Health Care Organizations, Health Care Economics, & Technology (NURS270)

Organizations

- A group of people who come together for a purpose or as a collection of people brought together for a predtermined purpose in a defined environment. - A purposefully designed, structured social system developed for the delivery of health care serives by specialized workforces to defined communitites, populations, & markets.

Attributes

- All organizations have defining attributes. - Each has a purpose, structure, & members who of the work of the organization - Situated within an environment from which resources are obtained & from which challenges are presented that require an organizational response. - Must be able to acquire resources, produce services, & changes as necessary to sustain their existence.

Focus of Mission

- All related to the delivery focus. - Research & teaching hospitals are associated with academic health centers whose mission includes the educations of professionals, as well as delivery of services. - Community hospitals offer general medical & surgical services to a surrounding community but most will not have a research or a teaching mission.

Minor Attributes - Organizational Environments

- Both internal environment as well as an external environment. - Internal consists of an integrated web of factors such as organizational culture, systems such as information systems or human resources management system, structural elements such as role responsibility, rules, & practices. - External consistent of those external forces, conditions, or events that affect the organization, such as economic trends or new laws & government regulation. - Interplay between the internal & external environments of the HCO, where organizational decisions & operations are affected by perceived forces from the external environment. - Organizations integrated into their environments will also change those environments in some ways, adding to the complexity of the relationship. - HCO policies created to meet environmental challenged might conflict with professional values or with legal guidelines, requiring actions to negotiate & resolve the conflict. - The need to change in response to environmental effects means the HCOs are complex & their work environments are notably ambiguous.

Scope of Health Care Organizations

- Broad & complex with numerous variables to consider when examining different types & categories of HCOs. - Limited to organizations that provide a range of health care services for health promotion, illness, & wellness care (hospitals, ambulatory care centers, home health agencies, clinics, nursing homes, provider offices, & long term care). - Can be classified mission, financial classification, & ownership.

Leadership

- Bureaucratic structures require authoritative leadership capable of controlling all aspects of the organization. Leadership has changed with this new era of organizational thinking where organizations are viewed as fluid, adaptive, & dependent on an engaged & activated workforce. - A leadership that creates inspiration, is able to sustain motivation to achieve results, & that values the contributions of all members. - These leaders have to read the environment & interpret the trends of changes for others. - Must be able to lead others through turbulent & uncertain environments & most be able to adapt to hange as readily as their followers.

Minor Attributes - Structure

- Collective of formal rules & policies that govern organizational practices & that promote the effective management of materials & resources. - Creates various roles & associated responsibilities that are required for organizational function. - Organizational rules, policies, & authority are necessary for the integration of diverse functions & activities across the organization into a coordinated system capable of supporting purpose of the organization. - A balance needs to be maintained that provides the structure necessary for sustaining the HCO while not producing unnecessary constraints. - Management authority & control is relatively weak in relationship to professional authority because decision making related to practice is not subject to control by those outside the profession. - Result of divided authority is that management control by those outside of the profession is limited to those work activities that lie outside the professional's scope of practice.

Consumer Health Informatics (CHI)

- Consumer health informatics is defined by the American Medical Information Association as a form of health information technology geared towards delivering better health care decision making based upon the consumer informatics stands at the crossroads of other disciplines, such as nursing informatics, public health, health promotion, & health education. - Perhaps the most challenging & rapidly expanding field in health informatics. - Paving the way for health care in the Information Age & advancing the medical home concept & the use of personal health records. - Includes technologies focuses on patients as the primary use of health information.

Complex Adaptive Systems

- Current theory describes the organization as having biological characteristics that allow the organization to react & change when stimulated. - Defines a new way of viewing organizations are organic & lifelike entities that are open to the environment & capable of transforming themselves in light of perceived opportunities & threats. - The organizations can read & interpret the environment & they can adjust & adapt though the coordinated action of the interdependent parts. - The need for change & adaptation requires that all organizational members to be engaged & motivated to meet the organizations goals. - Viewing the organization as a living social system recognizes the creative energy of the people who innovate to produce desirable products & services in uncertain, changing environments.

Nursing Informatics

- Defined by the American Nursing Association. - A speciality that integrates nursing science, computer science, & information science to manage & communicate data, information, knowledge, & wisdom in nursing practice. - Supports consumers, patients, nurses, & other providers in their decision making in all roles & settings. - Accomplished through the use of information structures, information processes, & information technology.

Health Care Economics

- Focused on how people deal with a finite resource & scarcity. - People are constantly juggling how to get the most of life & health by choosing how they use resources available to them. - Defined as behavioral spice that begins with two propositions about human behavior. - Human behavior is purposeful or goal directed, implying that persons act to promote their own interests.

Financial Classification

- For Profit or Not For Profit. - Difference is how the profits are distributed. - For Profit generate profits for shareholders while also providing health care services. - Not For Profit generate profits but are used for organizational purposes, such as building additional facilities, providing improved services, or acquiring new equipment.

Managed Care Organizations

- Health care providers & insurance companies assume a part of the financial responsibility for health care. - Patients pay a monthly premium for health care insurance. - Medicaid & Medicare have incorporated managed care into their health plans. - Patients can choose from several different plans under the managed care system, including preferred provider organizations., health care maintenance organizations, & patients may receive health care from a list of providers who participate in the PPO or HMO. - The health care services that these plans cover are determined by the employer & not the insurance company. - Insurance payment varies according to geographic region & depends greatly on the type & plan of coverage. - May often leave the patient with unpaid medical expenses or the need to obtain prior authorization before seeking treatment or medication.

Learning Organizations

- Intelligent, living systems perceive, respond, & adapt. - Changing & adapting are the result of learning - perceiving stimuli, organizing a change response, & then reviewing the results of the change to determine if a satisfactory outcome was obtained. - Learning organizations are those that are receptive to their environments, are open to change, & have adopted processes that allow their personnel to experiment, make changes, risk mistakes, & take responsibility for their decisions. - A culture of learning is important because professional judgement & decision making are central to the delivery of health care services in destabilized, uncertain environments.

Power

- Is commonly defined as the ability to influence others or to control events & circumstances. - Much of this power was in the form of the decision making that supported control of organizational operations. - Power is now seen as a more diffuse, even infinite, phenomenon in that much power resides in the individual or within teams in the complex adaptive systems. - It is no longer an exclusive tool of management because much decision making & action is the responsibility of those who function outside of the management structure.

Bureaucracy

- Max Weber developed the first theoretical model of bureaucracy in the early 20th century. - Described the principles of organization that created efficiency in work design & were thought to be the most effective way to organize work. - Also described the distribution of authority in bureaucracies, noting that authority grounded in position & divided into hierarchies was preferable to the authority derived from personal characteristics. - Bureaucratic designs was common to the large organization that developed during the Industrial Revolution because the manufacturing & distribution of goods required a rational system of centralized control to effectively acquire resources & efficiently convert them to a finished product. - The drawback to this model is that it takes little account of the organization as a social system within an environment. - Mainly focuses on authority & control to achieve efficient production within a closed system.

Private or Indemnity Health Insurance

- May be purchased on a group basis or purchased by individual consumers. - Most Americans with private health insurance receive it though an employer sponsored program.

Major Attributes - Specialized Health Care Workforce

- Notable for the highly specialized workforce needed to deliver health care services. - The work produced is complex, variable, & at times urgent. - The knowledge & skills that these workers bring to the HCO are necessary for the effective delivery of services in an ambiguous, challenging work environment. - The need for this workforce increases the costs for HCOs but it also benefits the organization in terms of maintaining standards & ensuring quality service outcomes. - An interprofessional approach to the treatment of human health problems not only is a distinguishing feature of the HCO but also serves to increase the complexity of the organization.

Medicare

- Provides health care coverage for all people ages 65 & orders, people who are permanently disabled, & individuals 65 & older with end stage renal disease. - Federal health insurance program that individuals or their spouses paid into through employment of self employment taxes. - Includes hospital insurance, supplemental medical insurance, Medicare advantage plans, or outpatient prescription drug coverage.

Clinical Research Informatics

- Relates to informatics whose objective is to advance the biomedical/health sciences through the humane & ethical use of informatics. - Included issues relating to the use of information & knowledge as well as the sound & socially appropriate collection & maintenance of person specific &/or de identified patient data. - Electronic health records will enhance the availability of clinical data for research & quality improvement initiatives.

Patient Protection and Affordable Care Act

- Requires that most US citizens & legal residents have health insurance. - Creation of state based exchanged though which individuals can purchase coverage with subsidies available to low income families. - A major expansion of the Medicaid program of the nation's poorest individuals. - The requirement for employers to cover their employees or pay penalties, with exceptions for small employers. - New regulations on health plans in the private market requiring them to cover all individuals, regardless of health status. - Establishment of national, voluntary insurance program for purchasing community living assistance services. - Increases in payments for primary services. - Greater support for prevention, wellness, & public health activities.

Clinical Health Care Informatics

- Seeks to transform health care & enhance human health through a creative & innovative use of informatics. - Transformation will be accomplished through a well educated & properly trained informatics, workforce, and enhanced performance of health care processes & systems, appropriate public policy, & a relevant research agenda. - Includes the development of direct approaches to patients & their families & even individuals who are not yet patients.

Clinical Informatics

- The application of information & communication technologies to the delivery of health care services. - Essentially the same regardless of the health professional group involved. - Has 2 sub domains - clinical health care informatics & clinical research informatics.

Medicaid & SCHIP

- The nations mayor public health insurance program for low income Americans, financing health & long term care services for more than 52 million people, including children & many of the sickest & poorest in our nation. - Medicaid has improved access to health care for low income individuals, financed innovations in health care delivery, & functioned as the nation's primary source of long term care financing. - SCHIP was enacted to provide coverage to uninsured low income children who did not qualify for Medicaid. - Medicaid & SCHIP are jointly funded by state & federal governments. - Eligibility is determined by income & need. - Medicaid payments are only paid to qualified hospitals, nursing facilities, & home health agencies & cannot exceed a reasonable estimate of the amount Medicare would pay for the same service.

Major Attributes - Public Trust

- The work of early HCOs gained the confidence of the public health that their altruistic purpose was to serve others by providing care & comfort, regardless of circumstances. - Currently, the level of public trust in HCO has eroded with the growth of managed care, national corporate chains of for profit HCOs, & allegations of fraud & a use by the HCPs. - People still turn to their physicians & nurses for help & advice & they still seek services offered by HCOs when they need help with health issues (indicates social contract is still intact). - HCOs that provide quality health care services & are good cooperate citizens will be able to maintain their positive image & their part of the social contract, regardless of profit status.

Major Attributes - Purpose

- To help others by providing health care services. - Can be determined by the organizations mission, vision, & values. - Mission statements described the organizations purpose based on a vision of what the HCO hopes to achieve. - Mission statements are describe the values that drive the work of the organization, such as quality & excellence. - Mission statements reflect strategic vision & focus & drive the work of the HCO.

Systems Theory

- View of organizations as social systems had an early beginning with the human relations school of organizational theorists. - Focused their study on the needs & desires of people who work in the organization. - Organization has social components that interact & that these components are affects by factors from the outside environment. - Social components interact with environment, technology, & organizational structure in an integrated fashion to create an unified, dynamic system.

Major Attributes

Distinguished from other types of organizations by their unique purpose, by their specialized workforce, & by the level of public trust that these institutions are primarily designed to help others achieve & maintain optimal health & well being.

Minor Attributes

Forms of purposeful organizations & are features they share in common with other types of organizations.

Ownership

Publicly or privately owned. - Publicly owned are seen as community organizations that are supported by government funding. Tax supported county or state hospital that provides generalized health care services or specific health services such as behavioral or mental health. - Private owned are investor owned, owned by religious or social organizations, & are not generally supported by public funding.