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healthcare 1

Definition of health care
health is defined by WHO, the authority of UN health decrees that says health is a state of complete physical, mental, and social well being not just the absence of a disease. A country’s healthcare system is set up to provide diagnosis and treatment when this health is compromised.
AOA
DO’s do a whole person approach instead of treating a specific symptom so that patients develop attitudes and lifestyles that prevent sickness not just fight it
Physical environment
environment impacts health, the physical environment includes exposure to chemicals like formaldehyde and radon that can cause cancer, hazardous work places, pollution
Social Environment
involve factors like poverty. People who are isolated and poor are more at risk of heart disease, diabetes, asthma, cancer and aids.
Leading causes of death in the US
malignantneoplasms
cerebrovascular disease
respiratory disease
alzheimers
diabetes
accidents
flu
kidney failure
septicemia
Primary Health care
shit that eliminates risk factors for a disease includes things like condoms, seatbelts and UV protection
(protection)
Secondary Healthcare
Focus on early detection of shit so treatments are more effective
(Detection)
Tertiary healthcare
part of treatment that reduces later complications (rehab)
The type of focus of healthcare
Right now focus is on secondary and tertiary healthcare, but that will change we shift to prevention. Affordable healthcare act advocates this by removing co-pays for preventative services, giving benefits to employers for wellness programs and requires chain restaurants to print calories
Components of healthcare system
Where is the healthcare provided (ex hospita)
Workforce who provides it (ex doctor)
Providers of equipment (ex pharmaceutical tech)
Educators of healthcare (ex lecom)
Financing mechanisms (ex medicaid)
Principal players in US healthcare
Government agencies (CDC, US dept of health)
Private nonprofits (Hospitals/LECOM)
Private Profits (pharmaceutical companies)
System Management
Each part of the healthcare system has to be looked over so management elements include administration, planning, regulation and evaluation
Judging health care systems
done based on the quality of care provided, how efficiently that care is provided and equity achieved.
The People of the US healthcare system
the system employs 15 million people in a variety of jobs that include primary secondary and tertiary care
Primary Care
what most people need because it includes personal treatment and prevention. includes immunizations, prenatal care and physicals for early disease prevention
Secondary Care
available in clinics and hospitals usually includes diagnostic and surgical procedures performed by specialists
Tertiary care
Super specialized care requiring shit normal hospitals don’t have examples include big name surgeries like transplant
Types of Facilites
discussing where healthcare is administered, either the facility is an inpatient or outpatient facility
most inpatients are seen in acute care community hospitals (nonfed short term)
Categorization of Hospitals
categorized by who controls them, size, function and average length of stay. This puts them into 1 of 4 categories, a general hospital, special hospital, rehab or psychiatric
4 types of ownership
government/nonfed (state and local)
government federal
private nonprofit
private profit
Community Hospital
nonfederal and open to the public for short term stay, can be either general or special.
Short term stay is less than 30 days
Average length of stay calculation
number of days stayed divided by number of admissions
Average daily census
average number of people served as inpatients today.
average number of inpatient days/ number of days in reporting period (like month is 30 days)
US Hospitals
make up 31% of US healthcare spending and are kept in check by the AHA that publishes the AHA guide and hospital statistics providing information about every hospital, more info comes from NCHS and US census bureau
Shrinking Beds
trend since 1990 shows increase number of hospitalization with shorter stays, and shrinking bed counts.
Reduction of beds could be due to costs to keep on more staff, bigger hospitals needing more money for fancy tech
Hospital Structure
Administration takes caare of money, PR fundraising
Medical consists of divisions by speciality, or organs
Committees oversee doctors clinical works, executive committee communicates with everyone else through judicial committee.
New Hospital trends
to attract more patients hospitals are incorporating alternative medicine (acupuncture) and making luxury suites.
Private for profit institutions include
pharmaceutical industry
commercial healthcare
nursing homes
for profit hospitals
Structure of a nonprofit hospital
Board of trustees who provide money or represent an important community institution, the leader of the board can also be the CEO but the top dog is the executive director
Structure of a for profit hospital
usually same set up of directors as the nonprofit, but depends on the type of business entity
Long Term Care
includes mad variety of supportive, rehab and nursing services provided to everyone who’s daily activities are restricted cause of a disability or chronic illness
nursing facilities
the term used for nursing homes who since 1990 became eligible for federal 3rd party reimbursement for their services
Nursing Home enrollment
number of citizens per 1,000 65 or older people has been declining since the 70s as the figure in 1999 was 43/1,000 but demand may increase as teh baby boomers (those born in the 60s) get older cause the occupancy rate in 2009 was 82%
Ownership of nursing homes
66% are for profit, 26% are nonprofit and 8% are government owned
Money for nursing homes
comes mostly from public funds cause in 2004 medicaid dished out 44% of their spending for low income and 28% to the elderly, 42% for the disabled but the elderly/disabled make up only 11%/14% of the people enrolled in medicaid
Nursing home care issue
it’s expensive and not many people get aid so possible solutions include better home services, health promotion, disease prevention and self care programs for the old folk
outpatient care: Ambulatory care
given to a person who isn’t hospitalized, it covers all healthcare services except community health and services for the bedridden so we can say most doctor patient contact is ambulatory care
Ambulatory care stats
2008 a million people (which is higher than the number in 2000) got ambulatory care in a doctors office, hospital outpatient department, or the ER.
80% of ambulatory care is in a doctors office though
Categories of private ambulatory care
Private solo doctors/partnership/group that’s paid on fee for service basis or capitance (per patient)
Salaried physicians
HMO
Health maintenance organization that can be anything from profit to nonprofit that’s responsible for providing and delivery services to people enrolled for a pre-negotiated fixed price. They insure people against the costs of medical services and also supply those services.
Ambulatory care visits stats
American averages 4 visits per person, with women making up 58% of those visits. This number increases for women over 45, while men under 45 are seen typically for injuries.
Rate of ambulatory care is increasing
Top dogs of ambulatory care visits
General or family practice 24%
IM 17%
peds 13%
OB-GYN 7%
the source of payments for a person going to any of these guys is usually private insurance
ER
outpatient ambulatory care department of the hospital
functions to provide care to critical patients and to people who have no insurance/nowhere else to go, also acts as a source of admissions for the hospital
Types of people who come to ER
nonurgent- minor condition
urgent – requires attention but not sever with time
emergent- requires immediate attention, time dependent
ED visits stats
41% of people seen in the ER are just uninsured and have nowhere else to go. The hospital doesn’t get paid for these people and the Affordable Care Act is trying to fix this by giving insurance to those that are uninsured to help out the healthcare facilities to make sure they get emergency patients
PUblic health department
local govts sometimes provide ambulatory health services in public hospitals through a local health department (theres 20,000) serving functions that primary physicians don’t want to focus on
Public Health Agency clinics
local health departments have small clinics devoted to preventing a specific disease, like the Bing chest center for TB and centers for STDs
People who provide healthcare: Stats
show a huge variety, in 2000 12 million people worked in healthcare thats 9% of all US employed. while in 2009 the numbers increased to 15 million, 11% of those employed
Of these, 25% work in offices while 40% work in hospitals this number is decreasing as the number of hospitals decreases
US doctors shortage
Doctor: Population ratio in 2008 was 27/10,000 and is expected to rise to a 50,000 shortage in 2020. To address this, more med schools have opened up and we have seen a huge increase specifically in DO medical student enrollment
Continuity of care
as opposed to doctors in other countries, doctors in the US see patients in their offices and in the hospital to provide continuity of care although some can specialize and become hospitalists that just stay in the hospital
primary care doctor
provide integrated care that most people and develop a relationship with their patients. Coordination of care is implemented by referral to a specialist, but the outcome is incorporated into patients ongoing care
gatekeepers of managed care organization that wants to minimize healthcare costs by pushing prevention and really urge minimal referals
Types of nurses
Nurse practitioner is practically a doctor almost
RN passes the boards and has degrees
LPN does a 12 month program after HS
Nurse’s aid- no HS diploma required
PA’s
established in 1960s and were doing 80% of what a doctor does by 1990, so very capable but work under doctors supervision
Involvement of US government
US is the least involved government when it comes to healthcare in developed nations, all it does is provide services to people who can’t get them on their own (the sick poor, mental and Native americans on reservations)
Powers of the Government
american federal government can’t do anything, it’s limited a lot by the US constitution but states have police power that lets them provide health and safety to their people, states will often dish out this power to local governments to set up things like county programs for mental health.
All the fed government can do is tax/spend for wellfare and control commerce
Federal government
3 branches for checks and balances, the legislative branch (congress) enacts laws regarding healthcare which are them implemented by the a division of the executive branch. The judicial branch serves to make sure those legislations are constitutional and punishes violations
Federal Agencies
The executive branch consists of lots of federal agencies set up to monitor and execute different things regarding health
Federal Agencies: DHHS
goal is to promote health and well being of all americans but most importantly those that are helpless (disabled, poor etc). Help is usually direct but also through funds via NIH which notably operates the CDC
Federal agencies : department of agricutulre and labor administration
1) manages nutrition policy, meat inspeection and food stamps
2) administers occupational safety and health act
Federal agencies: FDA
Protects against bad food and drugs with a focus on efficacy and safety, now includes radiological monitoring to minimize public exposure to radiation
Federal agencies: CDC
controls and prevents diseases, monitors labs, directs quarantine operations and programs for health education
Federal agencies: IHS
takes care of indians on or near reservations
Federal agencies: VA
8 million people in 2011 were enrolled in this program that provides healthcare in a system of 152 hospitals to Veterans, or people who served 90 or more days in the military and were given an honorable dischanrge
Federal agencies: DOD
addresses healthcare needs of the military among whom each branch has their own network of health facilities, providers within the DOD are also in the army and paid according to their rank
TRICARE
military health insurance
Therapeutics
Therapeutics providers are also part of the healthcare system and include companies and equipment like hospital furniture glasses prosthetics and x-rays.
in 2008 retail outlet prescription drugs cost the US $300 billion accounting for 12% of total national health costs
US healthcare dollars
also known as National Health Expenditure (NHE), it’s tracked and includes health consumption costs, investments in healthcare equipment and research.
GDP
Monetary value of stuff produced in a country and includes basically everything, in 2009 20% of all US spending was on healthcare and that’s 17% of total GDP
Health expenditure
Based on the GDP, US rate of health spending was 46% higher than the next runner up Netherlands, and 50% higher than Germany this shows US ain’t in line with other countries.
Increase of the NHE
increasing but at a slower rate, the increase is due to the fact that we’re more reliant on expensive technology
Payment for health services
us HEALTH expenditures are paid out of pocket, by private insurance, public insurance, charity and forgiven debt. 2/3 is p aid by hte insurance guys mostly public
Who pays out of pocket?
patients do! They include copays and deductibles which is a set amount you have to pay before the insurance company will start paying
Payment by a 3rd party
a third party is anyone who pays for a service thats not the patient or their family, so includes all types of insurance and employers
Private health insurance
a type of 3rd party payer usually obtained through employer but more employees are being required to pay for this coverage so could account for the fact that 73% of people were insured in 1990and by 2011 only 64% are insured
Health Insurance Blue cross blue shiedld
One of the biggest nonprofit insurance companies since 1929, some of its branches have turned into for profit alongside Metroplitan Life and these guys have to pay their shareholders
Managed Care Organization
traditionally patient contracted with provider of care and a third party payed but now patient contracts with an MCO who is paid for the care by the employer and MCO decides what care is received.
4 parts to medicare
A) hospital insurance
b) supplementary medical insurance (doctor visits)
c) lets you in MCO
d) new, started in 2006b to cover drugs
Management
process, comprised of social and technical functions and activities, occurring within organizations for the purpose of accomplishing objectives
Conceptual Skills
ability to critically analyze and solve complex problems
Technical Skills
reflect expertise or ability to perform a specific work task
Interpersonal/Human Relation Skills
enable a manager to communicate with and work well with other individuals
Hierarchy of Management
authority, or power, is delegated downward in the organization
Functional Organizational Structure
most common organizational structure; pyramid shaped; used in larger organizations; deep vertical structures; strict chain of command which ensure that communication and assignment and evaluation of tasks are carried out; used most frequently in HSO’s
Matrix Management Method
Admin structure; dual authority system where individuals are assigned to complete specific work tasks; advantages are improved coordination and communication, also increases flexibility of org to carry out work
Product/Service Line Management
organize around selected services to control service delivery; Adv. = resource control, accountability, enhanced clinical quality of service
Environment for HSOs
entities and influences outside of the organizations boundaries
Open Systems
Organizations that are affected by, and that affect, their environment
Exchange Relationships
Transaction between 2 or more organizations where something of value is exchanged and both gain value
Environment as a Influence
factor, trend, or issue that affects the focal organization; Examples – regulatory, community, financial, competition, sociocultural barriers, technology, etc.
Environment as a Resource
Organizations are dependent on this and are critical for their success; example would be a supplier
Input/Output Management Model
management acquires inputs, uses inputs to provide services, and creates outputs
Managers
Persons appointed to positions of authority who enable others to do their work effectively, who have responsibility for resource utilization, and who are accountable for work results
Line Managers
those that supervise other employees
Staff Managers
those that carry out work and advise their bosses
6 management functions
Planning, Organizing, Staffing, Controlling, Decision-Making, and Directing
Planning
Determining what to do and how to do it
Organizing
Establishing authority and responsibility management
Staffing
acquiring and retaining human resources
Directing
Initiating action in the organization by leading, motivating, and communicating
Controlling
Monitoring, adjusting, and improving aggregate performance
Decision-Making
Evaluating alternatives and making choices
Complexity of Work
Managers have a variety of roles, skills, and responsibilities such as day to day tasks like; core tasks, routine add-ons, and specialty add-ons
Domains of Management
Self, Team/Work Unit, Organization
Values
qualities desirable as ends in and of themselves, things that are important to us, and things we stand for/believe in
Missions
who we are, and what we are about; what we set out to do…our purpose
Visioning
determining a desired future state
Goals
states of being that we set for ourselves; an “aim” or an “end” that we see as desirable
Categorizing Missions
Ownership (for profit, non-profit, governmental), Service Area, teaching facility, payments, specialized vs general
Organizational Culture
Ingrained patterns of shared beliefs, values and behaviors, with associated symbols and rituals, that are acquired overtime by members
Relationship between values, missions, and goals
Values are the foundation for the HSO
Direct Care
Deals directly with the patients such as a hospital, nursing home, physician practice, and assisted living facilities
Non-Direct Care settings
support the care of individuals through products and services made available to direct care settings. Examples are consulting firms, associations, pharmaceutical companies, and medical suppliers
The main difference between direct care and non direct care setting is:
Provision of care
Employment of medical and health services managers is expected to change by what percent between 2008 and 2018?
Plus 16 percent
External domains of healthcare management include all of the following except
Patient Satisfaction
Internal domains of healthcare management include all of the following except:
Medicare/Medicaid
This function requires the manager to set a direction and determine what needs to be accomplished
Planning
This function refers to the overall design of the specific division for which the manager is responsible
Organizing
This function referes to acquiring and retaining human resources
Staffing
This function refers to monitoring staff activities and performance
Controlling
The focus in this function is on initiating action in the organization through effective leadership
Directing
This competency involves the ability to critically analyze and solve complex problems
Conceptual
This competency reflects expertise of ability to perform a specific work task
Technical
This competency enables a manager to communicate with and work well with other individuals
Interpersonal
Larger organizations are more likely to have all of the following except
Informal chain of command
Talent Management refers to which of the following
ALL OF THE ABOVE (Recruitment, Retention and Training)
Studier views the organization as needing to be results oriented, with which of the following pillars of excellence?
ALL OF THE ABOVE (People, service and finance)
Griffith says “championship processes” need performance measures in each of the following except
Directing
Dashboards are:
A way to measure organizational performance
Succession Planning is
Planning to replace managers who retire or move up
Healthcare policy is
Every healthcare managers job
Self management means
ALL OF THE ABOVE
Team management means
All of the above
Organization management means
All of the above
Which of the following competencies is more leadership oriented that management oriented?
Determining strategies for the future
Which of the following is not a contemporary leadership model?
Great Man
Which leadership domain would the competencies honesty and integrity be placed?
Self Development and Self Understanding
Which is a new trend for healthcare governance
Evaluations used to identify issues and correct
Which is a guideline for healthcare leaders when being responsible to their employees as per the ACHE Code of Ethics
Ensure a safe work enviornment
Which statement is true about Followership?
An effective leader must be able to inspire and get commitment from all people or
It should be recognized as a necessary component for an effective leader
Which statement is NOT true about the “Great Man” theory?
Behavior is an important component in determining what make a good leader
Which theory places its attention on the leaders style and the work situation but also recognize the importance of setting goals for employees?
Path-Goal Theory of Leadership
Find a leadership theory that correctly matches the stated leadership focus
Leader- Member Exchange Theory of leadership: Interactions between leader and subordinate
Which one of the EI (Emotional Intelligence) dimensions has the definition of “Social awareness skill, putting yourself in anthers shoes”?
Empathy
Which model of leadership supports the concept known as “tough empathy”?
Inspirational Leadership
From the Leadership styles for Healthcare personnel, which one focus on personal development and recommended for the top personnel?
Coaching style
Choose an inappropriate key leadership protocols
Perfectionism
Which is a barrier of key healthcare leadership?
New Technology
Which is a challenge of key healthcare leadership?
Physicians
What is (are) the focus area(s) for healthcare leadership ethics?
A and B (Bioethics and Managerial ethics)
Find an incorrect statement about leadership in today’s healthcare industry
Many clinicians have the management training which would help them in their new roles
Which is a leader development rather than a leadership development
The leader in collaboration with the superior
The healthcare leader who is concerned about the future, as well as today’s business must
Continuously reassess how he/she fits in the organization
Which is an incorrect statement about the future of the healthcare field?
The recently enacted Patient Protection and Affordable Care for America Act will provide full health care reform
Extrinsic rewards come from within the individual employee
False
Healthcare managers have power over employees and can force them to acti in certain ways
False
Everyone is motivated
True
Satisfaction progression refers to the interplay up and down Maslow’s continuum of needs
False
Herzberg’s theory of hygienes and motivators is not easily understood by managers
False
Avoidance learning is often referred to as positive reinforcement
False
Reinforcement theory is an appropriate way of characterizing how employees behave in organizations
False
Theory X, Theory Y, and Theory Z are all forms of motivation theories developed from a management perspective
True
Theory Y is derived from Japanese approaches to management
False
Intrinsic rewards are tangible
False
Intrinsic rewards are what motivate people
False
All employees are motivated by money
False
Motivation is not manipulation
True
People are born to motivate
False
Disengaged healthcare workers have an impact of an organizations bottom line
True
The future US workhorse will mirror the population and become younger, as well as more tonically and racially diverse
False
Understanding what motivates employees in different generations is becoming increasingly important for healthcare managers
True
Engaged employees are not as loyal beaches they are more interested in the best best opportunity
False
Motivation in the workplace is a new concept that needs more research in order to consider important
False
By 2020 a shortage of healthcare workers such as physicals, nurses, and public health professionals is expected
True
Maslow’s needs-based theory of motivation includes the following types of needs
Belonging
Self Actualization needs focus on
Higher level needs
Alderfer’s motivation theory is based on which of the following needs
All of the Above (growth, existence and relatedness
The Acquired Needs Theory was developed by
None of the Above ( Herzerg, Taylor and Vroom)
Acquired needs resulting form life experiences focus on
Affiliation
Extrinsic theories of motivation include
None of the Above
Scientific Management involves which of the following
determining the most efficient way to per form a job
Which of the following are considered to be types of extrinsic rewards
A and B above ( Money and Benefits)
Which of the following is considered to be a good motivational strategy?
Tailor rewards
managers interested in revitalizing employees focus on getting them to
All of the above ( get rest and relaxation, maintain fitness and eat right)
Engaged health care workers demonstrate the following characteristics
All of the Above ( focus on patient care, are productive, model behavior for others)
Between 2008-2018 total employment is expected to increase
10.1 %
What percent of all new jobs between 2008-2018 are projected to be in professional and service providing occupations?
50%
This generation values education, training and growth opportunities, flexibility and is considered risk averse
Generation X
This generation is respectful of authority, values duty, sacrifice, and accountability and recognition of hard work and a strong work ethics
Traditionalists
This generation values individuality, teamwork, and work-life balance
Baby Boomers
This generation is image conscious, team- oriented, values instant gratification and is achievement oriented
Millennials
“Value” for health care firms is defined as the quotient of ____________________ divided by cost
Quality
Health care concerns shared by the U.S., China and India include concerns over ____.
Lifestyle issues and behavior
Investor-owned facilities comprise about ____ percent of the hospital sector.
15-20
The Human Relations School ascertains that in order to improve productivity, management must
Understand the informal organization of workers
____ coordination captures aspects of both the programming and feedback approaches to coordination.
Relational
____ is the exchange of information about work performance between two people who are not in a hierarchical relationship.
Mutual Adjustment
In analyzing micro-level needs for coordination, it is helpful first to ask whether the work is ____________________.
Programmable
Most appropriately used if there is both high interdependence and high uncertainty
Lateral Relations
Specifies the form of intermediate outcomes of work as they are passed from one job to another
standardization of output
In the simplest of situations, acts as an adequate coordinating device to ensure that the work of different units meshes together
hierarchy of authority
The degree to which decisions are made at the higher levels of the organization
centralization
Responsible for the coordination of program issues across the traditional professional specialty departments
integrators and liaison roles
Responsible for activities and decisions that directly contribute to the provision of goods and services
line managers
Most needed when the work is relatively uncertain
feedback approaches
Best used when work is predictable and cause and effect relationships are well known
Programming approaches
Coordination of activities among organizational units
integration
The exchange of information among more than two people
group coordination
A(n) ____ approach to leadership emphasizes the actions that the person in the leadership role takes on the job.
Behavioral
____ leadership is defined as influencing followers by “broadening and elevating followers’ goals and providing them with confidence to perform beyond the expectations specified in the implicit or explicit exchange agreement.”
Transformational
Leadership can be defined as the process in which one engages others to set and achieve a common ____________________.
Goal
Studies have identified two types of support that those in leadership roles must provide for successful change: instrumental and ____ support.
Interpersonal
____ can be defined as the process of accomplishing predetermined objectives through the effective use of human, financial, and technical resources.
Management
One of the best ways to motivate physicians include ____
Reminders and Feedback
One myth about motivation is that motivated workers ____.
are more productive
The four central components of expectancy theory are ____.
job outcomes, valences, instrumentality and expectancy
The causes of motivational problems often fall into three categories: 1) inadequate definition of the desired performance, 2) impediments to employee performance and 3) ____.
inadequate performance-reward linkages
One of the key roles of the C-Suite is to interact with key ____.
External stakeholders
The need for ____ reflects an individual’s desire to associate with others in friendly circumstances.
affiliation
____ needs in Maslow’s hierarchy of needs are composed of two different sets of needs: the need for a positive self-image or self-respect and the need for recognition and respect from others.
Esteem
Three types of interdependence include ____.
pooled, sequential, and reciprocal
____ involves “directed autonomy” whereby individuals or teams are given an overall direction yet considerable leeway concerning how they go about following that direction.
Empowerment
Effective team performance is dependent upon a team’s ability to form ____ with other teams in a positive and productive manner.
Intergroup relationships
The ____ stage of team development is characterized by disagreement, counter-independence, and the need to manage conflict.
Storming
____ leadership is the legitimate authority given to a team member.
Formal
____ is the critical gateway between the decision to adopt the QI innovation and the routine use of the QI innovation, or integration of a new idea or practice into the operating system of the organization.
Implementation
____ group technique and Delphi technique elicit group members’ opinions prior to judgments about those opinions.
Nominal
____ learning is when problem solvers adjust their behavior and work processes in response to changing events or trends
Adaptive
____ reflects differences amongst the parties in understanding and carrying out duties.
Task conflict
____ boards have an important role to play in overseeing QI efforts and patient safety initiatives because they are the organizational entity legally accountable for quality of care.
Governing
____ can be useful in collecting information about beliefs and attitudes as long as they are anonymous and there is assurance the results will be acted on.
Employee Surveys
Three common myths or misconceptions about innovation are that (1) innovation is good; (2) there is a formula, and (3) innovation is ____.
Linear
____ feedback loops counteract or oppose whatever is happening in a system
Balancing
BATNA stands for “Best ____ to a Negotiated Agreement.”
Alternate
After simplicity, the second most important quality of one’s message is ____.
Vividness
____ explains how information spreads.
Contagion
A weakness of ____ is that it is not appropriate for exploring a particular idea or proposal in depth
interview design
____ is a negotiation tactic which involves trading off on issues that are of different value to each party.
Logrolling
Three major sources of power within an organization are ____.
structural, cultural, and knowledge-based
____________________ is a negotiation tactic which involves adding issues that are not tied to money or compensation
Nonspecific compensation
The ____ effect is the tendency to infer specific characteristics of a person or organization from our overall impressions or feelings about that person or organization
halo
____ learning is when problem solvers adjust their behavior and work processes in response to changing events or trends.
Adaptive
Incorporates a culture and processes to “radically reduce system failures and effectively respond when failures occur”
High-Reliability Organizations
Reimbursement for healthcare services that is designed to link payment incentives to quality and performance outcomes
Pay-For-Performance
Describes efforts to radically review and re-organize existing, or adopt new and innovative, work processes designed to improve customer value, organizational efficiency, and market competitiveness
Business Process Re-engineering
Developed a model of care that is a “patient-centered, holistic approach to healthcare, promoting mental, emotional, spiritual, social, and physical healing”
Planetree
Based on aspects of an organization or an individual’s actions that could impact overall quality or organizational performance
structural measures of quality
Designed to decrease medical errors and enhance patient safety
quality improvement interventions
Metrics based on the results of work performed
outcome measures of quality
Initiative through the Center for Health Design, which is working with partners to develop facilities that incorporate “evidence-based design” features demonstrated to reduce errors, improve quality and efficiency, and improve work experience
Pebble Project
Indicators of the activities involved in carrying out work in an organization
process measures of quality
A participative, systematic approach to planning and implementing QI in quality
Total Quality Management
____ power is when customers seek to drive down price and improve quality.
buyer
____ is the development of a broad formula prescribing a way in which a business competes and collaborates, sets goals, and establishes policies to carry out those goals in order to achieve the organizational mission.
Strategy
One school of modern strategic management encompasses an emphasis on ____.
industry structure and competitive forces
The five forces model suggests that firms should target the industry with the highest potential for above-average returns and then implement either a cost-leadership strategy or a differentiation strategy.
True
The overarching goal of assisting physicians and hospitals in adopting electronic health records (EHR) that meet industry standards is to have the technology used as a tool to accomplish health outcome policy priorities such as ____.
Improving care coordination
Approximately ____ of hospitals are estimated to have fully operational electronic health record (EHR) systems.
8-15%
A report on health information technology use among U.S. men and women aged 18-64 by Cohen & Stussman (2010) noted that ____ of adults in the U.S. used the Internet to search for health or medical information.
61%
The 1999 report by the Institute of Medicine, To Err is Human: Building a Safer Health System, stated that between ____ deaths could be attributed to preventable medical errors.
44,000-98,000
One form of medicine that caters to the diagnosis and treatment of non-life threatening conditions are ____________________ health care clinics often referred to as minor emergency clinics, doc-in-a box, urgent care clinics, or convenient care clinics.
Retail
Bachman identified six “mega-trends” that impact the demand-control model. These include ____, self-help/self-care, individual ownership, portability, transparency (right to know), and consumerism (empowerment).
Personal Responsibility
An example of a supporting plan that is driven by the strategic plan is..
All of the Above
How can intelligence on competitors’ strategies best be gathered.
Both A&B
How do the Mission, Vision and Value statements tie to the strategic plan?
They are reaffirmed during the planning process to ensure they are aligned with future strategic directions.
What are the components of Strategy Execution?
All of the Above
What is the department manager’s role in strategic planning?
All of the Above
What is the main purpose of strategic planning?
To identify how market forces may affect the organization.
What is the purpose of an organizational dashboard?
To facilitate management discussion regarding execution of strategies.
What is the purpose of tactical plans?
Identify the who, what, where, when and how of implementation.
What is the purpose of the planning assumptions in development of the organizational volume forecast?
C & D
Which aspect(s) of the SWOT analysis aim to identify external market forces?
Market Assessment.
Which of the following is necessary for successful strategy execution?
A & C
Which of the following is not a critical success factor for effective strategic planning?
Business plans for individual service lines.
Which of the following is not part of the market assessment model?
Power of Hospitals
Which of the following should be a major consideration in collecting leadership input to development of the strategic plan?
Input will necessarily be value laden.
Which of the following stakeholder groups should not be included in strategic planning?
All of the above should be included as appropriate
Which of the following statements about the inclusion of key financial indicators in the planning process is true?
Pricing and/or rate setting arrangements should be included.
Which of the following statements is/are true?
Resource availability should be considered when selecting strategies.
Why is execution of the strategy so important?
The strategic plan is useless unless it is executed appropriately
Why is it important to consider Innovations in Technology in development of the strategic plan?
They may represent a threat of substitute products
Why is it important to include past strategic performance as a part of future strategy development?
Understanding why past strategies succeeded or failed can help with future strategy success.
Leaders are ____ focused while managers are ____ focused
external
internal
Leaders
communicating with outside groups, motivate employees and stakeholders, set a direction of organization, spokesperson, transforming organization. Leadership is the process of influencing people to achieve organizational goals
Manager
following proper procedure, control resources, regulations keepings, staffing personell
Functional responsibilities
chief nursing officer, physician directer, Reports to top person in organization
Great man theory
certain traits determine good leaderhip. being tall, a man, strong, white
style approach to leadership
rather than looking at only the characteristics of the leader, researches started to recognize the imprtance of two types of behaviors in successful leadership. a succesful leaderr would fullly attentive to both types of leadership
two beaviorals in leadership-
completing tasks and creating good relationships-
situtational approach to leadership
set of theories focused on the leader changing his or her behavior in certain situations in order to meet the needs of subordinates. it implies a very fluid leadership process whereby one can adapt ones actions to an employee needs at any given time
Contingecy theory of leadership
the focus was on both the leaders stle as well as the situation inwhich the leader worked, thus building upon the the situtaitional and great man approach
path goal theory of leadership
placed its attenstion on the leaders style and work sitiuation but also recognized the importance of setting goals for the employees.
leadership memeber exhange theory
evolved over the concern that leadership was being defined by the leader, the followe, and the context. focused on inerations that occur between the leaders and the followers. leaders would be more effective with better relationships with their subordinates
transformational leader
could significantly change an organization an organization through its pepole by raising their consciouesness, empowering them, and then providing the nurtuting needed as they produced the results desired
self actualized leadership theory
introspective and concern for meaningfulness
Emotional intellifence
there are certian skills that a person needs to have to be well adjusted in todays world.
types of emotional intelligence
self awareness, self regulation, motivation, empathy, social skills
authentic leader
the central focus that people will want to naturally asociate with someone who is following their internal compasss of true purpose
Inspirational leadership
focus is on leaders who inspire by giving people what they need
health care leaders are called to be role models for ________ _______ and be able to
cultural competency, aatract mentor and coach those of different as well as similar backgrounds
Servant leadership
applies this concept ot top adminstratios ability toleade, acknowledgeing that a health care leader is largely mtoiviate dby a desure to serve others.
spiritual focus
does not imply a certain set of religoues beliefs but emphasizes ethics, values, relationships skills, and the promotion of balance between work and self. Defining our uniqueness
Coercive leadership
used inappropitately to get a desired/demanded response from a follower.
What are 3 other leadership styles that could be used for effectively in a hc setting over longer periods of time
participative, pacesetting, and coaching
particpative
Asking managers for their input and giving them a coice in making decisions will let them know they are respected and valued.
pacesetting style
a leader sets high performance standards for his or her followers ICU nursers
coaching style
recommended for the very top personnel in an organization- the leader focuses on the pesonal development of his or her followers rather than the work tasks.
competencies
skills, knowledge, and abilities
functional and technical domain
not sudddicient
4 domains provide competencies that are behavioral and relate both to the individual and to other pepople
self developmemt and self understanding, interpersonal, functional and technical, organizational
professionalism
can be manifested not only in the way people act but also in their mannerisms and their dress.
trust and respect
two way exchage if a leader is to get followers to respong
Visability thoughout the organization?
having a presence can assure workers that the top people are “at the healm” and give a sense of stability and confidence in the business
rounding
making sure that the staff know they are cared about, know what is going on, and know that proper follow up actions are taking place
open comminciators
holding back information that could have been shared with followers will cause ill feelings and a concern that other important matters are not being diclosed
calculated risks
being catious but not overly so or they might lose an opportunity for the organization
Not perfect
there will be erros in what is said or done
goverance
group of peole who collectively assume the responsibility for strategic function
sabanes-oxley
federal law that set new or enhanced standards for proprietary companies that are publicly traded
How often should a organization have a self assessment
at least annually
Key HealthCare leaderships barriers and challenges
1. Laws and reulations-barrier
2. physicians-challenge
3. new tech-barrier
4. culture of saftety-challenege
5. resouce limitation-barrier
6. economy-challenge
Ethics
principles determining behavior and conduct appropriate to a certian setting
biomedical ethics
actions a leader needs to consider as he or she relates to a patient
managerial ethics
involves business practices and doing things for the right reasons.
The American College of HealthCare executives ACHE
educating professionsal memebership as to the ethical responsibilities of healthcare leaders
exective programs
used to atteact medical personnel into a fast track curriculum to attempt to give hem essential skills they need to be successful
Baldrige national quality program
recognizes in its most recent criteria for performance excellence the need for senior leaders to create a sunstainable envirement for their org though the coninual development of future leaders by enchancing their personel skills
Distinguish ______ ______ from __________ ______
leader development from leadership development
professional associations
good way to network with people in similar roles
succession planning
do this so organization is not left at any time without a person to lead
Strategic planning
managerial process of developing and maintaining a strategic fit between an organization (mission and goals) and its environment (opportunities)…
Strategic planning is a process that…
Assesses present conditions
Anticipates the future
Makes decisions concerning organizational direction, programs/services, and resources deployment
SWOT analysis
strengths, weakness, opportunities, threats.
gather a snapchat of how the organization is currently interacting with the market in comparison to the internal capabilites and intended strategic direction of the organization and to identify market opportunities and threats that the organization may want to address in furture strategic efforts
SWOT inclides three distinict but intricately related components
1. the market assessment
2. statement of the mission, vision, and values
3. organizaational assement
Market assemsent
all aspect of market must be examined to determine whether they respresent opportunities or threats for the organization and to determine whether they represent opportunities or threats for the organization and to determine future implication for the organiation
Five force model
power of the health care workforce, cosumers and payers, innovations in tech, regulatory enviorment, competitive rivalry
power of the health care workforce
market trend response
power of consumer and payer
ulitmate purcherser
by identifying specific _____ _______ healthcare organizations can better target their services and potential growth
community needs
innovations in tech
represent the threat of subsitute products
Picture Archive Communication Systems
Reduces the need for storage space for films and readers and the staff to maintain those areas and allows for remote elctronic accessing of files, iltimately requiring a potentially smaller number of physicians necessary to interpret the images
centers for medicare and medicaid services CMS
changments in healthcare payment formulas that are frewuently followed by payers at local levels
Mission-
vision-
values-
purpose
specific future state-goals
define orgs ciltures
volume forecast
identifying orgs service area- usually by zipcode
baseline scenario
data collected fro several historical time periods and can be matched using mathematical formular to several more time periods
holding its market share growth
formualte how wellit would fare if it were to stay in current cource
key finanicial indicators
indicators such as operating margin, net income, gross and new revenues, bond ratings, fun raising, key fananical ratior,spayer mix, rate setting
Rollout of the plaon
1. communicated at all levels of the org
2. supporting plans such as the financial and budgeting operating, marketing, capital, and master facilites
strategic healthcare marketing
actvities the firm uses to satisfy costomer needs; the approaches managers purse to create, communicate, and deliver value in selcted markets and the means of capturing value in return- always focused on costomer
marketing
the activity, set of insitutions, an dprocesse for creating, communicating, delivering, and exchnaging offerings that have value for costomers, clients, parters and society at large
marketing concept
organization must create, communicate, and deliver costomer value to selected target makrkets more effectivel than its competitiion to achieve goals
costomer value
difference between the benefits a consumer perceibes from the purchase of a product, service, or idea and the cost to aqcuire those benefits
social marketing
design, implementation and control of programs calulated to inflience the acceptability of social ideas and involving consideration of product planning, pricing, communication, distribution, and marketing research
5 things Social Marketing is
the application of ocommericial marketing priciples and technique
used to influence behavioral change
focused on specific target audience
used in order to promote public health
intended to benefit society as a whole
cause related marketing
links a for profit compnay and its offereing to a societal issue (ie. breast cancer) wih the goal of building brand equity and increasing profits
5 slow progression ways to think about marketin
some mangers supported it but chose not to disclose its success
some were optimistic
fustrated when it didnt work
a hoax
just gettin started
external uncontrollables
political, economics, social and cultural, tech, regulatory, competetive
internal controllable
4 ps- product, price, promotion and place`
key stakeholder
customes, board of directors, suppliers, physicians
cross functional teams
provide input and insights throughout the strategic marketing process
Marketing strategy’s three main levels
Establishing core strategy
creation of the companys cpmpetitive positioning
implementation of the strategy
Establishment of a core strategy
first steo- starts with a detailed and creative assessment of both the companies capabilities (stregnth, weakness relative to competetors) and the opportunities and threats posed by the environment
creation of the companies competitive postioning
target markets are selected
implemtation of the strategy
market orientation org must be capable of putting strategy into place, optimal marketing mx,
Market
a diverse group of organizations or indiviudlas who have disparate needs for products and services
market segmentation
process of dividing the total market into groups or segments that have relative similar needs for products and services
concentration strategy
targets a single market in order to specialize with the objective of gaining a large share of the market.
Advantage- the focus creates a long term value to certain costumers
disadavantage- specialization may preclude the orgs from entering othe attractice markets
multisegment strategy
targets several semeents with dfferentitation among the selected group of costomers
advantage-extends the reach to a broader share of the total market
disadvantage- more organizational resurces are required to satify this
5 groups of variables commonly used to sekement health consumer markets
demographic(age, gender, ethnicty), geographic(state, location), psychographic(values, lifestyle choices), situational(life events), behavioral(usage rates)
positioning aspect
brings health care marketing close to tactical implementation, its positions itself
Business to business B2B
concentrates on organizational buyers- employees, mangerial consultants, contract enterprise providers, medical devices and pharmaceuticals
Derived demand
indicate that the demand for goods, services, and ideas in organization is derived frm cosumer demand
consumer behavior
totality of consumers’ decisions with respect to the acquisition, consumption and dispositions of goods, services, time and ideas y humans over time
What is the cosumer decison making process
1. problem recognition, 2 internal search 3 external search 4 alternative evluation 5 purchase 6 post purchase evaluation
what is the marketing mis
Price-value of product
product-good/service
promotion-markeitng activites used to communicate with target market
place- offeiring devilvey route
marketing plan
written document that serves to guide marketing initatives across the organization
ethics and social responsibilites
marketing discipline must take into consideration the impact that makreting activities have on indicdual, group, organizational and societal outcomes
Strategy
a method or series of maneuvers or actions to achieve result/goal
Quator back function
keeper of data
Strategic planning?
Strategic: What direction should our organization take, in line with our mission?
Operational planning
Operational: What are operational policies, procedures and programs that are consistent with strategic plan and consistent with our mission?
Strategic planning process steps
1) Values/Mission/Vision
2) Strategic Assessment
-Gather and analyze information
3) Formulate goals and objectives
4) Strategy Choice
-Identify specific strategies
5) Implementation
-Develop operational plans, programs, activities, and marketing initiatives
-Allocate resources
-Adjust organizational structure
6) Control
-Monitor and evaluate goal achievement
-Feedback to goal/objective formulation
External anaylsis
Environmental forces/sectors (economic, demographic, social, technological, competitors, etc.
–Identify threats and opportunities (organization and product specific)
Internal anaysis
Identify strengths and weaknesses
–Identify organizational capabilities: managerial, financial, human resources, technology, service delivery and management
Marketing audit
Internal and external marketing assessment
Services/products
Target markets/segmentation
Differentiation
Competitors
Distribution
Pricing
Promotion
Marketing defined
“A social and managerial process by which individuals and groups obtain what they need and want through creating and exchanging products and value with others.” (Kotler and Armstrong, 1991)
These exchange relationships are important to advance the organization’s mission and strategic position
two types of leadership

. Supervisor-subordinate: leadership of specific employees- manager

2. Institutional: leadership for the whole organization- executive level- CEO, COO

Leadership development strategies
Formal- courses to take, exams you must pass, mentor younger managers/leaders, involved in coaching
Informal- no formal program that includes above info. encouraging staff to do different tasks, assign different tasks, informal mentoring
Internal leadership development- succession planning, having people we need in the right spot
succession plannign
Transactional
manager’s focus on exchange process in supervising (carrying out the work)
–something of value is exchanged in this relationship: what is nature of exchange?
Provide time and effort to complete work and in exchange gets compensated/benefits/work experience for work also gets trust, connections, gets opportunity for long term job security
Transformational
: leader looks for an existing need/potential motive in employee in order to satisfy higher order needs- more holistic approach, which is based on interest in the person as well as the work
High order of needs
Safety Security Affiliation Esteem Self-realization
legitimate power
formal power or authority based on position in the organization- also known as position power
reward power
based on leader’s ability to reward desirable behavior- ex. A promotion, new title, pay raise, office location, control of resources-computers, administrator assistant, travel budgets
Coercive power
based on ability to punish/prevent someone from obtaining desired rewards
Expert power
based on having knowledge valued by the organization. Information technology (IT), cultural knowledge, financial knowledge, strategy knowledge
reference power
power due to engendering of admiration/loyalty (Charismatic)
Who has the most power in a orgaization
he who control the data/info
autocratic authorrity
Absolute authority/unilateral decisions. leader/manager makes the decision and announces it
benevolent
Structured decision-making, but use benevolence.
consultive
: Advisory, seeks input in supportive environment. leader/manager presents ideas to employees, invites questions and sells decision that they’re making
democratic
Team building for consensus- best way because everyone is on the same page and the decision is based on perceptive wisdom of the group. leader/manager asks the group of employees to make the decision
participattive authortuy
leader/managers present the problem, gets suggestions from employees and makes decision based on input
laissez faire
leader/manager part of the group and the group makes the decision with no excessive influence
Force that reflects the leader-
the value system of the leader relative to the employees like empowerment, innovation thinking, expectations of employees, confidence, prior experience with employees
forces withing subordinates
Skills abilities, knowledge, education, experience, need of independence
forces within the situation
nature of issue or problem that needs to be addressed or solved- time pressure, level of importance
Tannebum and Schmidt
Recognition that best style depends on forces internal to the leader, forces within subordinates, and forces in situation
readiness level
readiness to perform a task/function
-Ability: knowledge and skills to do a task
-Willingness: confidence, commitment and motivation to complete a task
situational leadership
Leadership can and should change as a function of subordinate’s “readiness” level
situational leadership model
Style 1-telling/unwilling and unable
style 2-selling- unable but willing
style 3-participating- able but unwilling
style 4- delagating- able and willing
Examples of interorganizational realtionships
1.hospital/nursing homes/health care organizations that outsources its food services
2. Hospital system- when a system acquires a free standing hospital
3.retirement community that contracts/outsources for its wellness or PT services.
4.managed care network(anthem)- offer insurance coverage/benefits so providers need to accept a participating relationship (participating providers)
basis for linkages
Access to information and expertise, compeition,resouces
collabrative relationships
work toward settlement that satisfies each party and maximizes joint outcomes. Usually this one.
comeptitve realtionships
the objective is to beat the other so therefore it is impossible for both parties to attain their goals. Ex. RMH and MERC (pharmaceutical company) if it’s a single drug that MERC makes and other facilities are depended on it, it creates a competitive situation because MERC can charge anything they want
Coelscing
partial pooling of resources by two or more organizations to pursue defined goals. Organization only putting some of their resources in to get goals
Voluntary relationship
HSO has choice
Alliance/network
loosely coupled relationship between two or more organizations to achieve purposes of substantial importance to members. group purchasing
3 types of ownerships
Merger: one HSO is absorbed by another; the merger retains the primary HSO name/identity
Consolidation: two HSOs combine and are unified as a new legal entity
Owned system: an HSO is acquired by a single system
3 categories of schema
1. market transaction-relationship on exhange
2.voluntary relationships
3.ownership
vertical integration
combination, under single ownership of two or more stages of production or distribution, or both that are usually separate
Usually referred to as “Continuum of care”
Basis: enhanced competitive position by controlling the patient in a good way.
advantages of Vertical integration
Reduced transaction costs
Assurance of inputs-
Better coordination of services-
Enhanced technological capabilities-
disadvantages of Vertical Integration
High capital requirements-
Potential for unbalanced throughput-
Reduced flexibility/higher risk-
Loss of specialization-
Diversification
the process by which HSOs add to existing product/service mixes and/or enter new markets with existing and/or new products/services
Basis: need to provide for different revenue sources, because of constrained, unpredictable, and uncertain environments
Market development
Product development
product and market development
New markets, current product- RMH adding outpateint
new product current market- retirment community adding a new program
new market and new product- ALS adds dysenia wing
Concentric
new services/products are developed by HSO to complement existing ones (related to core competencies)
conglomerate
development or acquisition of services/products that are unrelated to core mix of services or products
GE business screen
Used to analyze potential services based on analysis of:
–market attractiveness of service
–organizational advantages in providing potential service
Elements in market attractivess
market size, growth rate, profit margin, competitor intesity
elements in organizational advantage
market share, project share growth, reputation, unit costs, human resources
bending the cost curve
the reducing of health spending relative to projected trends
value
created when additional features of quality or cosumer service desired by a customer can be provided at the same cost or price
iron triangle of healthcare
improve quality of care, improve costs of care, and reduce cost and cost acceleration
patient protection and affordable care act
expands insurance coverage to 30 million citizens but its savings will be more than offset by higher expenditures resulting from the expansion of coverage
WHO criteria to rank Health systems
Health status (similar to quality), responsiveness to the expectations of the population ( similar to access), and social and financial risk protection (similar to cost)
value chain
interlinked activities among a set of firms whereby suppliers provide raw material input to manufacturers who process them and produce outputs for downstream markets
bureaucracy
government by bureau or offices
system
a complex unity formed of many often diverse parts subject to a common plan or serving a common purpose
why is a system view important
1.) health outcomes are determined by an array of forces and factors that spans much more than a nations health care infrastructure
2.)there are so many interdependent players that a systematic view helps to organize them and their interaction
3.)the concept of a value chain suggests that value is created along this collection of activities and requires effective partnerships
4.) payment reforms in the buyer sector must be accompanied by corresponding reforms in the provider delivery system
role overlap (duplication)
two roles perform the same task
Role gap (accountability)
neither role performs the needed task
role underuse (boredom)
role not assigned enough tasks
role overload (burnout)
role assigned too many tasks
role ambiguity (anxiety)
role not clear what the tasks are
role conflict (stress)
roles tasks are at cross-purposes
scientific management school
extended the weberian model by explicitly emphasizing the control element of bureaucracy
human relations school
developed a model of worker motivation that sharply differed from the taylorist approach and thus suggested a different way of management
decision making school
focused on how decisions are made and goals were set as on the structure of the firm- but all within a context with which weber and scientific managers were comfortable control of the work process and the worker
bounded rationality
guided by satisficing behavior and the use of programs and routines
institutional theory
viewed organizations as organisms that adapt to pressures from without and within
open systems theory
the idea that organizations exist within an environmental context from which it must secure resources, support, and legitimacy in order to survive and operate
ambidexterity
firms that are both centralized and decentralized, firms that have units that are both mechanistic and organic in structure etc.
resource dependence theory
organizations depend on other firms for critical resources and engage in strategies to protect themselves
population ecology
organizational forms, competition among forms for resource space, and organization-environment covariation
social network approach
describing the embeddedness of human behavior in social relationships
system perspectives
focused on the broader system in which individual and organizational behavior occurs
complex adaptive systems
composed of multiple diverse interconnected elements
external environment
focuses on heavily by resource independence, population ecology and institutional schools
hospital-physician relationships (HPRs)
executives efforts to improve this illustrates how the perspectives and insights of the different schools be used together
evidence based medicine
health care professionals identify and apply scientific information in order to make clinical decisions
micro perspective
the internal environment of organizations
leadership
the process in which one engages others to set and achieve a common goal often an organizationally defined goal
mangement
the process of accomplishing predetermined objectives through the effective use of human financial and technical resources
front line managers
provide supervision directly to care providers
middle mangers
responsibility for entire units within the health care organization
top managers
those who are responsible for managing the entire organization and hence have responsibility for all of the units within the organization
trait theories
examine personality traits associated with leadership success
behavioral theories
examine how those in leadership roles act towards those that they are influencing
contingency theories
examine how those in leadership roles are influenced by their surrounding environment and the subsequent performance within specific contexts
transformational leadership
-idealized influence
-inspirational motivation
-intellectual stimulation
-individualized consideration
transactional leadership
-contingent rewards
-management by exception (active)
-management by exception (passive)
-laissez-fair
goals
the larger aspirations of the organization whereas objectives refer to the subordinate goals that must be accomplished to meet the larger aspirations
objectives
subordinate goals that must be achieved to accomplish the overall organizational goal, are often many and compromise a fundamental place in strategic problem solving
SMART
specific, measurable, achievable, realistic, and time bound
strategic problem solving
an approach to integrating the strategic function of leadership involving goal and objective setting with the subsequent organizational action required to achieve the set objectives
followership
those who share a common purpoe with the leaser, believes in what the organization is trying to accomplish and wants both the leader and the organization to succeed
organizational culture
the deepest level of basic and shared assumptions and beliefs that are shared by members of an organization
performance outcomes
1.) patient related
2.) staff related
3.) management related
competencies
knowledge, skills, and abilities
senior management
C-class positions
administrative leadership
the instrumental and interpersonal support provided by those who hold senior positions in the organizations such as CEO COO and VP
clinical leadership
instrumental and interpersonal support provided by those who hold clinical positions such as physicians and nurses
selfcare
managing ones-self
Leaders vs. Managers
Have external focus. What’s going on outside?
Have internal focus.
Leadership Competencies
More forward thinking, set direction for organization, motivate employees and stake holders, keep entity on course, effective spokesperson, determine future strategies, transform organization.
Followership
For every leader, need a follower. Not everyone or should be a leader. True leaders inspire commitment. Leaders cant be self absorbed. Recognize importance of getting respect.
Great Mans Theory
Developed by idea certain traits determine good leadership.
Style Approach To Leadership
Leaders have different degrees of concern over each of these behaviors. Leaders would be fully attentive to both.
Contingency Theory of Leadership
Focused on leaders style and situations.
Situational Approach To Leadership
Leaders behavior incertion situations.
Path Goal Theory of Leadership
Leaders remove obstacles and recognizes importance of setting goals.
Leader-Member Exchange Theory
Interactions between leader and follower.
Transformational Leader
Change organization through people by raising their consciousness, empowering them, providing the nurturing needed as they produced the results desired.
Contemporary Model: Emotional Intelligence
Certain skills that person needs to be well adjusted in todays world.
Contemporary Model: Authentic Leadership
People want to naturally associate with someone whos following their internal compass of true purpose.
Contemporary Model: Inspirational Leadership
Leaders who inspire by giving people what they need.
Contemporary Model: Diversity Leadership
Leaders to address matters of diversity, whether with patient base or employees.
Contemporary Model: Servan Leadership
Top administrations ability to lead, acknowledging that healthcare leader is largely motivated by a desire to serve others.
Contemporary Model: Sprituality Leadership
Emphasizes ethics, values, relationship skills, and the promotion of balance between work and self. Define own uniquness as human being.
Coercive Leadership Style
Used inappropiatly. Shouldn’t be used unless leader is dealing with very problematic subordinate or is in emergency situation and needs immediate action.
Participative Leadership Style
Asking managers for their input and giving them a voice in decision making. Letting them know they’re respected and valued.
Pacesetting Leadership Style
Leaders set high performance standards for his/her followers.
Coaching Leadership Style
Leader focuses on personal development of his/her followers rather than the work tasks.
Protocols
Specific ways of serving in role of healthcare leader provide exemplary model needed to send correct message to employees.
Professionalism
Essential to good leadership. Manifested not only in way people act but also in their mannerisms and dress.
Governance
Group of people who collectively assume responsibilities for strategic oversight of healthcare organization.
Ethics
Principles determining behavior and conduct appropiate to certain setting.
Code of Ethics
Gives specific guidelines to be followed by individual members.
Integrity Agreement
Address commitment to follow ethical behavior by organization.
American College of Healthcare Executives (ACHE)
Educating professional membership as to ethical responsibilities of healthcare leaders.
Executive Programs
Attract medical personnel into fast track curriculum to attempt to give them essential skills they need to be successful.
Baldrige National Quality Program
Recognize in its most recent criteria for performance excellence the need for senior leaders to create sustainable environment for their organization through continual development of future leaders by enhancing their personal leadership skills.
Leader Development
Leader collaborating with his/her superior.
Leadership Development
Process in team based.
Patient Protection and Affordable Care Act
Will dramatically alter the way health insurance is administered.

Effective leaders do not:

A. Model themselves as walking mission statements who convey their visions with enthusiasm

B. Express themselves in words far more eloquently than in attitude or actions

C. Approach the job and its requirements with an optimistic mind-set

D. Influence people over which they have no formal authority

Express themselves in words far more eloquently than in attitude or actions

Chapter 7 in Introduction to Healthcare Management.

The most workable budgets are those created within the finance department and handed down to the operating divisions.

True
False

False

Chapter 8 in Introduction to Healthcare Management.

For a supervisor to truly command respect in the department, he or she must openly apply the power of the position at every opportunity.

True
False

False

Chapter 7 in Introduction to Healthcare Management

The fundamentals of consensus decision making do not include:

A. Applying rational techniques of voting or bargaining

B. The avoidance of hasty conclusions or agreements

C. Insistence that each member agree that he or she can live with the chosen solution

D. Analysis of the negative features of each alternative

Applying rational techniques of voting or bargaining

Chapter 9 in Introduction to Healthcare Management

A Pareto diagram displays the frequency of occurrences of an event or condition in order of importance or frequency.
True
False

True

Chapter 9 in Introduction to Healthcare Management

In addition to actively leading, effective leaders are also active in developing the leadership skills of some of their employees.

True
False

True

Chapter 7 in Introduction to Healthcare Management

A control chart shows the correlation between two variables.
True
False

False

Chapter 9 in Introduction to Healthcare Management

Goals and objectives:

A. Reflect overarching needs

B. Should be time-oriented

C. Are meaningful and measurable

D. All of the above

All of the above

Chapter 2 in Career Opportunities in Health Care Management.

An important rule of budgeting is:

A. Unused budgeted funds are carried over into the next budgeting period

B. Money left over in the capital equipment budget is applied to the operating budget

C. Those responsible for complying with budgets must participate in budget preparation

D. Expenses are always charged to one central authority in the organization

Those responsible for complying with budgets must participate in budget preparation

Chapter 8 in Introduction to Healthcare Management.

Effective leaders are able to get people to do their bidding by:

A. Showing them by example the way certain things should be done

B. Suggesting that higher management will be displeased with them all if a specific something does not get done right

C. Reminding employees that there is pressure on all of them to produce

D. Suggesting that we all owe our compliance to the organization for having provided our means to a living

Showing them by example the way certain things should be done

Chapter 7 in Introduction to Healthcare Management

It is advisable to avoid making a decision when:

A. The outcome is likely to be damaging to you or your department

B. Doing so will take too much time away from your regular work

C. You are emotionally upset or seriously distracted

D. You are able to shift the responsibility to another supervisor

You are emotionally upset or seriously distracted

Chapter 9 in Introduction to Healthcare Management.

Solitude is rarely effective in stimulating the creative thinking process.
True
False

False

Chapter 6 in Introduction to Healthcare Management.

The type of team that is characterized by a group assembled for a specific purpose is known as a “standing committee.”
True
False

False

Chapter 6 in Introduction to Healthcare Management.

Innovative people are unable to visualize to the extent displayed by their rational counterparts.
True
False

False

Chapter 9 in Introduction to Healthcare Management.

Waldenville Community Health Foundation provides:

A. Direct care

B. Nondirect care

Nondirect care

Chapter 3 in Career Opportunities in Health Care Management.

The acronym FACHE stands for:

A. Fellow of the American Chapter of Health Executives

B. Freshman and Certified Healthcare Executive

C. Fellow in the American College of Healthcare Executives

D. Fellow of the Association of Certified Healthcare Executives

Fellow in the American College of Healthcare Executives

Chapter 1 in Career Opportunities in Health Care Management.

Budgeting and cost control have been made appreciably easier by the cost-containment measures imposed on health care providers.
True
False

False

Chapter 8 in Introduction to Healthcare Management.

To encourage a service-oriented culture, effective supervisors:

A. Express their own values over and above those of the organization

B. Do not personally involve themselves in service activities but rather concentrate on leading

C. Treat their employees the way they want customers to be treated

D. Do not waste time on meetings but rather wait for staff to bring their problems to them

Treat their employees the way they want customers to be treated

Chapter 8 in Introduction to Healthcare Management

Group discussions increase the likelihood of elements or events accidentally coming together to create an opportunity.
True
False

True

Chapter 9 in Introduction to Healthcare Management.

Brainstorming is a freewheeling process in which ideas that arise are instantly evaluated and either scrapped or saved.
True
False

False

Chapter 9 in Introduction to Healthcare Management.

Completed staff work includes offering potential solutions as well as conveying problems to the supervisor.
True
False

True

Chapter 9 in Introduction to Healthcare Management

Critical shortages of certain valuable skills call for relatively quick hiring decisions before the applicants go elsewhere.
True
False

True

Chapter 9 in Introduction to Healthcare Management

Benchmarking usually results from some form of process, system, or structural reengineering.
True
False

False

Chapter 8 in Introduction to Healthcare Management.

The strength of the group dynamics of a team depends mostly on how willing leaders are to share authority, responsibility, information, and resources.
True
False

True

Chapter 6 in Introduction to Healthcare Management

To avoid potential legal problems, it is advisable to load project teams with a majority of non-supervisory employees.
True
False

False

Chapter 6 in Introduction to Healthcare Management.

Common law
A form of law that depends on judicial decisions as opposed to legislative acts. It is often referred to as judge-made law.
Interpretive justice
An academic approach to defining the justice system so that legal standards can be better understood—for example, defining what the U.S. Constitution means and how it applies to specific cases.
Precedent
The term “precedent” refers to legal cases (at common law) that were decided by judges. When issues arise that are similar to those in a previous case, those same principles will be used to decide the current case.
Legislature
The legislature is the government body that makes rules and laws that society abides by. Normally, legislators are elected officials such as congressional representatives and senators.
Statutes
A statute, in this context, refers to an act by a legislative body such as a law. The statute is the form in which the law is expressed.
Executive orders
An executive order is a requirement that the President makes of individuals or organizations under the jurisdiction of the executive branch of government. It is respected much like a law.
Binding policy
A policy is a requirement that an organization, group, or government agency adopts to make its organization run more smoothly. Therefore, a binding policy means that the policy is final and must be followed when it applies
Competent
Competence speaks to an individual’s ability to make decisions or perform tasks. For example, an individual must be competent to agree to a medical procedure, meaning that they are of sound mind, of legal age, and so on. Competent also means that a professional has the skills to perform a task, that is, a surgeon is educated, trained, and licensed to practice surgery.
Patient self-determination
Patient self-determination is a law that requires healthcare organizations to inform patients of their rights as they pertain to their ability to determine their own health care. For instance, a patient would be informed about their right to consent, their ability to accept and refuse care, and advanced directives.
EMTALA
Emergency Medical Treatment and Active Labor Act
HEAT
Health Care Fraud Prevention and Enforcement Action Team
HIPAA
Health Insurance Portability and Accountability Act
What is health?

The state of complete, physical, mental, and social well-being.

Not only absence of disease

What differentiates the osteopathic profession from the allopathic?
They treat specific symptoms
Name 4 determinants of health
health care
genetic inheritance
physical environment
social environment
Give examples of physical environment health risks/determinants

Farm workers: machine injuries

Office Workers: air pollution, asbestos, formaldehyde/radon exposure

Give examples of social environment health risks/determinants
Low socioeconomic families are at higher risk of CVD, DM, Asthma, CA, and HIV/AIDS
What is the central focus of health care?
restore health or prevent exacerbation of current health
What is primary health care?

Eliminating risk factors for disease

(e.g. wearing a seatbelt, using condoms, sunblock, smoke cessation programs, dietary changes)

What is secondary health care?
Early detection of disease for more effective treatments
What is tertiary health care?
Managing and treating identified disease to reduce or limit complications that may arise (e.g. rehab or limitation of disability)
Currently, the way our health care system is set up, what type of health care is emphasized?
Secondary and Tertiary
What makes up a healthcare system?
Facilities
Workforce
Providers of healthcare therapeutics
Education/Research institutes
Financing mechanisms
Who are the main drivers of the US Health Care System?

governmental health agencies

private, non-profit health care sector

private, profit-making health care sector

What are the elements of managing a healthcare system?
administration
planning
regulation
evaluation
How are health care systems judged?
quality, equity, and efficiency of the healthcare provided
What is primary care?

personal treatment and preventative measures

e.g. immunizations, prenatal care, routine check-ups

What is secondary care?

services offered at PCP offices and hospitals

e.g. surgeries, diagnostic tests, interventions (radiologists, cardiologists,ophthalmologists)

What is tertiary care?

highly specialized diagnostic, therapeutic, and rehab services that require specific tools or staff (beyond what a community hospital can do)

e.g. open heart surgery, organ transplants, chemo, extremely premature infants

What two categories are health care facilities divided into?
Inpatient and outpatient
How are hospitals categorized?
By control, size (no. of beds) , function, conditions treated, average daily census, and average LOS
Hospitals categorized by function fall into what four categories?
General
Special
Rehab/Chronic Illness
Psychiatric
Hospitals categorized by control fall into what four categories?
Government (non-federal)
– state
– local
– county
– city- county
– hospital districts
Government federal
Private, not-for-profit
Private, for-profit
What are some other ways that hospitals can be classified?
type of med condition
number of beds
control/ownership
What kind of ownership describes community hospitals?
non-federal, short-term general (including children’s hospitals)
Length of Stay is broken down into what categories?

Long term = > 30

Short term = <30

How is LOS calculated?
divide number of inpatients by the number of admission
What is daily census? How is it calculated?

The average number of people served on an inpatient basis

Divide the inpatient days by the number of days in the reporting period

In 2008, the largest portion of the US Health Care budget was spent on what?
Hospitals
What are some of the regulatory/reporting agencies for hospitals?

American Hospital Association

National Center for Health Statistics

Statistical abstract of the US by the US Census bureau

Most hospitals are ….
Non-federal (96%) community (86%) non-profit (58%) hospitals
What percent of non-federal community hospitals are state/local government owned?
22%
What percent of non-federal hospitals are private, for-profit?
20%
What is the overall trend in hospital and hospital bed numbers?

Shrinking numbers for both as hospitals are moving towards increasing hospitalizations while minimizing LOS

1990 –> 2009
1.2m/6.7k –> 950k/5.8k

What has contributed to the shrinking number of beds/hospitals?

high operating costs of smaller hospitals

difficulty in retaining quality personnel in rural areas

increasing economy of scale for larger hospitals

when the hospital performs a procedure many times its quality increases with each attempt (hence trend for more hospitalizations and shorter LOS)

What divisions form the hospital structure?
Administration
Medical Staff
Nursing Staff
Other diagnostic and therapeutic support (lab, ECG, EEG, pharm, psych, social service, respiratory, nutrition, OT, home health, med rec, adult day care, screening, hospice, pain mngt, sports med, women’s health)
How do hospitals offer outpatient care?
through ED, in an outpatient clinic, ambulatory surgery unit
What are the responsibilities of a hospital administration?
finance
personnel
provision of services (e.g. maintenance, housekeeping, dietary, laundry)
community/PR
Development (fundraising)
Medical staff divisions are organized by what three subcategories?
Specialty
Organ System
Diagnostic (esp imaging)
What are some examples of hospital committees?
Executive committee
Joint Conference committee
Credentials committee
Infections control comm
Pharma and therapeutics comm
Tissue comm
Medical records comm
Quality Assurance comm
Ethics consultation comm
Patient safety and risk mngt
What are some trends gaining traction in health care?

Complementary/alternative medicine (acupuncture, massage, stress reductions, pet/music/art therapy)

Luxury suites

What are the main for-profit health service enterprises?
therapeutics (e.g. pharm)
insurance companies
nursing homes (for elderly and chronically ill)
general for profit hospitals
for-profit managed care sector
What is the structure of a non-for-profit hospital?
Board of trustees (usually bankrollers)
President of hospital/CEO
executive director/executive VP
What is the structure of a for-profit hospital?
Can be same as non-profit, or can be run by the owner
Nursing homes are most closely associated with what type of care?
Long-term care
What is long-term care?
a range of supportive, rehabilitative, nursing, and palliative services provided to those who can’t perform daily activities due to chronic illness or disability
Nursing homes have been __________ since 1973/1974
declining (16k homes, 1.75m beds to 15.7k homes, 1.7m beds)
In general, most of nursing homes are what kind of institution?
66% for-profit
26% non-profit
8% government owned
Where does most of the money for nursing homes come from?

More than 50% from public funds

(Account for 44% of medicaid despite being only 11% of the enrollees)

Most physician-patient contact occurs in what medical setting?
outpatient (1.2b visits; 80% in PCPs offices)
What is ambulatory care?

care given to a person who is not a bed patient in a health care institution

covers all health care services other than community health services and personal health services for institutionalized patients

What are the two types of ambulatory care? What fields is each found in?

Pay-per-service: solo, group practice

Salaried: hospitals, public health, HMOs, home care, school/prison/industrial health services

In 2011, what percent of ambulatory medical care visits were to PCPs?
48%
18% – specialist
17% – surgery
10% – ED
7% – hospital OP
Of the 1.2 billion ambulatory patient visits, which sex made up a larger percentage? What was the trend?

Women – 58%

Men visit more for injuries before 45 years of age, women go overall more after 45

The average American made how many ambulatory patient visits?
4
What are the most visited ambulatory specialties?
General/Family – 25%
Internal – 17%
Pediatrics – 13.5%
ObGyn – 8%
Ophthalmology – 5%
Orthopedic surg – 4%
What was the main source of payment for ambulatory visits?
insurance (59%)
Medicare (21%)
SCHIP (15%)
self pay (6%)
What are the functions of the ED?
Care for critically ill/injured
Secondary PCP, esp. when PCP is unreachable (hours, HMO, geography)
Source of patient admissions
Take care of uninsured who have nowhere else to go
What are the types of patients that present to the ED?
Nonurgent
Urgent – Possible danger if not treated within hours; acute but not severe
Emergent – Requires immediate medical attention; delay will be harmful to patient; life-threatening
How often do the insured/uninsured go to the ED?
Insured – 20 visits per 100 persons
Uninsured – 42 visits per 100 persons
What functions do the 2,000+ governmental local health departments focus on?
Functions that PCPs have not wanted to focus on
What kind of services do public health agency clinics offer?
TB control
child health (vaccines/exams)
prenatal care
STD control
mental health problems
From 2000 to 2009 how did the number of providers of health care change?

increased by 2.1% (3.2 million)

12.2 m —> 15.5 m

Where are most health care providers working?
40% hospital
25% practitioners offices
16% nursing/care facilitieshospital numbers have decreased as the number of hospitals have decreased

Outside of physicians, what are some other examples of the 700+ skilled health occupations?
2.6 million RN
729k LPN
218k EMT/paramedic
268k pharmacists
What is the physician-population ratio? Why is this number misleading? What will the physician surplus/deficit be by 2020?

27.7 physicians per 10,000 people

This number varies greatly by geography

A deficit of about 49k physicians is expected

What is the difference between the US model of care and other hospitalist models?

US hospitalist see patients in both ambulatory and hospital settings

Other models:
1) hospitalist see only hospitalized patients
2) Other countries – the physician sees only ambulatory or only hospitalized

The difference is that the US system allows for continuity of care

What is the role of the PCP?

provide integrated accessible health care services; be accountable for addressing a large majority of health needs, developing sustained partnerships with patients, and practicing in the context of family and community

The care that most people need and use most of the time

What is coordination of care?
When the primary provider assesses the situation and refers the patients when necessary and integrates the referral summary into the ongoing care of the patient
What specialties are considered primary care?
Family Medicine
Internal Medicine
Pediatric Medicine
Geriatric Medicine
ObGyn
How does the role of the PCP when they work for a managed care organization?
In the managed care organization there is a conflict between the patients best care possible and the goal of the managed care organization to reduce referrals to specialists
Physicians and Nurses are regulated by …..
State law
What are the different types of Nurses?

RN – A.A. or B.A. in nursing, must pass licensing exam

LPN – vocational nurse, 12-18 month program with high school diploma, lower skill and knowledge than RN

Nurse’s aide – No education requirement, may have undergone formal education, or may have learned on the job

What are the functions of the PA?
conduct exams, diagnose and treat, order and interpret tests, counsel on preventative health care, assist in surgery, and write prescriptions
How many PAs were there in 2011 and how many training programs?

481k PAs

1.5k training programs

How does the US involvement in health care compare to other industrialized nations?
US is less involved than any other industrialized nation. Only providing for those who can’t take care of themselves
What populations are considered “not profitable to care for or are otherwise difficult”?
sick poor
mentally ill
Native americans living on reservations
short and long term care for elderly
infectious disease control
What gives the states the power to provide health, safety, and welfare of the people?
“police power”
The federal government gets all its power from the Constitution. What powers give it authority of some components of health care?

powers to tax and spend to provide for the welfare

ability to regulate interstate and foreign commerce

What is the legislative branch’s role in healthcare?
They enact laws to protect health (e.g. clean water laws) and affect the framework of the delivery of health care
What is the executive branch’s role in health care?
write regulations and administer legislation (Clean Water Act and EPA regulation; Medicare program with CMS/HHS regulation)
What is the judiciary branch’s role in health care?

Determines if legislation is constitutional or if it exceeds original parameters

Prosecution of health/safety law violations and settlement of contract disputes

Department of Health and Human Services
Most important federal agency in relation to health care
300+ programs
Mission: promote and protect health and well-being of all American esp. those least able to help themselves (elderly, disabled, disadvantaged)
Department of Defense/Department of Veterans Affairs

Provides health services to veterans (army, navy, air force, each has own network of facilities)

152 hospitals (in all states, DC, and PR), 807 ambulatory care/community clinics, 288 veterans center

8.4 million enrolled in 2011 (number increased from 7.7 in 2005)

Overseen by DOD; health personnel are members of military, salaried by military rank

TRICARE – Health services for military personnel (retired, living, or died on duty) and their dependents is paid for by DOD

Department of Agriculture
manages nutrition policy, livestock inspection, and food stamps
Environmental Protection Agency
concerned with clean air, water, and toxic dumping
Department of Labor
administers the OSHA
National Institutes of Health
A subsidiary of the DHHS that provides financial support (grants, contracts) for non-government agencies and directs biomedical research
Public Health Service
dates back to 1798
division of DHHS
operates NIH, CDC, and drug abuse control
Food and Drug Administration

protects against food, drug, and medical device/product hazards

ensures drug potency and effectiveness

regulates drugs, OTC, biologic products and derivatives, radiological equipment (exposure)

focus on efficacy and safety

Centers for Disease Control and Prevention
prevent/control disease and personal injury
foreign/interstate quarantine operations
improve clinical laboratories
develop standards for safe and healthful working conditions
Indian Health Services

provides health care for 2 million Native Americans/ Alaskan natives who live on or near reservations

provides hospital, ambulatory, preventative, and rehab care

28 hospitals, 58 health centers, 31 health stations, 5 school health centers

How does the VA define a veteran?
Anyone that has served 90 days or more in armed services and who received a general or honorable discharge
What are “therapeutics”?

equipment or pharmaceuticals

e.g. imaging/laboratory equipment, hospital furniture, needles, chemicals, gases, surgical instruments, orthopedics

Therapeutics accounted for what percent of the total national health expenditure?

12.8% = $300 billion – 2008

12.6% = $169.8 billion – 2000

What is included in National Health Expenditures (NHE)?

health consumption expenditures

investment in health care structures/equipment

noncommercial health care research to procure future health care expenditures

How much money was spent in health care?

13.8% of GDP – 1.4 trillion – 2000

17.6% of GDP – 2.5 trillion – 2009

Who spends the highest percentage of their GDP on health expenditures?
1. US
2. Netherlands
3. Germany
What trend is seen in health care expenditures?
Increasing cost, but the percent that it’s increasing by is decreasing
Why are health expenditures increasing?
because the increasing use of costly tech-based diagnostic and procedural interventions
What percent of NHE is spent on actual health care? What is the rest spent on?
84% spent on personal health care
The rest is on administration and investment
What were the five top costs for NHE in 2009?
Hospital – 31%
PCP/clinical – 20%
Rx drugs – 10%
Nursing home/home health – 8%
Administration – 7%
Where does the NHE get its funds?
Out of pocket
private health insurance
public health programs (medicare, medicaid, CHIP)
DOD/VA
charity care/forgiven debt
What percent of NHE did public and private insurance cover?
approximately 2/3
(39% public, 32% private)
What are “out-of-pocket” costs?
direct payments to PCP for uninsured
deductibles
coinsurance
extra payments to providers
What is a deductible?
a flat amount that insured must pay before insurance begins to make payments
What is co-insurance?
aka co-pay
a share of each service that the pt is to pay (may be expressed in percentages or set amount)
What are third-party payers?
anyone other than the insured/family and provider who are responsible for paying for health care services (employer, managed-care org., charity, worker’s comp., government agencies)
What is combination pay?
Pt pays co-pay
Insurance pays some of the balance
Provider forgives the unpaid balance as charity/forgiven debt
From 1990 to 2011, what happened to the percentage of Americans with health insurance? What is the main source of insurance for Americans?

Decreased from 73% to 64%

most people get insurance from their (spouses’) work; employees pay a portion of the cost

What categories are insurance companies broken up into?
Profit and non-for-profit
What is the biggest Non-for-profit insurance company? What are some examples of for-profit companies?

BCBS

Metropolitan, Aetna, and some BCBS

Who does the profit go to in for-profit companies?
the owners or shareholders
What is a managed care organization (MCO)?
instead of contacting provider and having a third party (insurance) pay, the patient contracts the MCO and the MCO is paid by the patients employer.
How has government spending changed since the 1960s?
It has paid for an increasing portion of NHE
’60 – 23%
’70 – 37%
’80 – 42%
’09 – 49%

Medicare was established under what Act?

Who were the original beneficiaries?

Social Security Act

persons 65+ who were eligible for social security or Railroad retirement

In 1973 what important provision was made to Medicare?
it was broadened to include permanently disabled workers and their dependents who were eligible for SS disability, and persons with ESRD
What are the 4 parts of Medicare and who funds them?

Part A – hospital insurance – Social Security taxes

Part B – supplementary med insurance (covers other health services and outpatient care) – general revenues/premium payments

Part C – allows participation in managed care organizations

Part D – Medicare prescription drug coverage (lowers cost of prescriptions) – premiums

How do the administrative costs for Medicare compare to those of regular insurance companies?
Much lower! (1-2%)
In 1992, what happened to the way that Medicare paid for services?
Medicare established the Resource-Based Relative Value Scale and replaced the old system of paying by what the provider charged
How does the RBRVS work?
It establishes payments by the costs of the resources needed to provide them
How is the cost of providing health care broken down and determined
Broken down into:
physician work
practice expense
liability insuranceThe payments are calculated by multiplying the cost by a conversion factor and adjusting for geography

How are hospitals paid by Medicare?

On an episode-of-care basis. The amount for each case is determined by a formula based on Diagnosis Related Group (part of prospective payment system)

Paid a fixed amount per patient discharged, based on ICD-9-CM.

Why were Diagnosis Related Groups (DRGs) implemented?
To control the Medicare expenditures
How does the ICD-9-CM work?
instead of paying fee-for-service, it expects each patient belonging to a certain grouping to display similar symptoms and in turn require similar resources. Ergo, the payment should be more or less the same.
What were Medicare expenditures in 2009?

$502 billion for 46 million enrollees – 2009

$224 billion for 40 million enrolles – 2000

When was Medicaid created? How was eligibility determined?

1965 at the same time as Medicare

Meant for those with low incomes and assets below a certain threshold (needs-based)

How is Medicaid funded? Who administers Medicaid? How does Medicaid pay providers?

federal and state tax funds

the states administer it

Medicaid pays on a fee-for-service/episode-of-care basis

What year was SCHIP created? Who funds SCHIP? Who administers SCHIP?

1997

federal and state governments

the states

What is the purpose of SCHIP? How many children were enrolled in SCHIP?

provides healthcare for uninsured children who aren’t eligible for Medicaid

6.7 million (700k adults obtained waivers)

What are some examples of Non-Government Organizations? What roles do they play in health-care?

American Heart Association, Red Cross, Visiting Nurse Association

perform services not rendered by other health care agencies, pursue research, advance the interest of population subgroups, public education/advocacy, will carry out certain tasks when asked by government agencies

What are some examples of Professional Organizations? What role do they play in health care?

Organizations funded by the members of a certain subgroup (e.g. AOA, AMA, POMA (Penn Osteo. Med. Assc.)

Often provide professional standards

How is health care system performance measured?
Evaluated on micro (individual practices or hospitals) or macro (regions, states, nations) level according to quality, equity, and efficiency of health care
How is the quality of healthcare measured?
In terms of:
structure – conditions under which the care is provided (facilities, equipment, HR, academic affiliation, etc)process – the activities that constitute healthcare (dx, tx, rehab, prevention, pt education)

outcomes – changes (desirable or not) in individuals/populations that can be attributed to health care

What are some indicators of population health?
-death rates (age-adjusted, disease specific)
-life expectancy
-time lost to premature death
-infant mortality
-health life expectancy at birth (years in good health; no disease or injury)
What has happened to life expectancy since 1990?
Increased by 3 years for men, women, and overall (men less than women)
How does the US compare to the 13 other civilized countries?
We are last in everything except for life expectancy at birth for males (10) and females (13)
What are some ways to measure clinical effectiveness based on outcomes?
– hospital readmission rates
– functional capacity after medical intervention
– long term pain and discomfort after medical treatment
– infection acquired during hospital stay
– five year mortality rate for patients treated for CA, heart disease, and others
How many people did not have insurance in 2006?
46.1 million
What did the PPACA of 2010 do?
– Makes health insurance affordable for everyone
– prevents insurances from denying insurance, charging higher premiums, or imposing life limits to anyone based on gender, health, or any reason
– extends coverage of children to 26 years of age
– requires that most individuals have health insurance
– expands medicaid coverage to 138% of federal level
– closes “donut-hole” of Medicare Part D
How does ObamaCare affect physicians?
1) Expands insurance coverage
2) Individual mandate
3) Regulate Insurance Companies
4) Physician Payment Increases
5) Small business Tax Credits
6) Administrative Simplification
7) Medical Liability Reform
8) Workforce Investment
9) Preventive Care Investments
10) Medicare Drug Rebate/Coverage
11) Public Health Investments
Comparative Effectiveness Research
Healthcare of the past:
earliest civilization health needs were met by a specific person or groups/ancient treatments were harmful in some cases & helpful in others/some of the most helpful were the use of herbs & plants for medication
Agencies of accreditation:
have been established to determine whether a training program meets acceptable standards
Those who choose a career in the health field seek:
more then economic security/other factors include the working conditions,& the opportunties for advancement in health care
Healthcare in the United States is influenced by:
the state of the economy the values of society,the law of supply & demand,& the technological development
The correct term for HIPAA is:
Health Insurance Portability and Accountability Act
Medicare is:
a federal health program for individulas 65 or older, certain younger people with disabilities and people with end-stage renal disease
To provide adequate care, the health care worker must be able to do——————–unique to each person.
recognize & accept the values, attitudes, & beliefs
The changes in the health care industry are due to:
new medical discoveries technological advances, & evolving health concerns
Maslow’s hierarchy of human needs is best ordered as:
physical, security, social concerns, self respect, & self worth
Effective communication consists of:
(3 parts) the sender, the message, & the receiver
A person’s character is the sum of:
behavior, attitudes, & values
Homeostasis can best be described as:
fight or flight
Managing stress can be achieved by:
nutrition, exercise, relaxation techniques & personal behavior changes
Active listening skills require:
interacts with the sender, provides feedback,indicate understanding,good listening skills
Nonverbal messages may include:
facial expressions,tone of voice & distance between sender & recieiver
When working with a patient from a different culture:
respect any culture, dietary preference
The term aerobic pertains to:
air
A pathogen is:
a microorganism that produces disease
A pathologist is:
one who studies disease
The mode of transmission for syphilis is:
direct contact
The mode of transmission for tetanus is:
a puncture wound
The mode of transmission for hepatitis B is:
blood to blood/ parenteral (by injection)
An echocardiograph is:
record of the heart & blood vessels made with ultrasound
A sonogram is:
record or image made by using sound waves
A mammogram is:
making a record or image of the breast
Radiopaque materials may be administered by:
mouth, rectum or IV
A film badge:
records the level of exposure to radio logic materials
The diagnostic medical sonographer produces:
two-dimensional images or sonographs of internal organs using sound waves at high frequency
(MRI)Magnetic resonance imagimg:
is a process that creates detailed image resolution & tissue contrast/useful indiganosing problems of the brain & spin
Interventional radiology allows a healthcare worker to insert tubes or catherters into—————————-to correct abnormalities
blood vessels
Bradypnea refers to:
slow breathing
Dyspnea refers to:
bad or painful breathing
Hematemesis refers to:
vomitting blood
Sublingual refers to:
below the tongue
Abduction refers to:
to take away from the body
range of motion exercise should be performed on nonmobile patients every
8 hours
Hemiplegia refers to a patient who:
is half paralized
a medical career in the area of osteopathy focuses on:
therapeutic approach to medicane
A medical career in the area of phlebotomy focuses on:
incision into a vessel
Opticians:
design & fit lenses & frames using an optical prescription
Optometrists:
examine & test eyes to evaluate vision & detect disease of the eye for referral to an MD
A normal vision reading is considered to be :
20/20
Oncology is the study of:
tumors or cancer
The term buccal refers to:
pertaining to the cheek
The term chiropractic medicine pertains to:
adjustment of the spine by hand
Hydrotherapy:
treatment with water
Osteoarthritis is:
inflammation of the bones & joints
Euphoria is:
state of feeling well
Gerontology is:
study of aging
What is the most commonly abused substance in the United States:
alcohol
The function of the mental health care team is to provide care and treatment for individuals with disorders of:
mind,emotion & behavior
Aphasia means:
without speaking
the term that means “pertaining to the outside of the body” is:
extracorporeal
The health care worker who helps patients strengthen and coordinate body movement using exercise is a:
Kinesiotherapists
Visually impaired people may be helped by the services of a(n):
orientation & mobility instructors or specialists
The term myoelectronics refers to:
pertaining to electricity & muscles
Speech pathologists treat disorders such as:
delayed language development the inability to speak, stuttering & articulation problems
Audiologists specialize in the:
prevention, indentification, assessment & rehabilitation of hearing disorders
Pharmacology is the study of drugs and their:
actions,dosages,side effects,indications,& contraindications
The responsibilities of a respiratory therapist include:
evaluate the patient to administer respiratory care & operate life support equiment under the supervision of a physician, monitoring respiratory care equipment, observing a patients response.
The goal of modern emergency care includes:
immediate aid,or first aid,at the scene of injury, transportation of the victim to a medical facility, administering CPR and treating shock.
Internal wounds include:
contusion or bruise
Abrasions result from:
the scraping of the skin or mucous membrane from the surface of the body
Most cases of poisoning occur:
in the home
Shock may result from:
trauma,electrical injury,insulin shock,hemorrhage,or as a reaction to drugs
Most marine injuries are caused by:
the victim
Effects of partial seizures include:
automatic actions,hallucinations,or twitching of muscle groups
The two types of fractures are:
open & closed
Exposure to heat can result in:
heat exhaustion, heat stroke & muscle cramping
To treat frostbite,an emergency health care worker should do all of the following:
bring the victim inside, give warm fluids if conscious, elevate and cover the affected area loosely with a dry dressing, immerse the affected area in slightly warm water.
Administrarors and information personnel may not have direct contact with patient, but they must follow:
confidentiality requirements
Health care managers need:
to be organized to work quickly & accurately, good communication skills.
Charting requires:
black ink
direct quotes
clearness
conciseness
Medical records personnel———–data. They do not ———–data.
organize, analyze, file and generate data. (they do not collect data)
Group insurance is:
open to company employees & their dependents
The medical transcriptionist:
listens to and types information to provide a permanent record.
Food service workers are responsible for:
preparing and delivering meals, helping a patient select a menu and processing the order.
Health and regulatory inspectors must:
enforce laws & regulations concerning employment hazards
Public health microbiologists are responsible for:
studying the relationship of people to organisms, testing foods, monitoring sludge from sewage treatment facilities and identifying organisms that cause disease.
Air pollution can adversely affect the following body systems:
respiratory,sensory, nervous & cardio vascular
Ecology is the study of:
living organisms and their relationship to the environment
The biosphere consists of:
air, crust of the earth and water.
Pitch,or the quality of sound that is heard, is determined by:
the speed of the vibrations against the eardrum
Biotechnology refers to:
the study of the manipulation of the genes of living organisms.
Eugenics can be defined as:
study of the methods for controlling the characteristics of humans and pertaining to new origins.
Biotechnologists work in which field(s) of practice?
including research,forensics,immunology & teaching
Profession:
requires specialized knowledge & often, long & intensive academic training
Plague:
disease that causes a high rate of death or mortality
Insurance:
payment for health care expenses, which may or may not occur
Voluntary organization:
provides research,education & support for specific concerns funded by donations & grants
Health maintenance:
health care at group rates
Registration:
official record of individuals qualified to preform certain services
Paraprofessional:
worker who assists a professional
Outpatient care facility:
provides surgical,diagnostic,& ambulatory care
Public health care:
provides care through federal, state, & local agencies for those who can not afford to pay for health care
Pandemic:
epidemic that spreads over a wide geographical area
Nursing Home Reform Law:
protects nurising home residents
Value:
rate of usefulness,importance, or general worth
Interpersonal:
relationships with others
Mass communication:
television, radio, film & newspaper
Attitude:
mental position or feeling
Habit:
seatled tendency of behavior
Hierarchy:
graded or ranked series
Assertiveness:
good listening skills
Behavior:
manner of conducting oneself
Character:
distinctive qualities that make up an indivdual
Body language:
nonverbal communication
Diversity:
quality of being different
Immunity:
high level of resistance to certain microorganisms or disease
Infection:
invasion & multiplication of pathogenic microoraganisms in the body tissue
Microorganism:
microscopic living organism , microbe
Nonpathogenic:
microorganisms that does not produce disease
Pathogen:
microorganisms that produce disease
Phagocyte:
cells that surrounds & destroys microorganisms and foreign particles
Phlebotomy:
incision into a vein to with draw blood
Recipient:
one who receives tissue from another such as in a blood transfusion
Sterile:
free from all living microorganisms
Anesthetic:
pretaining to a lack of feeling
Dependence:
addicition to drugs or alcohol
Hallucination:
senory perception that occurs in waking state but does not have external stimulus
Immunization:
process of becoming secure against a particular disease or pathogen
Pollution:
condition of being defiled or impure
Withdrawal:
unpleasant sysmptoms resulting with stoppage of drugs or irritabilite,impaired attention & physical illness
1. Health care policy is
every health care manager’s job
2. Dashboards are
A way to measure organizational performance
Griffith says “championship processes” need performance measures in each the following areas except
Directing
Succession planning is
Planning to replace managers who retire or move up
The main difference between direct care and non-direct care settings is
Provision of care
This competency reflects expertise or ability to perform a specific work task
Technical
Employment of medical and health services managers is expected to change by what percent between 2008 and 2018?
plus 16 percent
This function requires the manager to set a direction and determine what needs to be accomplished.
Planning
External domains of health care management include all of the following except
Patient satisfaction
Organization management means
sharing of information,collaboration ,communication
Larger organizations are more likely to have all of the following except
Informal chain of command
Team management means
assigning work tasks,review of performance,task interdependencies
Self-management means
managing time, information,being responsive,keeping current
Internal domains of health care management include all of the following except
Medicare/Medicaid
This competency enables a manager to communicate with and work well with other individuals
Interpersonal
A high deductible health plan with a savings option represents a form of consumer driven health plan that
All of the Above
Access to the care of specialist physicians is limited in which type of health plan?
Health Maintenance Organization
CHIP is a program that provides for
Children in low income families who would not typically qualify under Medicaid
Cost sharing is required of those covered by:
All of the Above
Efforts to control the costs of Medicare have been undertaken via legislation mandated to create prospective payment systems for
Skilled nursing facilities using RUGs
In purchasing health insurance, which of the following is NOT typically a consideration?
Liability
Individuals who have coverage under the Medicare Program include:
All of the Above
Many of those who are uninsured:
All of the Above
Medicaid provides coverage for low-income individuals who
All of the above
Medicaid spending increases are the result of:
A & C
Medicare includes coverage of all of the following EXCEPT:
Mental health care under Part E
Medicare spending has increased as a result of:
B , C , & D
Private health insurance coverage includes the following types:
All of the Above
Problems associated with the care of active military personnel and retirees include all of the following EXCEPT:
Access to medical centers in major metropolitan areas
The growth in health insurance in the U.S. came about as a result of:
All of the Above
The Medicare Prescription Drug, Improvement & Modernization Act of 2003 includes provisions to:
All of the Above
The Patient Protection and Affordable Care Act includes provisions for the following:
All of the Above
The primary reason that healthcare managers should be concerned about healthcare financing and health insurance is:
All of the above
The TRICARE military healthcare system provides coverage for
All of the above
Which of the following is characteristic of the way the uninsured utilize the health care system?
They delay seeking care, eventually ending up in emergency rooms
Which type of HMO offers the most flexibility for participating physicians?
Independent Practice Association
Which type of managed care offers patients flexibility in accessing their physician of choice?
A & B above
Who bears the costs of providing care to the uninsured?
Everyone, including all of the above
True or False? Catastrophic health insurance coverage is the most commonly purchased type of health insurance today
False
True or False? Changes in the extent to which individuals have health insurance coverage in times of economic downturn tend to be absorbed by private health plans, rather than public ones.
False
True or False? Comprehensive health insurance coverage typically includes hospital coverage, but not physician services.
False
True or False? Elderly Medicaid beneficiaries account for the majority of the program’s spending.
True
True or False? Enrollment in conventional indemnity health insurance plans has increased in the past 15 years.
False
True or False? Funding for the Medicare Program is derived only from federal taxes.
False
True or False? Health insurance policies have not used lifetime limits to control total exposure for the costs of care.
False
True or False? Medicaid and Medicare are private insurance programs administered by the federal government
False
True or False? Medicaid is a federally-mandated program that is administered by the states.
True
True or False? Medicaid programs are uniform across the states.
False
True or False? Public sources of funding accounted for slightly less than half of all expenditures for health care in 2008.
True
True or False? Risk is a concept in health insurance that involves a group sharing the costs of losses incurred by the members of the insurance pool.
True
True or False? The Centers for Medicare & Medicaid Services project that health spending will be 30% of GDP by 2012.
False
True or False? The health plans provided for under Part C of Medicare are sometimes referred to as Medicare Advantage (MA) plans.
True
True or False? The majority of the uninsured population is comprised of adults aged 35 and older.
False
True or False? The Patient Protection and Affordable Care Act of 2010 calls for changes that will impact insurers, businesses, consumers, and healthcare providers.
True
True or False? The VA has programs that cover children with certain birth defects born to female Vietnam Veterans.
True
True or False? The Veterans Health Administration is the largest health care system in the world.
True

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