Healthcare Organizations

Question 1

types of healthcare organizations

Answer 1

• Institutional Providers
• Consolidated systems and networks
• Ambulatory-based organizations
• Other Organizations
• Supportive and Ancillary Organizations

Question 2

Traditionally classified as acute care
hospitals, long-term care facilities, and
rehab facilities

Answer 2

institutional providersch

Question 3

Characteristics that differentiate
institutional providers:

Answer 3

1- Types of services provided
2- Length of direct care services provided
3- Ownership
4- Teaching status
5- Accreditation status

Question 4

Provide a wide range of services to multiple segments of the population

Answer 4

general care

Question 5

• Services targeted to specific disease entities or patient populations.
• Examples- cardiac, burn, oncology, children’s, OB, etc.

Answer 5

specialty care

Question 6

Length of Direct Care Services Provided

Answer 6

Acute Care Facilities (Hospitals)
* Short-term, episodic care
Long-term Care Facilities
* Care needed for extended
periods, in excess of 30 days

Question 7

Institutional Providers- Ownership

Answer 7

• 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.

Question 8

Ownership Forms-Public institutions

Answer 8

• 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

Question 9

federal level examples

Answer 9

veterans, members of the military, Native Americans, and inmates of correctional facilities

Question 10

state level examples

Answer 10

Health service teaching facilities, chronic care facilities, and correctional facilities

Question 11

local level examples

Answer 11

county-supported and city-supported facilities (health department)

Question 12

Ownership Forms-Private Nonprofit (not-for-profit) Organizations

Answer 12

• 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

Question 13

Ownership Forms- For-profit Organizations

Answer 13

• 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

Question 14

Directly affiliated with a school of
medicine and at least one other health profession school

Answer 14

Academic health centers

Question 15

Provide the clinical portion of a
medical school teaching program

Answer 15

Affiliated teaching hospitals

Question 16

teaching hospitals

Answer 16

• 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

Question 17

Institutional Providers-Accreditation Status

Answer 17

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.

Question 18

examples of accredited institutions

Answer 18

The American Nurses Credentialing Center (ANCC)
The Joint Commission (TJC)
The National Committee for Quality Assurance (NCQA)

Question 19

Consolidated Systems and Networks

Answer 19

*Healthcareorganizationsareorganizedintoconsolidated
systemsthroughtheformationoffor-profitornot-for-profit
multihospitalsystemsandthedevelopmentofnetworksof
independentlyownedandoperatedhealthcareorganizations.
* Organizedalongfivelevels:
*Largenationalhospitalcompanies,mostofwhichareinvestor-
owned.
* Largevoluntaryaffiliatedsystems.
*Regionalhospitalsystemsthatcoveradefinedgeographicarea.
* Metropolitan-basedsystems.
*Specialinterestgroupsthatownandoperateunitsorganizedalong
religiouslines,teachinginterests,orrelatedspecialinterestsdriving
theiractivities.

Question 20

Ambulatory-Based Organizations

Answer 20

• 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.

Question 21

community services

Answer 21

• 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

Question 22

subacute facilities

Answer 22

• 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

Question 23

home health organizations

Answer 23

• 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.

Question 24

Long-Term Care and Residential Facilities

Answer 24

• 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.

Question 25

Hospice and Palliative Care

Answer 25

* 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

Question 26

Nurse-Owned and Nurse-Organized Services

Answer 26

* 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

Question 27

Self-Help and Peer Assistance Voluntary Organizations

Answer 27

* 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

Question 28

Supportive and Ancillary Organizations

Answer 28

Regulatory organizations * Accrediting bodies * Third-party financing organizations *Pharmaceutical and medical equipment supply corporations *Various professional, educational, and training organizations

Question 29

Regulatory Organizations

Answer 29

* 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

Question 30

Accrediting Bodies

Answer 30

* 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)

Question 31

Third-party Financing Organizations

Answer 31

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.

Question 32

Pharmaceutical and Medical Equipment Supply Organizations

Answer 32

Nurses play a significant role in setting standards for safe and efficient products that meet consumers’ and organizations’ needs in a cost-effective manner.

Question 33

Horizontal Integration

Answer 33

* 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.

Question 34

Vertical Integration

Answer 34

* 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.

Question 35

what are Acquisitions and Mergers

Answer 35

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.

Question 36

System Theory Organizations evolve in an orderly and holistic manner

Answer 36

Systems theory explains complex systems holistically and can be either closed (self-contained) or open (interacting with both internal and external forces)

Question 37

Systems theorists focus on the interplay among the system components within a framework of:

Answer 37

￿ Inputs: Resources such as people, money, or materials ￿ Throughputs: Processes producing a product from the inputs ￿ Outputs: Product of inputs and throughputs

Question 38

Chaos Theory Change is disruptive and not orderly

Answer 38

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.

Question 39

Nursing Role and Function Changes

Answer 39

* 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.

Question 40

Leaders can

Answer 40

* 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.

Question 41

Managers can

Answer 41

* 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.

Question 42

Followers can

Answer 42

* 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.