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Leadership Exam 2 > Healthcare Organizations and Structures > Flashcards

Healthcare Organizations and Structures Flashcards

1
Q

what are healthcare organizations

A

Systems composed of people, institutions, and resources designed to address the healthcare needs of a target population.
Economic, social, and demographic
factors affect the purpose and
structuring of the system, which, in turn, interact with the mission, philosophy, and structure of healthcare organizations.

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2
Q

healthcare organizations provide two types of services

A
  1. Illness care (restorative)
  2. Wellness care (preventive)
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3
Q

Types of Organizations

A
  • Institutional Providers
  • Consolidated systems and networks
  • Ambulatory-based organizations
  • Other Organizations
  • Supportive and Ancillary
    Organizations
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4
Q

what are institutional providers

A

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

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5
Q

Characteristics that differentiate
institutional providers:

A

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

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6
Q

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

A

general care

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7
Q
  • Services targeted to specific
    disease entities or patient
    populations.
  • Examples
A

specialty care

Examples- cardiac, burn,
oncology, children’s, OB, etc

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8
Q

Institutional Providers-
Length of Direct Care Services Provided

A

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

The healthcare network refers to interconnected
units that either are owned by the institution or
have cooperative agreements with other institutions
to provide a full spectrum of wellness and illness
services

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9
Q

Institutional Providers- Ownership

A
  • 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.
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10
Q

Ownership Forms-Public institutions

A
  • 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
  • Examples:
    Federal Level: veterans, members of the military, Native Americans, and
    inmates of correctional facilities
    State Level: Health service teaching facilities, chronic care facilities, and
    correctional facilities
    Local Level: county-supported and city-supported facilities (health
    department)
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11
Q

types of federal level institutions

A

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

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12
Q

types of state level institutions

A

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

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13
Q

types of local level institutions

A

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

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14
Q

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

A
  • 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
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15
Q

Ownership Forms-
For-profit Organizations

A
  • 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
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16
Q

Institutional Providers-
Teaching Status

A
  • Academic health centers: Directly affiliated with a school of
    medicine and at least one other health profession school
  • Affiliated teaching hospitals: Provide the clinical portion of a
    medical school teaching program
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17
Q

teaching hospitals

A
  • 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
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18
Q

Institutional Providers-
Accreditation Status

A

A healthcare organization accredited by an
external body has the structure and processes
necessary to provide high-quality care.

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19
Q

private organizations
* Examples include:

A

play significant roles in establishing
standards and ensuring care delivery compliance with
standards by accrediting healthcare organizations.
* Examples include:
The American Nurses Credentialing Center (ANCC)
The Joint Commission (TJC)
The National Committee for Quality Assurance (NCQA)

20
Q

Consolidated Systems and Networks

A

Healthcare organizations are organized into consolidated systems through the formation of for-profit or not-for-profit multihospital systems and the development of networks of independently owned and operated healthcare organizations.
Organized along five levels:
Large national hospital companies, most of which are investor-owned.
Large voluntary affiliated systems.
Regional hospital systems that cover a defined geographic area.
Metropolitan-based systems.
Special-interest groups that own and operate units organized along religious lines, teaching interests, or related special interests driving their activities.

21
Q

Ambulatory-Based Organizations

A

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.

22
Q

Community Services

A

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

23
Q

Subacute Facilities

A

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

24
Q

Home Health Organizations

A

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

25
Q

Long-Term Care and Residential Facilities

A

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.

26
Q

Hospice and Palliative Care

A

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

27
Q

Nurse-Owned and Nurse-Organized Services

A

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

28
Q

Self-Help and Peer Assistance Voluntary Organizations

A

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

29
Q

Supportive and Ancillary Organizations

A

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

30
Q

Regulatory Organizations

A

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

31
Q

Accrediting Bodies

A

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).

32
Q

Third-party Financing Organizations

A

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.

33
Q

Pharmaceutical and Medical Equipment Supply Organizations

A

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

34
Q

Horizontal Integration

A

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.

35
Q

Vertical Integration

A

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

36
Q

involve one organization directly buying another

A

Acquisitions

37
Q

involve combining two or more organizations and their assets to form a new entity.

A

Mergers

38
Q

System Theory
Organizations evolve in an orderly and holistic manner

A

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

A healthcare system is composed of decision makers, policy makers, groups of people, and organizations. The actions of each group influence the system.

39
Q

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

A

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

40
Q

System theory
The survival of the organization (seen as an open system) depends on its evolutionary response to changing environmental forces.

A

The response brings internal changes, which produce changes that alter environmental conditions.
The changes in the environment bring about changes in the internal operating conditions of the organization.

41
Q

Chaos Theory

A

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.

42
Q

Nursing Role and Function Changes

A

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.

43
Q

Leaders can

A
  • 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.
44
Q

Managers can

A
  • 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.
45
Q

Followers can

A
  • 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.

Leadership Exam 2 (7 decks)

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