Chapter 5 Flashcards
Glaser describes three realms of social activity
individual, institutional, and societal—each having an impact on the health professional’s effectiveness and sense of well-being.
Institutions sit at the interface between the individual and the larger society
External Factors
that Influence
Health Care
Institutions
- Health policy
- Federal/state/local regulations
governing practice - Accrediting agency standards
- Healthcare financing systems
that document care and serve as
sources of quality monitoring
and reporting
Institutional Culture
basic assumptions about
the world and the values that
guide the life in organizations
Institutional Climate
shared perceptions of and meaning attached to the policies, practices & procedures
employees experience and behaviors being rewarded, supported & expected
Public-sector relationships
within institutions of public life
Public-sector relationships
characterized by abrupt changes from
extreme remoteness to extreme nearness with the expectation that
the relationship will be temporary
private-sector relationships
are reserved for the world of family, friends, and other intimates.
administration’s role
safeguard the interests of the
institution and all its component
members including patients, families,
staff at all levels and lead the effort to
establish a positive workplace culture.
Effective administrators
include the participation of key component
members in the design and review of policies and practices.
Laws and
Regulations
Affecting
Professional
Caregivers
- Major categories include:
- To ensure professional
competence - To prevent discrimination
- Others
HIPAA – 1996 Ted Kennedy.
- Protect people from losing their health insurance if they change jobs or have pre-existing conditions
- Create standard electronic formats for many administrative transactions.
- Protect privacy and security of personal health information
MEDICARE
- Part A: hospital insurance - inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care. - skilled care has time limit.
- Part B: - Doctor and outpatient care as well as durable medical equipment.
- Part C or Medicare Advantage: - replaces part A and B with a private plan and may cover more things in some instances and less in others. May have higher deductible and co-pay.
- Medicare Part D – prescription drugs.
Patient bill of rights
- Information Disclosure – right to accurate easily understood information.
- Choice of Providers and Plans
- Access to Emergency Services -
- Participation in Treatment Decisions. –
- Respect and Nondiscrimination
- Confidentiality of Health Information
- Complaints and Appeals - Fair and efficient process for resolving differences including a rigorous system of internal review and an independent system of external review.
- Consumer Responsibilities. – Consumers take reasonable responsibilities.
PTA patient care and supervision
- PT services are provided directly by the PT.
- PTA only individual who assists PT
- Responsibility is the PT
o Referrals
o Examination and reexamination
o Plan of care
o Deciding when to render service and when to use PTA
o Revision of plan of care
o Conclusion of episode of care
o Responsibility for hand off communication
o Oversite of all documentation of services.
o Consultation
- Considerations for how much collaboration with the PTA
o Education, training, experience, and skill level
o Patient or client critically, acuitly, stability, and complexity
o Predictability of consequences
o Setting in which care is being delivered
o Federal and state statutes, and rules or regulations
o Liability and risk management
o Mission of physical therapist services for the setting
o Needed frequency of reexamination.
Supervision of PTA
- Physical therapist assistant should at least be in general supervision of PT. Must at least be available for telecommunication.
- Ability of the PTA shall be assessed on an ongoing basis by the supervising PT.
Physical therapy State Practice Act
statute defining the scope and practice of physical therapy within the jurisdiction
“licensed physical therapist assistant is required to function under the direction
and supervision of a licensed physical therapist to perform physical therapy procedures delegated and supervised by the licensed physical therapist in a manner consistent with the rules adopted by the board.” - Iowa
- Offsite supervising of PTA
o PT available for telecommunication
o Regularly scheduled collaboration with PT.
o PTA can request a supervisory visit by PT
In case of need for reexamination
Shall be made at least once a month
Shall include
* Onsite reexamination
* Review of plan of care
* Evaluation of need and recommendation for utilization of outside resources.
Title VII of Civil Rights Act (1964) and Equal Opportunities Act (1972
employment can’t be discriminated against on race, color, sex, religion, or national origin. (I think Transgender and sexual orientation have been added to this on the Bostock V. Clayton County supreme court case in 2020)
Equal Pay act (1963)
Requires men and women to receive equal pay for equal work. There’s still a substantial gender pay gap however. If the pay gap continues to shrink at the rate it has equality wont exist until 2052. Longer for women of color.
Age Discrimination and Employment Act (1967)
40 to 70 antidiscrimination in employment.
Rehabilitation Act (1973) and Americans with Disabilities Act (1990) – ADA
Can’t discriminate against disabled for employment, and must have a reasonable accessible workplace.
Universal (1985) and Standard Precautions (1996)
PPE provided by employer to protect employees and patients.
Patient’s rights documents
that include the right to:
- considerate and respectful care
- accurate and complete information
- participation in health care decisions
- privacy and confidentiality (within
constraints of the law) - information about the institution
itself - continuity of care.
Patient’s responsibility
documents that include the
responsibility to:
- Provide as complete a medical
history as they can - Follow facility rules and
regulations - Show respect and thoughtfulness
- Meet financial commitments
- Cooperate with agreed-on
treatment plans
Quadruple aim of institutions.
Patient Experience ->
Population Health ->
Reducing Costs ->
Care Team well-being
All four goals are necessary to achieve quality health care.
