treated by a member of an anesthesiologist group that contracted with the hospital. Before the day of the surgery, Cordero had never met the anesthesiologist, who wore no identification showing his affiliation with the anesthesiology group. He also did not advise Cordero that the hospital assumed no responsibility for the anesthesiologist. Cordero suffered brain damage from the procedure. She remained in a vegetative state until her death 3½ years later. At trial, the court dismissed the claim for vicarious liability, saying the plaintiffs failed to present evidence either that the hospital “actively held out” the doctor as its agent or that it misled the patient into believing that he was its agent. The appellate court, however, concluded that affirmative action is not necessary to mislead the patient. In its ruling, the court explained that while a hospital is generally immune from liability for the negligence of independent contractors, such as doctors, there is an exception when the hospital’s actions or omissions suggest that the doctors act on its behalf. The court cited a number of factors that can determine whether the doctor has been “clothed with the trappings” of apparent authority: • whether the hospital provided the physician; • the nature of the medical care and whether it is typically an integral part of treatment received at a hospital (e.g., anesthesiology, radiology, emergency care, etc.); • notices of the relationship or disclaimers of responsibility; • the patient’s opportunity to reject care or select a different physician; • the patient’s prior contacts with the doctor; • special knowledge about the doctor-hospital relationship. The hospital’s contract with the anesth ...

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The SETI project and other efforts to contact or listen for messages from extraterrestrial life were once funded by our government. Should the government support this endeavor? Is this search for intelligent life a scientific mission? What was your answer to the Drake Equation based on the values you used to calculate N, the number of advanced civilizations in our galaxy that are attempting to contact us? Finally, comment on how you think the news would be received that contact is established with some other intelligence? What would be the reactions of you, your neighbors, and the citizens of the U.S.? .

The SETI project and other efforts to contact or listen for messages.docx

suzannewarch

The Service-Oriented Architecture (SOA) strategy allows businesses and organizations to offer their products and services to customers and trading partners using a standards-based integration protocol. Web Services depends on SOA for delivery. SOA uses Extensible Markup Language (XML) to exchange data and information to its products and services consumers. One of the SOA characteristics is that the integration is loosely coupled, thus simplifying integration. Write an eight to ten (8-10) page paper in which you: 1.Analyze five (5) ways in which SOA reduces the total cost of ownership (TCO). 2.Examine five (5) ways in which using XML enables data and information exchange between clients and servers using Web Services in an SOA environment. 3.Compare and contrast the loosely coupled architecture to a tightly coupled architecture in terms of TCO, maintenance, and implementation issues. 4.Analyze three (3) advantages and three (3) disadvantages of using a standards-based integration strategy. 5.Use at least three (3) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources. .

The Service-Oriented Architecture (SOA) strategy allows businesses.docx

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