Healthcare Organizations Flashcards
types of healthcare organizations
- Institutional Providers
- Consolidated systems and networks
- Ambulatory-based organizations
- Other Organizations
- Supportive and Ancillary Organizations
Traditionally classified as acute care
hospitals, long-term care facilities, and
rehab facilities
institutional providersch
Characteristics that differentiate
institutional providers:
1- Types of services provided
2- Length of direct care services provided
3- Ownership
4- Teaching status
5- Accreditation status
Provide a wide range of services to multiple segments of the population
general care
- Services targeted to specific disease entities or patient populations.
- Examples- cardiac, burn, oncology, children’s, OB, etc.
specialty care
Length of Direct Care Services Provided
Acute Care Facilities (Hospitals)
* Short-term, episodic care
Long-term Care Facilities
* Care needed for extended
periods, in excess of 30 days
Institutional Providers- Ownership
- Establishes the organization’s legal, business, and mission-related imperatives.
- Can affect efficiency and quality.
- Influences structure of organization, services provided, and patients served
- Significant differences are found within the three sectors related to teaching status, location, bed size, and corporate affiliation.
Ownership Forms-Public institutions
- Provides health services to individuals under the support and/or direction of local,
state, or federal government - Answers directly to the sponsoring government agency or boards
- Indirectly responsible to the elected officials and taxpayers supporting them
federal level examples
veterans, members of the military, Native Americans, and inmates of correctional facilities
state level examples
Health service teaching facilities, chronic care facilities, and correctional facilities
local level examples
county-supported and city-supported facilities (health department)
Ownership Forms-Private Nonprofit (not-for-profit) Organizations
- Referred to as voluntary agencies controlled by voluntary boards or trustees and provide care regardless of a patient’s ability to pay
- Excess revenue over expenses is redirected into the organization for
maintenance and growth - Exempt from paying taxes because they commit to providing an important
community service - The ownership influences how organizations are structured, what services they provide, and which patients they serve.
- Include churches, communities, industries, and special interest groups such as the Shriners
Ownership Forms- For-profit Organizations
- Referred as proprietary or investor-owned organizations
- Operate with the specific intent of earning a profit by providing healthcare
services to individuals who can afford to pay for these services. - Example: HCA Healthcare
Directly affiliated with a school of
medicine and at least one other health profession school
Academic health centers
Provide the clinical portion of a
medical school teaching program
Affiliated teaching hospitals
teaching hospitals
- Offer access to state-of-the-art technology and researchers
- Usually have more costly care
- Receive government reimbursement to cover the additional
costs associated with the teaching process - Are often located close to their affiliated academic
institution and in urban and economically disadvantaged
areas
Institutional Providers-Accreditation Status
A healthcare organization accredited by an external body has the structure and processes necessary to provide high-quality care.
* Private organizations play significant roles in establishing standards and ensuring care delivery compliance with
standards by accrediting healthcare organizations.
examples of accredited institutions
The American Nurses Credentialing Center (ANCC)
The Joint Commission (TJC)
The National Committee for Quality Assurance (NCQA)
Consolidated Systems and Networks
*Healthcareorganizationsareorganizedintoconsolidated
systemsthroughtheformationoffor-profitornot-for-profit
multihospitalsystemsandthedevelopmentofnetworksof
independentlyownedandoperatedhealthcareorganizations.
* Organizedalongfivelevels:
*Largenationalhospitalcompanies,mostofwhichareinvestor-
owned.
* Largevoluntaryaffiliatedsystems.
*Regionalhospitalsystemsthatcoveradefinedgeographicarea.
* Metropolitan-basedsystems.
*Specialinterestgroupsthatownandoperateunitsorganizedalong
religiouslines,teachinginterests,orrelatedspecialinterestsdriving
theiractivities.
Ambulatory-Based Organizations
- Many health services are provided on an ambulatory basis. The organizational setting has been the group practice or private physician’s office.
- Prepaid group practice plans (managed care systems) combine care delivery with financing and provide comprehensive services for a fixed prepaid fee.
- The goal is to reduce the cost of expensive acute hospital care by focusing on out-of-hospital preventive care and illness follow-up care.
- Examples include surgicenters, urgent care centers, imaging centers, and primary care centers.
community services
- Focus on the health of the community, control of infectious agents
and provision of preventive services under the oversight of public
health departments. - Examples include: School Health Programs, Adult and Children
Day Care Centers, and Visiting nurse associations
subacute facilities
- As hospitals began to discharge patients earlier in their recuperation, the subacute facility, also known as a long-term acute care (LTAC) hospital, emerged as a healthcare organization.
- Deal with patients who are just out of surgery, or who are acutely ill and have complex medical needs
home health organizations
- May be freestanding or owned by a hospital
- Professional nurses lead the care team and provide expertise in
assessing patients’ self-care competencies, designing a plan of
care to promote patient independence and coordinate the
personnel and material resources needed. - Have the potential to keep older adults, those with disabilities,
and persons with chronic illnesses comfortable and safe at home.
Long-Term Care and Residential Facilities
- Known as skilled nursing facilities
- Provide long-term rehabilitation and professional nursing services
- In residential facilities, no skilled care is provided, but individuals
are offered safe environments in a home-like setting designed to
honor the dignity of each person.
Hospice and Palliative Care
- Hospice Care
Can be located on inpatient nursing units or in the home or
residential centers in the community.
Focuses on confirming the reality of death and providing care
ensuring dignity and comfort - Palliative Care
Meets the needs of patients experiencing chronic illness who
may not qualify for hospice coverage
Offers continuous care—symptom control for serious illnesses
with other treatments
Increase patient satisfaction and quality of life
Nurse-Owned and Nurse-Organized Services
- Owned and operated by nurses
- Administered by schools of nursing and serve as a base for faculty
practice and research along with clinical experience for students
Self-Help and Peer Assistance Voluntary Organizations
- Composed and directed by peers who are consumers of healthcare services
- Enable patients to provide support to each other and raise community consciousness about the nature of a specific health condition (Alcoholics Anonymous)
- Rapid increase in community geriatric organizations, sponsored by healthcare organizations and offering multiple services for promoting wellness and rehabilitation
Supportive and Ancillary Organizations
Regulatory organizations
* Accrediting bodies
* Third-party financing organizations
*Pharmaceutical and medical equipment
supply corporations
*Various professional, educational, and
training organizations
Regulatory Organizations
- Set standards for the operation of healthcare organizations
- Ensure compliance with federal and state regulations developed by governmental administrative agencies
- Investigate and make judgments regarding complaints of the services and the public
- Approve organizations for licensure as
providers of healthcare - Monitor functions in healthcare organizations
Accrediting Bodies
- Accreditation refers to the approval,
recognition, or certification by an official review board that an organization has met certain standards. - For a healthcare organization to participate in and receive payment from either Medicare or Medicaid, the organization must be certified as complying with the Conditions of Participation (CoP)
Third-party Financing
Organizations
Identify the procedures, tests, services, or drugs covered under healthcare insurance programs and influence the delivery of healthcare.
* The government, through the CMS, represents the largest third-party organization in healthcare provision.
* Private health insurance carriers are composed of not-for-profit and for-profit components.
* Commercial insurance companies represent the private sector.
Pharmaceutical and Medical
Equipment Supply Organizations
Nurses play a significant role in setting
standards for safe and efficient products that meet consumers’ and organizations’ needs in a cost-effective manner.
Horizontal Integration
- When organizations that provide similar services come together.
- Example: a group of acute care facilities that come together to provide coverage for an expanded region.
Vertical Integration
- When organizations align to provide a
full array or continuum of services - Benefits include enhanced
coordination of services, efficiency,
and customer services. - Example: an acute care facility, a
rehabilitation facility, a home care
agency, an ambulatory clinic, and a
hospice.
what are Acquisitions and Mergers
Acquisitions involve one organization
directly buying another.
Mergers involve combining two or
more organizations and their assets
to form a new entity
Must consider Economic, Social, and
Demographic factors as they are the
forces driving the evolution of healthcare
organizations.
System Theory
Organizations evolve in an orderly and holistic manner
Systems theory explains complex systems holistically and can be either closed (self-contained) or open (interacting with both internal and external forces)
Systems theorists focus on the interplay among the system components within a framework of:
Inputs: Resources such as people, money, or materials
Throughputs: Processes producing a product from the inputs
Outputs: Product of inputs and throughputs
Chaos Theory
Change is disruptive and not orderly
Chaos theory sees the universe as filled with unpredictable and random events.
* According to the chaos theory, organizations must be self-organizing and adapt readily to change to survive.
* Organizations must accept that change is inevitable and unrelenting.
* Using creativity and flexibility, successful leaders will be those who can tolerate ambiguity, take risks, and experiment with new ideas in response to each day’s
unique situation or environment.
Nursing Role and Function Changes
- Increased number of positions for
leaders and managers - Increased awareness of the need
for healthy work environments - Increased need for nurses to
influence policy and politics.
Leaders can
- Leverage existing partnerships with community organizations and nurse leaders of other systems.
- Seek opportunities to mentor nurses with leadership potential and interest in
learning more about the healthcare organization. - Develop communication systems that provide information on patients receiving
services at various points of care in the organization as systems are integrated.
Managers can
- Share with nurses the connections between direct patient care and the
organizational mission and strategic plan to empower nurses to engage in the
decision-making process. - Foster a healthy and psychologically safe working environment within units to
achieve optimal patient care outcomes. - Provide opportunities for nurses on the unit to explore leadership and
management functions.
Followers can
- Stay abreast of local healthcare industry news to gain an understanding of how
the systems and organizational structures are changing. - Share ideas during team meetings about how your organization can achieve the
fifth aim of the Quintuple Aim to increase joy and meaning in healthcare.
