Flashcards

Question

Identify and discuss the areas where the board of governors oversees the hiring of medical staff.

Answer 1

A group of people called a planning staff determines MOU many physicians for each department in a healthcare organization (HCO) will be required and drafts its findings in a medical staff recruitment plan. The board must agree with the plan JOJ it to take affect. The board considers how many patients will be requiring services SO the doctors can work at their craft, if1 there is sufficient monetary resources to pay the physicians and if it is worth it to the HCO to spend the money. The board investigates doctors on their staff to make sure they are proviing excellent medical care and the board ultimately appoints physicians based on their credentials for a set period Of time. The board maintains oversight Of any outside agreements made between the HCO and groups outside of the organization. The board and the HCO lawyers review written agreements and decide whether or not the HCO will enter the agreement.

Answer 2

Financial support is needed a healthcare agency to be successful. Debate has existed over who should provide the financial support and MOU much financial support is necessary. The following questions apply to e debate. Do physicians make enough or too much money? Should patients have to pay more JOJ medical services? Do insurance companies profit too much from premiums? Appeasing all involved in the financial needs of the HCO is difficult because layoffs or degradation in quality may occur. The prospective payment system (PPS) was designed to determine a that would be paid per sickness, referred to as a diagnosis-related group (DRG) by Medicare 1O patients entering the hospital. Doctor's fees were determined Áa the relative value scale. Insurance companies followed suit and set limits on their payments. Because the various groups adopted the same strategy, HCOs had to accept the terms to remain competitive.

Answer 3

In order for a mission statement to be fulfilled within an HCO, B strategic system must be followed. A strategic system requires the HCO to respond to the changing climate of the healthcare setting. The people within the organization, those receiving medical service from the organization, and businesses which interact with the organization, will react to changes; the HCO must measure the changes against the mission and make adjustments as necessary. Plans need to əq developed to make sure the HCO is in touch with the spoken and unspoken concerns of the people responsible JoJ its financial success. Once the mission is established, plans of action must be defined in a business plan. The business plan should define objectives that can be measured and monitored for success. When and who will be tasked with completion of the items within the business plan should be described. Many HCOs are forming alliances within groups of providers who perform tasks related to a common disease, or service s lines as part of their business plan. The doctors cannot perform medical procedures without available facilities, the facilities are maintained by people providing clinical support services, and the interaction should be addressed in the business plan

Answer 4

A valiant effort has been made to oversee if HCOs are achieving excellence while servicing patients. The Joint Commission on Accreditation of Healthcare Organization and the quality improvement organization were both formed for this purpose but neither has produced long-term positive results. Lawsuits have become a common way for people to seek monetary compensation for poor care. Unfortunately, there are many frivolous lawsuits that have impacted the desire for physicians to take risks that may be beneficial to patients. The National Quality Forum (NQF) has been a more successful tool in the oversight of HCOs. The group evaluates the HCO based on a detached perspective focusing on what the physician is actually doing and comparing that to the end result. Those getting better results are scored higher and subjectivity is removed from the equation. The Agency for Healthcare Research and Quality can be contacted to see how different HCOs are doing, thus allowing people choosing an HCO to see the results.

Answer 5

A healthcare organization (HCO) is constantly changing its strategies so it can function at its optimum capability, which is known as a continuous improvement strategy. A mission statement outlines the fundamental goals of the HCO and declares how it will uniquely strive for excellence within the industry. After reading the mission statement, the reader should understand why the HCO formed. The virtues of the HCO should be detailed in the mission statement. The mission statement should be visible and known by employees within the organization and accessible to those people visiting the HCO. The mission statement should become the standard for the HCO and all changes and modifications to the HCO should be weighed against the mission statement. Employees and anyone else doing business with, or representing the HCO in any way, should be in compliance with the mission statement.

Answer 6

Healthcare organizations (HCOs) have to listen to the needs and wants of their customers. Consumers want good care at a reasonable price. They want their physicians to be knowledgeable in their service and fair in their pricing. Consumers want every area Of their healthcare needs to be covered Aq insurance and their physicians. D HCO that is well-managed will listen to the needs of their consumers and make the necessary modifications to meet əul patient's demands. The care provided will not only include what S! necessary while a patient S! at the doctor's office, but also include the needs of the patients in the aftermath of their recovery. D well- managed HCO will make an effort to help patients maintain wellness and avoid illnesses The departments within O well-managed HCO will communicate and work together effectively for the good of the patients The HCO will combine what is known to work well within the healthcare industry while creating new strategies for the success of the medical providers and the patients.

Answer 7

Healthcare organizations (HCOs) are open systems which can be defined as o group of people who are affected Aq and communicate with those people whom they represent. An HCO uses their assets both concrete and abstract to care for a group of people Every part of the system must work together for an HCO to be successful; in turn, the HCO can only be as successful as its weakest component. In order for the HCO to function, products-- both human and nonhuman--and money must change hands, which are interactions known as an exchange. Some groups of people are required Aa contract to interact with company and they are called exchange partners People who Own stock or have a financial tie to an organization are a group of exchange partners known as influential. They can give or withhold resources in order to accomplish a personal goal. An HCO represents the medical providers and the people needing service and must balance the needs and wants of both groups

Answer 8

Clinical systems need technical and logistic support from the HCO to function properly. This support includes detailed and up-to-date information on the people needing medical services. The physicians providing patient care need to be informed on best practices or protocols that have been accepted within the industry. The patient's billing and payment status is important to know. Another area of support needed by a clinical system from an HCO involves the personnel involved in the system. The best workers are desired and the system relies on the HCO to find and keep quality employees happy. State of the art technology is used by the best clinical teams which are supplied by the HCO. People who must visit the healthcare organization should have easy access to the building and should be provided with a comfortable atmosphere both of which are provided by the HCO. HCOs use people who form responsibility centers to determine when there is a need for improvement and to discover and implement process improvements

Answer 9

Each year the board of a healthcare organization will meet and determine goals for major areas affecting the overall success of the organization. The board details each area in a balanced scorecard so they can visually track the HCO's success throughout the year. Each area on the scorecard is rated for success and the end result is a clear representation of each quarter's successes and failures. The amount of money an HCO is making is a standard area that is tracked by boards. When the board allocates the budget, it does so on the basis of the different categories on the scorecard. When setting the goals on the scorecard, the board reflects on the HCO's past performance, other HCOs' performance, market performance and areas that are of priority to the HCO; how the money will be allocated, or the budget is created, and the board makes modifications and eventually agrees upon the HCO's budget. Each department is given an operating budget allocating how its resources will be used.

Answer 10

The groups or organizations financing an HCO, or stakeholders, must be satisfied because they are responsible for the growth or failure of an HCO. If physicians choose not to be a part of an HCO, the HCO has lost revenue and cannot grow. If people using an HCO's services are dissatisfied and discontinue use, revenue is lost. The more people involved in the HCO the better its success. If there is discourse between stakeholders, the HCO must remain neutral, listen to both sides and come up with the best possible solution that will appease all involved in the problem. The HCO relies on word of mouth of people they service to spread amongst the places and institutions they frequent. The fewer friendships or networks the HCO forms in the local population, the less influence the HCO will have and fewer customers will use their services.

Answer 11

In order for the future of healthcare to run more smoothly effort must be made on the part of healthcare organizations to develop strategies that will avoid the need for complex and expensive medical procedures. As people live longer, they will need medical care at a greater rate and for a longer period of time. Effort must be made to educate people and encourage people SO that they will make better choices when it comes to health. Cigarette use and other harmful activity must be discouraged and those who are already addicted should be helped in quitting. Maintaining healthy weight should be emphasized. It is much more cost effective for a healthcare organization and the population to avoid medical procedures if possible and maintain healthy lives instead Both curing diseases as well as developing strategies to help people avoid getting diseases is the goal of an integrated health system (IHS)

Answer 12

A healthcare organization (HCO) has many people who work together to bring the organization success. The happiness of the people contributing to the organization is important for an HCO to consider. Some people are paid to work for the HCO, while others work for free; both groups must be respected SO they will work at their optimum ability. When several people come together for a common purpose an associate organization is developed. Internal organizations will communicate the needs of the group with the HCO. The medical technology and materials needed Aa an OH come from outside vendors. The HCO needs money to get the merchandise and often makes deals (called strategic partnerships) with outside companies that are mutually beneficial to the HCO and outside company. Because the type of care varies from patient to patient, a physician may need to refer the patient to another physician or care facility. Sometimes an HCO will make deals that benefit both the HCO and the source of their referral. Government oversight of HCOs requires HCOs to give certain private information to the government when requested

Answer 13

The Institute of Medicine's Committee on Quality Healthcare in America looked at the current state of the healthcare industry and developed guidelines of expected behavior for the future. The protection of patient's health at a more efficient rate is an expectation. Use of the appropriate type of medical care the first time a patient visits a medical provider is another goal. This calls for less subjectivity in patient care from physicians and an increased use of evidence-based medicine. Giving the patient all options available for the treatment of his or her medical condition and allowing them to make an informed decision without pressure from a physician is another goal for future HCOs. HCOs should be available for patients at their hour of need. Education of patients on preventable illnesses should be part of an HCO's planning and budget. HCOs should begin considering that both poor and rich people need care and should be able to provide affordable plans so all can access and use their facilities.

Answer 14

Medical care has become more efficient and successful over time. People within the field have developed new treatments for disease and new ways to prevent disease. AS a result, technology has been created to assist in medical care and has evolved with medicine. Older demographics, or the fact that people live longer as a result of better medical care has led to advancements and greater use of medical care. The increased cost of healthcare has resulted in the need for government intervention. When people cannot afford coverage, they look for government assistance. ƏUL government could not afford to pay JO the gaps in coverage and political dissatisfaction was the result. The solution has been to create set rates on medical procedures SO medical providers cannot overcharge consumers and consumers can in turn take financial responsibility for their healthcare coverage--a system known as managed care. The goal has been to achieve the best medical service with the least amount Of money being wasted.

Answer 15

When a CEO is chosen, the board should clearly explain its expectations in an employment contract. The contract should not only detail the board's needs but should also explain how the board will evaluate the CEO and how the CEO will be paid for his or her services. If for any reason the relationship fails, the contract should explain how it can be voided. Legal problems may arise so this part of the contract should be clear and understood by both the board and the CEO. The board and CEO should work together to determine areas of improvement for the HCO that will occur within the next calendar year. The contract should clearly discuss how the CEO will be rewarded for working for the HCO. The salary and other compensation should be competitive so a good CEO will remain within the organization. Bonuses for meeting and exceeding benchmarks may be part of the CEO's contract

Answer 16

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the America Osteopathic Association are 2 agencies that ensure hospitals are following required guidelines. Their oversight is required by insurance companies and other people who financially fulfill patient's obligations. The government has similar agencies that ensure that financial transactions are completed within set guidelines. In order to make alterations or create a new hospital, the hospital must frequently obtain a certificate of need from the state government. Companies who pay medical benefits on behalf of those in need use quality improvement organizations (QIOs) to ensure that the financial transactions are completed fairly for both the insured and the company paying for benefits. Because anyone in need of medical services can access a hospital, child protective services and other agencies acting on behalf of populations of people in need have interactions with healthcare organizations. Although most HCOs do not pay community taxes, they are responsible to the community's expectations and must communicate with and comply with community standards

Answer 17

There are many people who work in a healthcare organization (O)H) in many roles, such as those that service patients and those who serve administrative roles. An HCO's success depends upon əu morality of the people involved in the organization. Employees must value people and want to serve every individual regardless of the patient's appearance or belief systems. Every person should be shown the same level of esteem and dignity The people working within an HCO must strive to provide the best care possible. After an illness Sl cured, the person relieved still wants some level of service from the HCO and this fact must be considered for an HCO to be successful. The fact that the healthcare industry S! constantly changing and new and better techniques can Əq applied 0 meet the demands of change, should dq known ÁQ those working for an HCO A successful HCO will communicate its desires and expectations to potential employees and hire people based upon their agreement with the HCO's standards. Positive rather than negative reinforcements should be used to gain compliance from employees regarding the set standards.

Answer 18

D healthcare organization (HCO) provides service to people needing medical care and the HCO must be responsive to the needs Of this group of exchange partners People who are ill or need medical care want excellent care in an adequate setting and want their medical providers to listen to their concerns and the concerns of any loved ones who are present. HCOS must be able to act as representatives for the people who need medical care, protecting their interests and acting on their behalf. The groups, including insurance companies, Medicare and Medicaid who pay the HCOs are exchange partners with the HCO. HCOs must consider the groups needs pue represent the groups and themselves in a mutually beneficial way. HCOs should understand that those paying for medical services want to do SO by paying the least amount necessary for quality care. Companies who pay for health insurance for their employees often use an intermediary or buyer to dous different insurance companies JOJ the best rates and service. The buyers are another group of exchange

Answer 19

All people will need to visit a healthcare organization (HCO) at some point in their lives. Some are financially capable of paying for the medical care while others are not. The population and government must share in the cost of providing medical services to all people in need. It is important that healthcare organizations exist to reduce the spread of diseases. Easy access to medical facilities is a reason people to locate in an area and jobs are available at an HCO. HCOs strive to provide the best and most affordable medical services. Benjamin Franklin articulated these reasons for needing hospitals in a population in 1760. These are the same reasons HCOs have formed and are successful in today's society.

Answer 20

Natural disasters can occur at any moment and preparation for potential issues that could cause the IOSS of protected information within a healthcare organization must Əq a part of healthcare company's plan. Information that is entered into the computer should be copied and kept away from the place of Input SO if a disaster occurs, the information can be retrieved. The frequency that information will be copied should be predetermined and scheduled. The education of management and personnel within an organization iS critical. Everyone should be walked through exactly MOU they should react in case something unexpected should occur. plan should be developed 1OJ who is responsible for retrieving the copied information and how it will Əq input back into the system once the system is fixed. D computer virus, or bug sent through a computer system which is meant to destroy the system, must əq prepared for. Many companies offer programs to detect and stop viruses from harming the system Time and money should be spent in the careful selection of the very important virus protection programs.

Answer 21

The people or companies who own hospitals have frequently decided to merge their hospitals together. When 2 or more organizations decide to bring their hospitals together but remain as separate owners, the arrangement is called an alliance. All owners have to agree on major decisions and getting agreement can an insurmountable task. When D or more organizations come together to create new and separate hospital, a health system is created. D health system has one decision maker who is responsible for the needs of the organization as a whole, rather than the separate parts that created it. Most hospitals are health systems Health systems often come together to provide service to the most amount of people over the largest distance possible The result iS that one Organization profits from an entire area or many areas. For example, Q major city like Houston, Texas requires many different hospitals Memorial Hermann Owns many hospitals in different parts of the city, thus providing services for most people living in and around Houston.

Answer 22

Most HCOs do not have an environment conducive to extended care, So they may work with long-term care providers Because the people in the community that the HCO serves are important contributors to the HCO., the HCO forms partnerships with local groups that provide community service. An HCO must be kept clean and the equipment must remain in good condition, OS many will hire outside companies to perform the task. Materials are needed for an HCO to provide medical care and an HCO will often enter into extended agreements with vendors that include discounts on bulk orders and better supplies. The need for educated people to work in the healthcare industry is always high and many HCOs will give money to local educational institutions for students in the healthcare field. Most HCOS are paid through the use Of insurance, SO they will partner with certain plans for the mutual benefit of both the insurance company and the HCO.

Answer 23

Discuss how outputs are measured on the operation balanced scorecard.

Answer 24

D healthcare organization (HCO) often has many different healthcare centers under its umbrella. Each center can have a separate governing board, called 2 subsidiary board, that communicates with and report to each other and to the main HCO board. Subsidiary boards are important because they are located within the community they serve and therefore know their patients and their marketplace best It would Əq difficult for a governing board located in one city or state to make effective decisions for a healthcare location in another city or state. Because the healthcare centers under an HCO's umbrella can differ in services they provide, subsidiary boards ensure that people who are familiar with the specific types of services being offered are represented on the board Having boards for separate organizations makes it easier the separate healthcare organizations decide to become one in a joint venture because each HCO involved has a board representing its unique interests. The various boards allow for certain tax benefits because the organizations are functioning separately.

Answer 25

Employees who feel respected and are treated well work harder for their employer. Managers within 2 successful healthcare organization (HCO) recognize and foster good relationships with the employees they manage--a theory known as service excellence. Making an employee happy within an OH and creating an organizational culture means providing them with the materials and education required to do their jobs correctly. All people within an HCO and customers of the HCO must be treated fairly and equally by management. Employees should feel secure in bringing up concerns SO management can evaluate issues and take action when necessary. Healthcare management should never lie to employees or ignore inquiries made by employees. Management should refrain from making subjective decisions when possible and instead rely on scientifically proven facts. The leaders of an HCO should act like they want their employees to act. If they are upholding positive standards, most employees will follow the management's lead.

Answer 26

Chief executive officers (CEOs) communicate frequently with and advise board members although they are not typically members of the board. The CEO of an HCO is chosen by the board, SO the CEO and the board have a close relationship. The CEO iS the board's eyes and ears within the organization and the board relies on the CEO for accurate and essential information. Problems can arise if a CEO in any way tries to advance his or her own agenda rather than protecting the HCO as a whole. S example, a CEO may advise the board that O certain department needs funding for a project If the board gives the money and the project fails, a CEO may Kn and hide the failure to protect his or her personal interests. Choosing trustworthy and honest CEO becomes vitally important to an HCO. Doctors hold seats on most boards within HCOs. They know best what iS going on in the healthcare field because they work in it everyday. The doctors on the board must be careful to represent all doctors as 2 whole rather than address problems or make improvements that will help əul doctor serving on the board personall

Answer 27

Board members are not full-time employees of the healthcare organization (HCO). Many have separate careers from their duties on the board. Leaders within the HCO are tasked with helping the board be successful. One way in which department leaders can help the board is by providing the board with data that relates to their department. The board needs the HCO's leaders to be their eyes and ears within the organization. The communication between the supervisors and the board should be in writing and should provide all essential information that a board needs to make informed decisions. The data provided should be free of bias and should be fact based. Because a board member does not necessarily work within the healthcare organization it governs, supervisors are responsible the instruction of board members on relevant material. The supervisors within an HCO become the face of the board. They must represent the overall goals and ideals of əu! board to the customers and employees they come in contact with

Answer 28

Leaders are needed to oversee an HCO in many ways. It is up to management to find areas that are in need of improvement within their healthcare organization. TOp managers need to know how their HCO is impacting the population where it is located and should spark communication with community leaders to determine the Impact On a smaller scale, department managers can determine how their HCO is doing by asking questions of employees and customers. Because the details of patient's records are OS important, leaders within an HCO should consistently review how information S! Input and make sure employees are knowledgeable in the process and its importance. Senior management should be involved in creating education plans for their department managers to implement and department managers should use the plans to educate new employees or existing employees about new developments. Both senior management and department management should be involved in developing strategies to make the HCO better. Both levels of management should be involved in making sure the people within their organization are working together in a positive way and should be involved in overcoming conflicts when they arise.

Answer 29

Beyond the administrative and budgeting duties the governing board of an HCO have they must also oversee and maintain the quality Of the medical services provided for by their organization. This is an important duty, because failure to provide quality care can result in legal action. Quality is monitored by outside agencies like the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and government agencies. The board allocates monetary resources to quality care, creates regulations for its employees called medical staff bylaws and is involved in ensuring quality leadership is hired within their organization. The oversight of hiring medical staff Aq the board and holding applicants to strict standards provides the HCO with quality employees The board members are supposed to be neutral and should hire based on merit rather than personality or other political factors. If a problem arises with the medical services provided to a patient, əul case S investigated fellow medical providers through a process Of peer review. The board hears the results of the peer review and ultimately decides if culpability applies.

Answer 30

As various aspects of business are analyzed, solutions need to be created to make the healthcare organization run better. Performance improvement teams (PITs) are formed to create new and better business tactics. "Plan Do Check Act" (PDCA) or the Shewhart cycle is a system that helps PITs form new ideas and carry them out. The Plan step involves the investigation of current work process to find any areas of inadequacy and the determination of reasons for the inadequacies. The Do step requires the PIT to brainstorm on better ways of completing the task that will overcome the inadequacies ultimately choosing a best practice. The Check step requires the PIT to set in action its new plan and. determine if it actually works in a real setting rather than just in theory. The Act step requires the PIT to bring the new idea to actualization and move on to a new process improvement.

Answer 31

The governing board must assess the need for growth of their healthcare organization (HCO). In order to determine how many people within the population surrounding an HCO will need to use its facilities for inpatient or outpatient care, an epidemiologic planning model is used. The model is used to determine what types of doctors will be needed based on past use. The model divides the actual usage of a hospital for either a particular procedure or number of customers in the previous year by the total number of the particular procedure or number of healthcare customers of the industry as a whole within a designated community for the previous year. If an HCO cannot compile the data itself, it can buy the information from an outside vendor. An HCO can look at the results of past models to see if they were indeed accurate. This can help the HCO decide if a change has occurred in the marketplace and to identify specific types of people who need healthcare service

Answer 32

Departments within 0 healthcare organization (HCO) have goals they must meet and their performance iS tracked in an operation balanced scorecard. One area on the scorecard reflects how much the HCO is being visited-- -known as demand for service. The number of clients an HCO is seeing and how that number has increased or decreased is a measurable area on the scorecard. Another area in the scorecard measures MOU many of all the people in the surrounding community of an HCO are using the particular HCO being measured. The HCO may look like they have seen a good number of patients for a year but if their competition has seen twice problem is identified. Another area on the scorecard measures if the proper treatment is being administered regardless of 'Auew as the patient's request. The ability for an HCO to respond to needs of patients is another measurable area.

Answer 33

A board can be sued by outside parties. The board as a whole is typically the target and the board has lawyers to represent them in case of a lawsuit. Because most board members are part of the medical community they have significant ties to the healthcare industry. For example, a person may serve on the board for an HCO while working full-time as a CEO of a medical supply company. Legal issues can arise over conflicts of interest. If the hospital was looking to switch medical supply firms, the board member should not use his influence over the board to make sure his company is chosen Personal investment and work information should be stated by each board member to avoid potential problems. In HCOs which work for the needs of the community rather than to make money, legal issues can arise around how they spread their wealth amongst the community they serve. This should be a non-biased process and is governed by inurement rules. When two separate businesses become one--called consolidation--or when an organization working for the community, becomes one that makes money from the community (called conversion), legal issues may also arise

Answer 34

Some of the actions of a healthcare organization are governed by law and a good board will be knowledgeable about the law and make sure their organization is participating in authorized activity at all times. A successful governing board will provide continuing governance education (CGE), which means they will make sure the people working within their HCO know the most up-to-date and most highly recommended medical practices and procedures. The governing board should promote participation from all members when the board comes together because each person on the board is valuable and should be heard. If individuals on the board are involved in any private activity that could conflict with the best interest of the board, the individual should be required to disclose the information. A separate group of people disassociated with the board should be formed to maintain oversight of the board and resolve any conflicts that arise within the board. The board as a whole manages the chief executive officer and this duty will not be overlooked by a successful board.

Answer 35

When a spot is open or becoming open in a governing board, many boards have the power to pick a replacement and these boards are referred to as self-perpetuating boards. Sometimes the people who own the HCO or work within the HCO can select board members. The leaders within the board are nominated and accepted by the board members. Most boards have a group of people who seek members to work on and lead committees and seek people to be on the boards. The committees are called nominating committees and they pick candidates for board approval based on the number of board members needed. There is a designated time frame board members can serve on a board, 3 or 4 years being the standard. Some boards require their members to invest monetarily into the HCO. Most board members are not paid for their service, but serve for the experience and dignity the position holds.

Answer 36

A governing board does not always have the time available to carefully research and consider every issue that comes before them They must assign some of their responsibilities to other people or groups of people who can make the appropriate effort--which is a system called delegation. Standing committees, such as an executive committee, are often given responsibilities from the board. The standing committees should be given detailed tasks to complete and timelines for completion to ensure they are in fact performing the function they are assigned. If a standing committee is not specialized in a certain area that must be addressed, the board can form an ad hoc committee for a designated timeframe. The ad hoc committee is tasked with investigating a problem and finding solutions for the governing board. The opinions of ad hoc committees are almost always implemented by the board, because the committee is created for a particular function by the board.

Answer 37

Clinical systems oversee the groups of people formed to work together on a particular case or patient. People needing medical care often have problems that require seeing a variety of physicians and offices to care for their ailment; clinical systems help all people involved function together in the best possible way. These alliances of physicians and caregivers are known as microsystems and must rely on help and oversight from the leaders and other departments within their organization. Microsystems need communication support and help to determine the best ways to make a positive medical experience for both the people needing medical service and their loved ones. Because the same patient may see several different doctors each with their own diagnoses and treatment options, some level of communication must be maintained in order for the patient to receive the best possible care. People involved in the microsystems should monitor this communication and make necessary alterations.

Answer 38

Every successful organization will put its overall goals and broad ethical standards into a mission statement. In a healthcare organization (HCO), the governing board creates the mission and all modifications to the HCO are measured against the mission to ensure compliance. When considering modifications, the board first takes a look at a big picture of the healthcare field to find areas that need improvement. Based on the information gathered, the board can consider new strategies that help their HCO become more competitive while remaining in line with the mission statement. The board then considers cost, in terms of both human and non-human capital to complete the strategy--which is referred to as resource allocation decision making. There are immediate costs and costs that will continue for however long the project takes to complete. If all of the information gathered favors a project, the HCO will proceed

Answer 39

There are many departments within a healthcare organization. Management of the people working in each department is essential and a supervisor is assigned to each group to oversee activity, making it a cybernetic system. A cybernetic system is one that is overseen by either a human or non-human to ensure it is functioning correctly. The supervisor of a healthcare organization (HCO) cybernetic system must detect areas that are not in compliance with expected results and make necessary changes to regain compliance. If the supervisor in charge of a workgroup is not meeting the HCO's goals, action will be taken to get the supervisor in compliance so the supervisor is accountable to the corporation as a whole. Each level of people within an HCO is accountable to somebody, all the way up to the owners who are accountable to themselves. A supervisor of the information technology department should not be accountable to a supervisor of a surgery center. The 2 departments are unrelated and the supervisors are the same level of management. Different areas in the HCO will have an accountability center that knows their processes and can manage the group successfully

Answer 40

Main leaders in healthcare organizations maintain oversight and communication with multiple departments and large numbers of people. There is a chain of communication that leads to the governing board in an accountability hierarchy, but many healthcare organizations are under a mesh system. This means that one person, who is the supervisor, has communication over many different channels, and the various departments have unique organizational goals that may be different from the main organization's goals. The mesh system leads to the creation of groups within the organization called service lines. Service lines reflect the needs of their specific patients rather than a generic goal. Objective measurements are used to evaluate service lines and if a service line is not functioning properly, it can be replaced. Service lines understand how easy they can be replaced and in return, function better to avoid it.

Answer 41

potential board member should be able to weigh information carefully and without bias and form decisions based on logic rather than emotion. Board members should be able to maintain the best interests of the HCO and its owners at all times. They must be motivated by doing a good job rather than how their position can further their personal lives. The board members must know the people their HCO will provide service to, including their needs and wants from the HCO. Not only do the board members need to know the medical profession, but they must also be skilled in business and negotiation. Board members must be available to serve when needed. The board members should have prior positive experience and be well thought of by people who have worked with the members in the past. A variety of types of people--including those with a variety of skills and those with different backgrounds--should be on the board. Different genders, races and ages should be considered based on merit

Answer 42

A governing board that is full of ideas and process improvements but never makes the next step in implementing their ideas, is as ineffective as a governing board that never has a new idea. When strategies are created, the governing board must determine when the strategies will be implemented and follow the timeline as much as possible. If issues arise, the timeline should be adjusted, but movement forward towards completion must be the overall goal Strategies cannot be implemented without the appropriate knowledge to do so. The board is involved in improvements they initiate, but are also responsible for government-regulated activity. In order to complete a task correctly, research must be completed before the project even begins. Board members and their employees handle the task of gathering appropriate information. Because there are multiple areas that must be considered with great detail by the board, the board needs to take time on each important issue. If their careful investigation is not required, the board can approve these items in a consent agenda.

Answer 43

The board must consistently check to ensure the HCO is functioning properly and well. One way the board checks quality is by watching how well each department does with its goals set forth when the HCO's financial plan or budget was created. If a major area of concern arises, the board will alert the department head to develop a strategy to fix the problem. The board is not meant to fix it themselves, but rather ensure that it is addressed. To make sure that the information received by the governing board is true, audits are conducted within the HCO and the board ensures the audits are completed to their satisfaction. At times, audits are requested from companies not related to the HCO especially in areas of monetary oversight. The goal of using external auditors is to make sure the HCO is covered legally from discrepancies and to make sure auditors within the HCO are being honest and doing their jobs correctly. All major business opportunities conducted between the HCO and outside companies are overseen by the board.

Answer 44

In order for subsidiary boards to function properly, they must have the freedom to make decisions and oversee their healthcare organization separately from the main board of the HCO. The main governing board of the HCO must have oversight of each of the subsidiaries and their oversight is detailed in their reserved powers. Reserved powers are powers that the main board maintains to control its subsidiaries. The overall goals of the HCO are important to everyone affiliated with the HCO and the governing board of the HCO makes sure the subsidiaries are in line with the goals. If one subsidiary has a dispute with another subsidiary, the board decides how the issue will be overcome. The governing board of the HCO is in charge of the purchase or release of assets, how money will be dispersed among the organization and managing the subsidiaries

Answer 45

Because the healthcare organization (HCO) is dynamic, customer service must constantly be monitored and made better, which is a theory known as continuous quality improvement (CQI), created by W. Edwards Deming. How well the HCO is functioning and CQI must be analyzed by quantitative analysis and comparison to set standards or benchmarks. A HCO cannot be successful financially or in any other way without bringing in people to use its services Developing strategies to maintain the people already using the medical provider and developing strategies to bring more people into the practice is another aspect of CQI. It is important that those who work within the organization feel they are valued and know that their voice is heard. Employees need to know that their opinions can lead to new processes, which is a concept known as empowerment Open communication between business leaders and employees is fundamental in employees feeling empowered in the workplace

Answer 46

The people who are on the board of an HCO are typically temporary and the board job is not their primary source of employment. The board makes determinations together but their plans must be set into action by one person. A chief executive officer (CEO) is chosen by the board and the individual chosen is the main representative of the board. He or she leads the employees within the organization and is the contact point for those people interacting with the HCO outside of the organization. The CEO must be knowledgeable in every aspect of the HCO because he or she is the communication source between the board and the remainder of the HCO. A person who fulfills all of the requirements is hard to find and the board must choose carefully. The board should compile a list of traits they desire from a new CEO including specific qualities, education and experience.

Answer 47

Medical staff is arranged based on common goals, but the arrangement of the staff varies by healthcare organization (HCO). The staff is arranged to provide excellent service in the most cost beneficial way. This includes ensuring that patients are treated well while resources are not wasted. Allowing people to make payments that they can afford will help an HCO be able to service a large number of people who may not have paid anything for healthcare services. The education and experience of doctors hired by the HCO is very important in providing excellent care. The HCO should arrange staff so that it can ensure the doctors are happy in their work. Salary and other financial incentives must be comparable to other organizations. Promotion and education opportunities should be provided for the doctors. The HCO must be effectively sustained economically and socially.

Answer 48

Effective managers are vital to a healthcare organization's (HCO's) success. Education on how to be an effective manager is necessary for a manager to be successful. Managers need to be taught how to listen to their employees as well as their supervisors and implement new ideas, rather than just providing a sounding board for problems When a new procedure or practice is passed down from the board for implementation, the manager must be taught how to effectively transition his or her staff to accepting the new organizational path. Management capabilities can be taught and a successful HCO will spend money and time training their managers. Effective managers will make sure that evaluations are completed on employees and on the organization fairly and without bias so the HCO can be improved. The manager should protect the integrity of the evaluation system for the HCO while removing any personal feelings from the process.

Answer 49

Clinical expectations are standards for what resources, both human and non-human, will be required in completion of a medical procedure or patient care. These standards are set and accepted by the medical profession as a whole so patients, insurance providers and physicians all know in advance what they will need to complete a patient's treatment. Clinical expectations are part of the following 3 groups: functional protocols, patient care plans, and patient management protocols. Standard practices followed by healthcare providers in the completion of routine medical care are grouped under functional protocols. Functional protocols are used frequently and are typically memorized by providers. A functional protocol is a step-by-step process by which a treatment is carried out. If a part of the protocol is not followed, the results can be detrimental to the patient. By following a functional protocol exactly, the steps can be traced in case a problem arises. The healthcare organization should clearly define situations where a specific protocol should be applied and when it should not be. The protocols should be monitored occasionally for possible improvement.

Answer 50

Many situations will arise where a healthcare manager will have to implement a new strategy that may be unpopular with the staff. For example, the governing board may decide that the HCO needs to save money by limiting the amount of overtime available for nurses. The nurses may deem this as unfair. It is up to the manager to hear both sides and make both sides as happy as possible. One way for a manager to encourage a positive conclusion is to treat every person involved with the same respect regardless of his or her position. Management should also make decisions based on facts rather than emotions. If necessary, the manager must fire the employee to resolve the conflict. Managers should have the ability to act as a mediator in disputes and look for areas that need to be communicated more clearly. Sometime managers may need to approach a situation by explaining to their employees that the board has come to a conclusion and nothing will change the decision, so acceptance is the only strategy

Answer 51

Patient care plans are one group of clinical expectations. A unique patient care plan should be created for every individual who visits a healthcare provider. Once a physician listens to a patient's symptoms, he or she should begin a plan of action based on applying known medical treatments, or management protocols, to the patient care plan. The plan should clearly state the desired outcome of a treatment plan. What exactly the physician plans to do to treat the patient, or component activities, should be detailed in the patient care plan. There should be a place where details of care can be written down in order to communicate with other potential medical providers. The patient care plan should have a timeline with expected dates of treatment. There should also be a place in the plan where evaluation of the plan for effectiveness can occur and redesign can be possible.

Answer 52

The medical field is complex and there are many areas of specialties Not only do the many different types of patients need to be served by people familiar with how to care for each unique issue, but lab tests are required and the office must operate clerically. There are few HCOs that can provide every service requested to the extent that will meet or exceed the patient's needs. The leaders within the HCO must oversee the organization and find areas where cooperation with doctors or other external offices is necessary Doctors who are knowledgeable in a variety of areas of medicine, known as primary care providers (PCPs) sometimes partner with HCOs to either work for the HCO or work with the HCO. If an HCO does not provide a specific service, it may partner with specific providers who specialize in the area of need.

Answer 53

Resources are a measurable area on the operation balanced scorecard. One part of the area of resources is known as physical units. Management must project how many employees are needed at a given time, at what times equipment can be used, and how much inventory is on hand. All of the areas are tracked in physical units. The price of physical units is determined by a standard industry amount placed on what is used by the healthcare organization, which produces costs--another part of resources on the balanced scorecard. The number of resources and how well they are being used is part of the resource condition measures portion on the scorecard. Another area on the operational scorecard involves employees and is called associate resources. The specific qualities each employee possesses that will benefit the organization is tracked in an area known as supply measures. How well the qualities are being matched to the organization's needs is measured. Another measurable area under associate resources is called development measures and involves assessing employee's skills to make sure they match with the needs of the organization and the search for educational opportunities when they apply. Satisfaction measures are used to determine how happy the employees are with the healthcare organization they are working for. How happy an employee is, is directly tied to how long they will work for a company and their attendance and their happiness is analyzed through loyalty measures.

Answer 54

The role of a healthcare organization (HCO) is to ensure that patients are treated based on evidence, that people seeking healthcare are satisfied and happy with their experience, and that physicians enjoy doing their job personally and professionally Managing the numerous physicians and other healthcare providers employed by an HCO is difficult because there are so many people in several different locations. The fact that many doctors are experts in a specific area rather than general practitioners compounds the problem, because each physician has a special way of providing care based on their expertise. The way physicians earn their income adds a problem area for the HCO. If a physician refers a patient, the referring doctor sometimes gets paid for the referral. If paid for each treatment provided, many physicians will provide more care than necessary to make more money. If limited by an insurance company, the physician will make less money. The conflicts in how physicians are paid results in physicians putting less effort into helping patients avoid getting sick, because they get paid more when they provide healthcare services rather than preventing them.

Answer 55

Quality of care can also be tracked by how well the organization is in compliance with accepted standards by the healthcare industry as a whole, through the use of process quality measures. Some programs like Medicare fine HCOs for noncompliance with industry standards of care. Best practices can be applied to any area where the HCO is failing. A step-by-step instruction of treatment has been created by CMS, which is defined by the patient's diagnosis or symptoms. The National Quality Forum has created a more general approach, which is based on best practices for the industry as a whole rather than based on a specific medical problem. They list 30 procedures that should be followed to ensure the patient is well cared for in a secure environment. Another agency, the Malcolm Baldridge National Quality Program, has established a list of areas where the provider's competence can be tracked to determine the level of care being provided. Working equipment and qualified staff are needed to provide quality care to patients and their availability is tracked on the operational balanced scorecard under the heading of structural quality measures.

Answer 56

By applying a decision model in the process of determining the best medical course of treatment, the patient can feel secure that whatever treatment is used will be beneficial and necessary. The patient can also feel secure that the doctor has not just based his or her treatment on a test, but rather has applied logic and weighed options before deciding the best course of action. Applying a decision model ensures that the physical and monetary price of a medical procedure is completely necessary for proper treatment. If the best treatment is done the first time, the patient will have an easier time during the procedure and in recovery and will typically not have to repeat or try a different procedure. Many times there is more than one way to treat an illness, but applying the decision model assures that the best treatment is chosen. If a patient has a medical problem, quick treatment is often necessary and important Applying a decision model in the beginning will avoid unnecessary time being wasted on incorrect treatments.

Answer 57

The operational balanced scorecard tracks how happy the person receiving treatment is with the care they received. The happiness of the people visiting a healthcare organization (HCO) can be determined by questioning the people upon departure or upon completion of care. The HCO can create their own surveys or external companies can be used. The benefit of using an outside company is that they have standard questions that are used industry wide and thus management of one HCO can compare its results to another HCO's performance. Generic measurements of satisfaction can be also be used that apply to any organization, not just healthcare. SERVQUAL has created this type of measurement system that asks questions regarding broad areas like reliability and empathy. Ultimately, the HCO needs to discover if the patient would revisit the HCO and if they would recommend the HCO to others Many times a patient is required by insurance to get a referral from his or her doctor; or they just value the opinion of a doctor they know regarding another physician. How happy the doctor is with the service provided by the referred doctor is tracked through the use of questionnaires. Any other person who has received service from an HCO is frequently surveyed for their happiness with the HCO.

Answer 58

Because all medical care is completed by people, the people administering care are a major factor in the process of providing quality care. Healthcare provider's development is part of the continuous improvement process. Healthcare providers should be encouraged to take a proactive role in determining new and fresh ways of maintaining good clinical performance. The medical providers should be involved in brainstorming sessions to determine better methods of performance, what schooling they need to stay abreast of changes in the medical field, and rewards for acceptance of any changes that are made. The result of the process will be a new and better path for clinical activity. Healthcare providers should approach continuous quality care with the mindset that process can always be made better and each area of the process should be investigated to decide if a better way can be applied. The person's need, who is receiving the medical treatment, is most important and the good of the whole HCO should be valued.

Answer 59

Part of a successful healthcare organization's (HCO's) plans should include strategies to make communication successful. Data and other information are continuously exchanged within departments and many times the information needs to be transmitted to others, both inside the organization and outside of the organization. Each level of the accountability hierarchy has a designated role in the communication process. Most communication that affects the HCO as a whole is conducted through the computer. The Internet is used to communicate with external customers while the company's Intranet is used to communicate within the organization. A patient's personal information is typically input into the computer creating a patient record. The patient's payment status is tracked on an accounting ledger. The information is sensitive and must be protected whether it is kept in a computer system or in paper files.

Answer 60

The people who work as managers within a healthcare organization (HCO) must be educated in the industry as well as with the specific department he or she is overseeing. The owners count on their managers to identify problem areas and be intelligent enough to fix the problems. The education level of management is typically a master's degree or doctorate. Supervisors are accountable for their department's performance and many HCOs use a multi-rater review to grade the supervisors every year. The manager of the supervisor who is being evaluated, other supervisors at the same level and people who work for the supervisor all have input. The National Center for Healthcare Leadership creates standards for good managers and the performance of healthcare supervisors can be weighed against these standards. After reviewing the results of the supervisor's review, the HCO will design a personalized development plan, which is a plan of action to improve the supervisor in areas of need. Because there is turnover in management of an HCO, some supervisors are chosen by the HCO to fill upcoming positions in a succession plan.

Answer 61

Once the market is identified and segmented, a healthcare organization (HCO) uses strategic functions to determine the best strategies to align the HCO with the market. The HCO may need to adjust its goals as detailed by the governing board to reflect the findings of the needs and wants of the employees, customers, and other companies who the HCO must market to. The HCO must create a strategic position to make sure it is reaching its customers in the most effective way so they will begin using or continue to use the HCO. The HCO must consider how new and advancing medical equipment will affect the market. The HCO must determine how much money it can spend to get more customers. Determining what strategies other HCOs, either new or existing, are employing should be investigated to determine their effect on the strategic planning.

Answer 62

Healthcare organizations (HCOs) must maintain a safe working environment because they are regulated by the government to do so, and because of the nature of their business. Human Resources perform the specific job duty of ensuring safety regulations are met as set forth by the Occupational Health and Safety Act. Human Resources must also ensure that people are treated equally within the organization following the Family Medical Leave Act and the Civil Rights Act of 1964. To avoid issues of discrimination, many HCOs will look at the population they serve and determine the percentage of minorities and women who live in the population. The HCO then tries to match the percentages of employees they maintain with the general population. It is also important that the HCO addresses and trains employees to avoid sexual harassment issues. People have various opinions on what is actually considered sexual harassment so the HCO should have a clearly stated policy on the issue.

Answer 63

For a healthcare organization (HCO) to keep the best employees available, it must pay them based on how well they are performing their job functions. If employees are doing well, the HCO can respond by giving them extra money beyond their salary, called incentives. The amount an HCO can afford to pay employees, however, has to be in line with the company's profits. If the HCO is not doing well financially, it cannot afford to pay employees more. The HCO should evaluate employees fairly when determining who to give more compensation to. It is sometimes hard to determine what role each person within the HCO has played in the HCO's success. The HCO should make it clear to employees that an incentive is a bonus and may not happen again. Typically, upper management receives incentives first and the leftover is distributed to lower level employees.

Answer 64

Healthcare organizations are large and must have space available for the many units contained in their facility. The healthcare buildings must be cleaned and maintained. The food service areas and waiting rooms must be maintained. The facility maintenance of an HCO is known as a plant system. Part of the responsibility of leadership of the plant system is to use the space within the HCO in the best way possible to provide safety, convenience and aesthetic appeal. When people visiting the healthcare facility feel secure and comfortable, they get better faster. If the HCO looks better, more people will want to visit, so putting money into the design aspects of the HCO is worthwhile. Medical equipment is necessary in an HCO so the design of the HCO must reflect the placement of these necessary items. Some departments of the HCO require more room, which must be provided for in the design of the HCO.

Answer 65

There are many areas that must be considered when a planning unit evaluates the status of the population that the healthcare organization (HCO) services. The people within the community the HCO services must be analyzed to determine what types of illnesses have historically and may in the future affect them. Another area of examination is how the people of the service population feel about and react to healthcare services. Some market areas are poor and have little access to healthcare other than through government assistance. Other areas have high employment rates and high access to health insurance. This must be examined by the planning team so the HCO will know how and from whom it will be receiving payment. It is important for the planning team to determine how happy and how educated its employees are. The planning team should determine how many doctors are available to the population it services and what types of services they provide, to avoid over saturating the market with one type of physician.

Answer 66

Part of a healthcare organization's marketing strategy includes branding. The HCO wants people in the population it services to associate its facility with positive feelings. One way an HCO can induce a positive public image is to reach out and communicate with the people it services. For example, an HCO can send a monthly letter with recipes that are healthy including the HCO's name information and logo. The HCO has now reached many people who will associate the brand with a positive message. The HCO can sponsor activities that people will enjoy. A food drive with carnival games for children can send a message that the HCO cares for the community. The food drive in no way asks the community to use the HCO's facility, but places a good impression in the minds of those who participate. The HCO can use the news media to convey a message or can tie the HCO to fixing a problem that the media identifies. If, for example, the media is discussing tobacco use among teens, the HCO can provide information to help teens stop smoking so the HCO can be tied into the story in a positive way.

Answer 67

Human Resources are responsible for the oversight of employee benefits. Every employee is required to pay certain taxes, and the payroll department automatically removes the amount from the employee's paycheck and pays the appropriate party including Social Security, Medicare, and federal and state taxes. The healthcare organization (HCO) is required by law to hold worker's compensation insurance coverage and unemployment insurance. Employers pay employees to take time off work for illness, specific holidays and some provide paid time off for personal or vacation time. Most HCOs offer health insurance coverage to their employees and automatically deduct the premiums from the employee's paycheck The HCO also contributes money into the health insurance coverage reducing the cost for the employees. Some HCOs provide money for employees who work for the HCO for a certain number of years and retire-money which employees can receive in a lump sum or monthly.

Answer 68

The plant services department is evaluated to ensure it is meeting the standards set forth by the healthcare organization (HCO). One area that is evaluated is how well the plant services department completes all tasks requested of them. If their performance does not meet the needs of the HCO, the department is failing. Another area that is measured is how well the department uses money allocated in the budget. The department is responsible for investigating outside companies to find the best products at the lowest prices. The plant services department is evaluated on how well it retains its employees. Because the department is responsible for the aesthetic appeal of the organization, which is directly related to customer satisfaction, the department is evaluated on the how well they provide the upkeep of facility.

Answer 69

It is important that a healthcare organization (HCO) identifies and caters their marketing strategies to a well-defined customer base. The HCO can look at the whole market and place each person into defined groups--which is a process called market segmentation. Market segmentation is important because it ensures that people are getting an appropriate marketing message based upon their Circumstance. For example, elderly care is specific to seniors and money spent on marketing these services to 25 year olds is money wasted. The market can be divided based on income and any other factors that will have an effect on the customer's buying decisions. Once the market is segmented, the HCO must determine the best way to reach the customers in each group through a marketing strategy. These strategies will change and must be adaptable as the market changes.

Answer 70

Employees of a healthcare organization (HCO) are subject to reviews, usually at least once a year, based on how well they are doing their jobs. The reviews are meant to determine areas where an employee is functioning well and areas where the employee may need additional training to become more in line with the HCO's goals. Measuring competency is one way to achieve a performance review, but is typically reserved for supervisors and professionals Competency describes traits a person has that help him or her do her jobs, which can be analyzed objectively. To ensure the employees are happy working in the HCO, Human Resources gives regular questionnaires. The questionnaires can include questions about the employee's supervisors and about the HCO as a whole. It is important for the employees to know that they can answer the questions truthfully, and without fear of retribution, so they are not required to put their name or other identifying information on the survey. Human resources can determine areas where dissatisfaction lies and takes steps to make those areas better I

Answer 71

Healthcare organizations (HCOs) employ many people and these people must be paid through salary and other compensation including benefits. Computer systems are used to manage the payment of employees because errors are detrimental to the HCO and the employee. Each Job within the HCO iS paid a predetermined amount based on the education and skills required for the job Human resources maintain and update salary information. An HCO does not have an unlimited budget to pay for employees and sets limits on the number of employees working within the HCO through the use of position control. This is meant to assure there are only enough employees necessary to meet the needs and demands of the HCO. Some people within the HCO get paid per hour they work. Others get paid salary which is a set figure that does not change even when more than 40 hours are worked. Both types of employee's wages are overseen AQ Q payroll system which ensures each is paid correctly.

Answer 72

Pre-qualifications that are required of job applicants are pre- determined by the HCO. The HCO may require a degree or special training, for example, and if an applicant does not have these qualifications they will not be considered. Affirmative action policies are those which are mandated by the government and must me complied with. They often require a company to hire a certain number of minority employees. After the potential employees have been interviewed, the process for picking the people to be hired follows pre-set rules and must be in line with affirmative action. Once hired, employees should be put through consistent training regarding how the organization functions, benefits that will be received, and the goals of the organization. Most HCOs require new employees to work as conditional employees and will only become permanent after proving they can work successfully within the HCO.

Answer 73

Many healthcare organizations (HCOs) encourage the use of transformational management. The goal of this type of management is to help employees get better through training and encouragement, rather than through discipline and reprimand. HCOS should train supervisors on strategies that will help them implement transformational management strategies. Many managers are trained to use punitive measures to get what they want from employees, so the transformational style may be new. Management should be well versed in the HCO's principles so they can communicate those principles effectively and clearly to the employees. Management is responsible for looking at their department and finding areas that are in need of improvement Oftentimes, these improvements require money from the established budget. Sometimes the money from the current budget is used, so managers must look for areas that can be improved in the future to avoid their being ignored in the future budget.

Answer 74

It is better for a healthcare organization (HCO) to promote from within and invest money in making internal employees better. New employees are still needed and HCOs follow set protocols to bring these employees to the organization. The Human Resources department establishes how many employees are working for the HCO at a given time and how many employees are needed. Each occupation within the HCO has specific job duties, which are detailed in a job description which is used to make salary and requirements fair to all people working at the same job. How much the HCO will pay for a specific position is uniform and pre-determined based on the job. If there is any special treatment given to a certain type of applicant for recruiting purposes it is pre-determined and the tools used to bring new employees (including recruiting strategies) are detailed and uniform.

Answer 75

Many healthcare organizations (HCOs) implement service excellence programs to create a successful workforce. The theory behind these programs is that if employees are given the tools and encouragement to do their jobs at the highest quality possible, the employees will respond by providing superior performance. The HCO must provide leadership that cultivates a culture of excellence. The supervisors must recognize a good job and respond with praise so the employees know they are being recognized. Education programs are integral to the development of employees. The only way an employee can perform well is to know how to do his or her job. Employees can then expand on the minimum requirements to perform beyond minimal expectations. Training should also include customer service strategies and strategies to maintain a positive and happy attitude even in the midst of stressful situations. Customer contact is a huge part of an HCO employee's job, so it is important the employee knows how to convey a positive attitude even in the most difficult times.

Answer 76

The Human Resources department creates a workforce plan which is used to determine how many people are needed to work in each department of the healthcare organization (HCO). Human Resources factors in how many people are employed and will continue to be employed for the period of time the workforce plan is created for The salaries and other compensation for employees should be projected in the workforce plan. If there are known areas where salary or other benefits will change, these should be detailed in the workforce plan. Human Resources must communicate with the various department managers to get information required for the plan. As the organization changes, so should the plan and it therefore requires consistent evaluation. If the plan uncovers a need for new employees or a need for the retention of employees, Human Resources develops strategies to cover the needs. Human resource planning plays a critical role in the lives of employees. If there is a surplus of employees, the HCO may have to let some employees go.

Answer 77

Employees are instrumental in the success of a healthcare organization (HCO). HCOs have responded by investing money into training employees because they are such important assets. HCOs offer new-hire training programs to ensure the employees are well informed of their benefits and the goals of the HCO. Most HCOs provide training to help an employee move up within the organization, including how to provide better customer service to patients. Loyal employees who work many years for the HCO will eventually retire and Human Resources provides training to help these employees make the transition. The HCO may even help those people who are laid off find other places of employment. If the HCO opens another branch or department, Human Resources will explain how these changes can make an impact on current employees, like the possibility of new jobs, for example.

Answer 78

Because healthcare is a service-based industry, many people are employed by a healthcare organization (HCO). Some are independent contractors who work within the facility but are not on the payroll of the HCO. Some people work for the HCO who are not paid, called volunteers. Employees are necessary for an HCO to remain in business and their happiness makes an HCO run better The HCO must be competitive in salary, benefits and working conditions, because each employee has a choice of employers. The employees and departments must effectively work together because most people visiting a healthcare facility will encounter more than one caregiver. Employees see and interact with the HCO's customers, so how they feel about the HCO and their jobs is important as they create an image of the HCO. An HCO provides a lot of jobs to the population it services, so employees need the HCO to be successful to maintain employment

Answer 79

Sometimes an employee has an issue or problem that they feel should be escalated because they are unhappy with the response they are given. Many healthcare organizations have an ombudsman office that Human Resources can refer the employee to. A representative from the ombudsman office will act as an intermediary to represent the employee in front of the necessary parties. The goal is to diffuse the situation. If this is not possible, and the employee is represented by a union, he or she can file a formal grievance which can result in the union bringing legal action against the HCO. Managers should know how to handle the grievance process to avoid the escalation to a lawsuit. Supervisors should keep a well-written account of the problem and look into the problem fairly. Human Resources should try to come up with compromise when available. Even if the employee is not represented by a union, his or her problems matter and Human Resources should take all complaints seriously

Answer 80

Healthcare organizations (HCOs) must have a plan to handle a mass amount of people visiting the HCO at one time. In the event of any catastrophic event, either naturally caused or unnaturally caused, many people at one time may be in need of emergency medical care. In the event there is a need for a large amount of medical attention at once, the healthcare staff should stop any work they are doing that is not critical and attend to the large amount of incoming patients. There should be a team who can decipher the patients' symptoms and determine which area of the hospital a patient must be seen by. A team should look for places for the victims to stay in case they have lost their homes. Another group should be responsible for providing treatment to people who are in the hospital because of unrelated injuries. The HCO should have vendors in mind for any extra equipment or supplies that may be needed to meet the increased demand.

Answer 81

Consultants, whether internal or external, should be used strategically. The task that is given to the consultants should be well defined and stated so there is little room for misunderstanding. The more information the consultant has about the area of concern, the better job he or she can do in fixing the problem. If the problem can be fixed by people already employed by the healthcare organization, it should be. Consultants who are experts about the specific problem should be used and if an expert cannot be found, gaining a second or third opinion is a good strategy. The consultants should not be left to work at their own pace and discretion. The HCO should maintain oversight and make sure the consultants are meeting expectations. There should be clearly defined avenues of communication for the consultants so they can work quickly and efficiently.

Answer 82

Once a person acquires a disease, they need medical treatment and the sooner treatment is given, the more effective it is. Community support from healthcare organizations (HCOs) is needed to find these people and help them avoid spreading the disease. The HCO must figure out ways of locating these people, which is part of providing secondary prevention. An HCO can find people by providing free testing to the population it services because once they are found, the HCO can help provide needed healthcare. Many people exposed to a potentially deadly disease need to be sought out by an HCO because they do not willingly seek medical treatment. The HCO must create strategies to find people who are at high risk for disease and get them into a facility to be tested. The HCO should help preventative programs like Narcotics Anonymous (NA) in any way it can as a responsibility to the community

Answer 83

A successful healthcare organization (HCO) constantly evaluates its various parts to look for areas that can be improved. Many hire internal consulting groups that may oversee specific departments, or move around and analyze many departments for possible areas of improvement. The role of these groups is to perform 6 basic functions for the HCO. One role is to analyze the marketplace where the HCO exists. The group should constantly watch for alterations in the types of people living in the community the HCO services, or anything else that may need to be addressed by the HCO's upper management. Another role of consulting groups is to ensure the HCO they represent is in the best possible place for future growth This means making sure the HCO's goals are consistently updated to reflect strategies that move the HCO forward. Another role of the groups is to make plans into the future that will meet the new goals. Another role is to look at other HCOs in the service area and look for any opportunities to capitalize on their successes and failures. The updating of medical equipment should be investigated to determine if the acquisition is cost effective. Many HCOs will work closely with people tied to government and a role of internal consultants is to foster these relationships.

Answer 84

The main leaders of an organization have to make sure every department is functioning properly and that the overall output of their organization is satisfactory to the owners of the organization An executive information system (EIS) is designed to monitor how all of the areas within an organization are functioning and provides upper management a way to retrieve the data as a whole or in smaller pieces to be analyzed. The data warehouse must be managed so it will contain the data needed for the reports Executives will not access an EIS unless they can easily use the program and have the ability to manipulate the data as they desire The EIS has to be able to give the leaders the reports they need, so communication between leadership and those creating the DSS is especially important. Training is vital so the benefits of using the EIS system--rather than traditional and known tools used by management--are taught to employees

Answer 85

Information technology applications are complex and evolve overtime. The first step in the development of an information system requires managers to figure out all the information they can about the system the organization is using--a process called systems analysis. It is difficult to improve a system without knowing its current capabilities and shortfalls. A wish- list of the performance functions of the new system should be created within this step. The analysis of different types of new systems and the current system and their individual pros and cons should be created. All of the information should be combined and analyzed to determine the best course of action for the organization. This should be presented in writing to the decision-making executives. The executives should read over the information and give their authorization in writing so the next step of the process can begin.

Answer 86

Expert systems are a type of DSS system that can have authority over and make decisions about areas needing support in the healthcare field. The expert system has several parts including a section with known information, a section that holds information called a database and a section that applies rules to determine possible outcomes. The expert system has an area where information can be input, called a user interface, and a workspace where data is kept. All of the areas work together and communicate with each other in a system. An expert system is meant to be used to solve problems in lieu of human involvement. Expert systems are used in the healthcare industry in a variety of ways, including alerting the organization of out-of-the-ordinary uses of insurance. If, for example, a person lives in Arizona and consistently sees the same set of doctors and the person's insurance cards begin to be used in Florida, an expert system can identify the problem and alert the necessary parties.

Answer 87

Once an area of need is discovered concerning information technology within a healthcare organization, a team of specific people within the organization should be formed to work together in addressing the problem--a process called project organization. A top executive should maintain oversight over each member of the team and the overall project. An expert from the information technology department should have oversight and manage the people working on the project. Experts from every business unit who will be affected by the use of a new system should have input on the project including doctors, department leaders, and information technology personnel. A person who can communicate the expert's resolutions with the top executive overseeing the project should be available. Sometimes a healthcare organization does not have the manpower to oversee a project on their own and must hire an outside company to perform the task. The structure of people involved in the project should remain consistent whether completed within the organization or outside of the organization

Answer 88

The Human Resources department of a healthcare organization is typically large and extensive. A chief operating officer leads Human Resources as a whole and underneath him or her is a vice president. Because Human Resources are responsible for so many different functions, it is branched into many different departments. One department is responsible for finding and bringing in new employees. Another is responsible for any income that employees receive in the form of money or benefits. Another department is responsible for ensuring each employee has the proper training for his or her job function. If the HCO offers any other plans that benefit employees that are outside of the heading of compensation, another department is created to oversee these programs. The Human Resource department is responsible for improvement in its quality and there is a separate department led by a supervisor who is responsible for overseeing the administrative and goal-oriented focuses.

Answer 89

If the healthcare organization does not have the human resources available to employ internal consulting groups, it may choose to hire an outside company for certain functions. Outside companies can be used to evaluate the marketplace, investigate other healthcare organizations, determine and suggest areas where the HCO can improve and facilitate discussion within the HCO. One benefit of using an outside agency is that they are unaware of existing policies and practices and can give an unbiased viewpoint. Outside agencies have no vested interest in any one opinion and therefore can be a successful intermediary for more than one vantage point. The HCO can pick an agency that specifically handles a specific business problem to take advantage of their expertise. Outside agencies can be hired on for a set project and released so they do not remain on the HCO's payroll for an extended period of time.

Answer 90

As healthcare organizations (HCOs) grow, they may decide to make a pre-existing healthcare facility better through remodeling and expansion. The HCO may choose to buy or rent a different facility or part of a facility. Either way, the HCO does not keep on its regular payroll a construction team to complete the work and must therefore hire people from outside of the organization. The HCO will generally ask for bids on a project to determine the best choice in who will complete the work. The National Fire Protection Organization created the Life Safety Code and is just one of many organizations whose regulations must be followed. It is important that the HCO choose a construction team that knows the regulations and will follow them. Money and resources may be needed to get the building in line with set guidelines and the construction team should make the HCO aware of any extra investment that will be needed as soon as possible.

Answer 91

Marketing in a healthcare organization (HCO) goes beyond simply bringing in patients to the organization. The marketing plan must consider how important the quality of the healthcare being provided is to the people needing it. The HCO must ensure it has doctors available to the patients brought in through the marketing plan and that it has the materials available to service those patients. Because there is typically an insurance company or some other party paying for the medical services provided, the HCO must factor in their marketing strategy the needs and wants of the companies actually paying. Some of the HCO's customers, whether they are patients or insurance companies, may feel that different healthcare services are acceptable in fixing their condition. It is important the HCO considers the inconsistencies in emotions about acceptable healthcare in their marketing plan.

Answer 92

Clinical performance has to be monitored for efficiency and possible improvements. The Leapfrog Group, National Quality Forum, Institute for Healthcare Improvement (IHI) and the JCAHO all recommend quality healthcare practices that will help improve clinical performance. The JCAHO created National Safety Patient Goals. The Goals listed include the following: ensuring that people receiving medical care are properly identified so mistakes in care can be avoided, ensuring that medicines that could have potentially harmful side effects are administered correctly, avoiding medical mistakes, and ensuring that healthcare providers are discussing patient problems openly and frequently. Pay for performance (P4P), or paying healthcare providers based on positive results stemming from their patients care, has been used by many health insurance companies to help facilitate good clinical performance. If physicians are paid to provide better care, the patients will benefit from the P4P programs. The insurance companies are hoping that P4P payments will encourage a reduction in costs associated with incorrect care.

Answer 93

Plant services operate under a hierarchy created to oversee the departments. The department is led by a chief operating officer and below him or her is the vice president. One unit of plant services involves the building and equipment upkeep and improvement. Another department oversees the accrual and space necessary for new and existing materials. Another main department is responsible for the oversight of space used within the healthcare facility. One branch of this department is to ensure that the needs of people visiting the HCO are met. This includes hiring people to ensure the HCO is safe, providing shuttle service from the parking lot and greeting visitors upon arrival. The other branch oversees the upkeep of the facility, including cleaning the inside and maintaining the landscape outside of the facility.

Answer 94

A healthcare organization (HCO) must employ various strategies to determine the needs and wants of its customers so it can develop a marketing strategy that reaches the appropriate people with an appropriate message. Formal surveys are used to question any group of people, from patients to employees, to uncover areas that they want changed or addressed. The HCO can use the information to develop their goals specifically for a group's preference. To gain more information, the HCO can gather small groups of people from a specific market group into a focus group. This provides an environment where the HCO can learn even more about the specific needs of a group of customers and how to most successfully meet their needs. The HCO can identify problem areas by maintaining monitors in the facility. Monitors can be comment cards for employees or customers to fill out or the requirement of written incident reports when anything goes awry within the HCO. Finally, the HCO will require its supervisors to keep their ears open when working within the HCO. They should be asking questions and listening to employees and customers, which is an activity that requires the supervisors to spend time out of their offices and in the daily activities of the HCO.

Answer 95

The most commonly used long-term care facility is a nursing home. Nursing homes provide care for people with a wide range of illnesses and diseases. Some are there to care for elderly patients while some have staff which help people overcome an illness or injury. Most nursing homes are owned by corporations which make money from the facility. Some are owned by businesses not trying to make money or by other types of individuals or groups who own the nursing home to serve a community and not to make money. Some are government owned. Nursing homes have had some recent trouble staying afloat financially because they are not being used enough. People are requiring specific types of services that many nursing homes cannot provide to everyone. The American Healthcare Care Association (AHCA) monitors nursing home quality and there are many complaints that have been found valid by the AHCA.

Answer 96

Most clinical support services (CSSs) determine how well they are doing by studying the end result of patient care. If a CSS is involved in an end result that is either unexpected or could be avoided, the problem is addressed to improve future performance. Test results that determine an illness do not change the end result for the patient, unless done incorrectly, so the way the test is performed should be evaluated. The methods which clinical support service representatives employ to complete their work are evaluated for efficiency. The following of protocols and determining if specific tests are done correctly can both be monitored to determine how well an employee is doing his or her job. Many CSS managers will establish routine tests to determine if their CSS is in compliance with quality results. The tests are performed frequently enough to see a pattern for each individual or CSS being tested.

Answer 97

Managers of CSSs are responsible for assessing the cost associated with increased quality measures, protocols that are created and money needed for capital. The budget manager determines the future need for the CSS based on market share and the CSS manager must consider these forecasts in the budget. The budget manager looks at the past budget to see areas where the budget was met. The budget manager collects data to see how well the CSS is performing compared to other CSSs so goals can be set. The budget manager provides information regarding the assessment of finances provided by the finance committee of the board. Salary changes and increased cost of medical equipment are gathered by the budget manager. Line supervisors review the budget and make sure it is in line with maintaining customers' happiness. The line supervisor knows what affects the daily activity of a CSS so he or she should be the voice in ensuring the CSS is bettered by the new budget. Line supervisors represent all units of the CSS and should try and represent each unit equally during the budget process.

Answer 98

Surveys and questionnaires are used to determine how happy a customer of a clinical support service (CSS) is with the service they have received. Another way to ensure quality service is being provided is to hire people to randomly do business with a CSS while secretly recording their experience. The CSS can also ask normal patients to meet and discuss their experience with the CSS. Because a CSS relies on doctors sending patients to use their services, it is important for the CSS to determine how happy the doctors are with the service of the CSS. The CSS can determine this by asking the doctors to fill out a questionnaire once a year. Gathering patient and doctor responses is not enough to improve a CSS. The CSS must act on the information. The CSS can do this by a variety of methods including providing more training for its staff or increasing its budget to make way for new technology or more employees.

Answer 99

Because there is such an extensive number of nurses working for a healthcare organization who are specialized in many different areas, the nursing staff must be coordinated and overseen. A chief nursing officer (CNO) is generally responsible for the oversight of the nursing staff. His or her duties include ensuring the nurses have appropriate education, bringing in and keeping employees, and determining the job expectations of the nursing staff. Beneath the CNO are department managers called directors who oversee unit managers The education requirements of nurses vary by profession. Professional certification rather than a bachelor's degree is sufficient in specific areas of nursing care while upper management is typically required to have education beyond a bachelor's degree. Registered nurses (RNs), for example, need a certification not a bachelor's degree to work in the field. Nurses who specialize in a field typically need a master's degree, which is a requirement of nurse practitioners.

Answer 100

Each healthcare organization (HCO) must determine if it is cost effective to offer or use clinical support services (CSSs). The people who administer CSSs are often asked for input as to the future need and new areas of need for CSSs. Two models are used to determine the need of a CSS. One model multiplies the number of people who may need a CSS by the number of times that the use of a CSS has been needed, which is then multiplied by the number of times the CSS was actually used, which is then multiplied by how much of the market the specific HCO has. This equation, once completed, gives the amount of a particular CSS that is needed. The information input in the first model is non-specific, but is based on averages. The second model uses numbers from previous years of how many times a CSS was used and then uses forecasts to determine the future needs of CSSs.

Answer 101

Information systems have been developed to evaluate the effectiveness of nurses and the care they provide. Patient-scheduling systems keep the schedules of patients and can therefore track problems or inadequacies in the treatment of patients in a timely manner. The expenses of a nursing unit are tracked through information technology, which can be used to find areas where costs can be reduced or eliminated. Because the staff schedule is kept on the computer, reports can be run to see who is or is not coming to wire and when more nurses were needed but were unavailable. The system can track how the nurses are servicing patients of various needs based upon the information nurses input into the system like patient care plans, for example. The system can track how long it takes nurses to care for a patient thus tracking nurses' productivity.

Answer 102

A computer program is generally used to analyze staffing needs and create a schedule. The program should be able to determine the right amount of nurses and other caregivers that will be required and also ensure the right type of nurses are working at all times. The systems should help managers make a difficult schedule so they do not have to waste human resources to complete the schedule. The system should be able to pick appropriate staff so that the organization does not have to pay for extra hours or to bring in nurses when there is a shortage. The system should create a month- long schedule that can be manipulated at any time if necessary. The system should recognize holidays and weekend shifts and spread the shifts out fairly. If an employee needs a day off, the system should make sure such requests are treated fairly among all employees.

Answer 103

Nurses either work in institutional nursing, meaning they work for a corporation or institution or they work in community nursing working for the needs of the population in their service area. Institutional nurses meet the demands of many different settings, including hospitals and long-term care facilities, so a wide range of skills are required of each different type of nurse. The nurses are often specialized in a particular type of care based on the institution they work for. For example, a nurse in a neo-natal intensive care unit must have a different skill set than one working in a nursing home. Nurses who work in community nursing require a knowledge base that will help the population in general, including teaching how to avoid illnesses and maintain a healthy lifestyle. Some will teach the elderly how to exercise, while some will teach students how to care for themselves. There are many opportunities in both institutional and community care for any person interested in the nursing field.

Answer 104

The field of clinical support services (CSSs) is highly competitive and in order to remain in business, a CSS must process as much work as possible. Many healthcare organizations and physicians' offices have in-house CSSs that take up part of the market share. To remain competitive, a CSS must provide excellent service and most have patients fill out questionnaires to determine how happy they are with the service they have received. The CSS has to advertise as much as possible to get doctors to use their services but, if patients are treated poorly when using the CSS, there are plenty of other CSSs the physician or patient can choose the next time around. Many CSSs who process tests for patients go to the physician's facilities to retrieve the tests rather than having a patient drive to the CSSs office. Members of a CSS team should be positive and pleasant to do business with, especially because it is such a highly competitive environment.

Answer 105

Information systems created to evaluate the effectiveness of nursing care record the illnesses patients are faced with, so the end result of the care given by nurses can also be tracked, including times when an error is made. When something goes wrong with a patient's care, the problem is recorded and input into the computer system so these deviations from quality care can be evaluated for improvements. The computer system can tell if a variety of nurses are available at a given time to provide quality care or if other structural standards are being fulfilled. The computer system can create surveys and the results of the surveys can be input so management can run reports and determine areas where customer service is lacking and can be improved. Doctors are also questioned to determine how happy they are with the nursing staff, to uncover any areas of concern or needs for improvement.

Answer 106

Many CSSs will give benefits to doctors, or physician amenities, if a doctor uses their service. This is an attempt to ensure the physician either begins using, or continues to use a particular CSS. The goal is to keep the physician happy. The CSS can offer a wide range of options they can perform for the doctor and get the physician results of any completed services quickly. The physician will want to keep their patients happy as they too rely on return customers, so a CSS willing to work with the physician to make patients happy is highly regarded. The CSS can offer software that will allow the doctor to input information the CSS can receive immediately making for faster service times in both receiving and sending information. Insurance can be verified and tests can be requested quickly and easily with the use of a computer system.

Answer 107

Diagnosis and treatment of illness is not the only demand patients have in the healthcare industry. Clinical support services (CSSs) cover helping patients with after care and doctors will establish the use of clinical support services when needed by the patient. A physician, for example, typically does not have the training to help a patient stop drinking alcohol, but can treat the damage to a patient's liver caused by extensive alcohol use. A doctor, after treating the patient's liver, can recommend CSSs to help the patient overcome his or her addiction. Laboratories that process test results are also CSSs. Healthcare organizations (HCOs) can chose to train staff in house to perform some of the job duties of a CSS, or can chose to pay a CSS when necessary. A cost-benefit analysis of using a CSS must be completed by the HCO to ensure whatever path they chose ultimately best services patients' needs.

Answer 108

Nurses have the most frequent and extensive contact with a patient. Nurses are essentially the eyes and ears for doctors within a healthcare organization. Nurses communicate with doctors to make sure that they have a plan of action for the patient that is detailed and complete. As the nurse monitors the activity of the patient, he or she is responsible for communicating his or her findings to the doctor. Nurses create patient care plans and monitor the patient and his or her family for any potential areas of concern that may need intervention. Nurses keep track of medication and care given to a patient. Nurses must remain in close contact with CSSs. Nurses must keep a written account or incident reports if any problem arises that could be questionable. Nurses communicate with families about the patient's illness and help the family in whatever way possible regarding the patient's medical condition.

Answer 109

1. The nurse must care for patients by using either his or her judgment or by following the direction of a doctor or other healthcare staff, a job duty known as delivery The nurse must follow protocols while administering patient care and use his or her knowledge to ensure protocols are followed as closely as possible, a job duty known as appropriateness The nurse has a responsibility to provide quality care so that the person receiving the care and his or her loved ones are happy with the service, a job duty known as amenities and marketing. The nurse should be involved in making sure a patient receives care when needed and without having to wait excessively, a job duty known as scheduling and recording The nurse should ensure quality care is being provided according to the goals and values of the organization and if that it not happening, should fix problem areas, a job duty known as performance improvement. The nurse should provide input on how many people and what supplies will be required, a job duty known as planning and budgeting. The nurse will help bring in new nurses and be a positive force in the staff so nurses will want to remain, a job duty known as human resources 2. 3, 4. 5. 6. 7.

Answer 110

It is not cost effective for a healthcare organization (HCO) to outsource all of the necessary clinical support services (CSSs), because many departments within the HCO can provide the services. CSSs are still necessary for any services that are too difficult for in- house compietion. If proper execution of a CSS can be completed in house, it should be, because that is a cheaper alternative than paying a CSS. If a physician has no ties to any particular CSS, they are not supposed to refer a patient to one CSS over another Because of this, CSS providers must market to patients and physicians when the CSS can offer discounts for use. Insurance companies tend to pay in bulk for CSSs. These contracts are important to the CSS so they must offer excellent service at fair and competitive price. This may mean charging less for services to get an overail large contract.

Answer 111

For clinical support services (CSSs) to be effective, they must be evaluated and measured for quality. A major area of quality for CSSs is technical quality. If sloppy work is completed or the employees are insufficiently trained to do their job correctly technical quality is not achieved. A CSS expert should be well trained and have a formal education to backup their training. CSS experts require high salaries so they are typically placed in managerial roles over people with an informal education. The CSS experts should attend ongoing training, which should include tools to overcome professional disagreements between experts that sometimes arise. The CSS experts should also receive special training on how to oversee the nonprofessional staff working beneath them. Protocols are created for CSSs to follow. When the CSS experts and the nonprofessionals receive adequate training regarding accepted protocols, both can provide higher quality healthcare.

Answer 112

CSSs must be fast, which requires a proper amount of staffing to meet customer demands. This can be a difficult process because, although some demand is normal, many medical conditions exist without forewarning and it is impossible to know beforehand what the demand will be. When a CSS provider receives a service request it is labeled emergency, urgent or schedulable. Emergency request must have immediate attention even if some quality issues are overlooked. Urgent requests are expected to be processed quickly, but also correctly. Schedulable requests can be satisfied at a set time that both the CSS and patient agree upon. The type of service a physician or hospital provides determines the type of demands they typically request. Emergency rooms will frequently have emergency demands for example. Computerized scheduling systems can be used to assess various factors and help design a schedule that will meet CSS's demands.

Answer 113

How well clinical support service (CSS) specialists complete their job is analyzed and reviewed to find opportunities for increased quality Quality can be traced by evaluating how well protocols are followed The normal functions completed by CSSs should be monitored by people outside of the clinical support team, to look for areas of opportunity. The type of CSS that is provided to each patient is tracked in the patient record and these records can be a source to determine any areas where quality was unfulfilled. Mistakes and duplicate work can be tracked--which are both causes of technical quality failure. Tracking of end results compared to what the result should be to determine areas of mismatch is completed to ensure quality. The point of tracking quality should be to ensure a patient is receiving good treatment. Sometimes, duplicate work is required to fulfill a patient's needs. The point of finding mistakes is not necessarily to punish someone, but to stop the mistake from happening in the future.

Answer 114

Because the healthcare field is constantly developing new and better ways of providing medical services, new and better technology is also consistently designed. Clinical support service (CSS) managers look for these advancements and create programmatic proposals that reflect the CSS's need for different technology. It is important to understand that all technology is not necessary just because it is better. If the price of the new technology is more expensive than its potential benefits, it should not be purchased. A formula to determine how much the technology is worth has been created. The number of people who will need a service is multiplied by how much the new technology will help make the service better, which is multiplied by the dollar amount applied to the benefit of the service, which gives the total amount in dollars that buying new equipment will help the CSS for a year.

Answer 115

The healthcare organization should provide ambulatory agencies with any help possible, because they are servicing the population the HCO also services. As part of its community-assistance strategy, the HCO should help programs that bring healthcare to patients, especially when the patients cannot afford to or otherwise do not have the means to visit a healthcare facility. Although HCOs are not directly involved in ensuring patients have a place to live, if the facilities are inadequate or patients become homeless, the HCO industry will clearly be affected. The HCO should communicate and help agencies that provide support for people with housing problems to come up with ways to fix problems that result from the inability of a patient to find a place to live.

Answer 116

Most people late in life would rather live in their own homes rather than move into a nursing home or other long-term care facility. A good alternative is to provide housing where people can live independently but still have close access to healthcare providers in times of need. Unfortunately, there are too few of these types of facilities and they are often too expensive for most elderly people. People who want to stay in their homes should be assisted by healthcare organizations with care services that can be delivered at their home. If they cannot afford to pay out of pocket for these services or do not have insurance to cover the expenses, home owners can use the equity in their homes to pay for the services The elderly person may need to change his or her house to accommodate a need, such as the need of a stroke patient to be in a wheelchair. The government will help the elderly pay for housing when in financial need.

Answer 117

The health of the population as a whole is a top priority for healthcare organizations (HCOs). This means providing services for people who are not sick in order to maintain their health. Providing long-term and full-time healthcare is expensive and many people simply cannot afford it. One strategy an HCO employs to prevent a person from having to live in a full-time care facility is training people who are relatives or non-professionals on how to care for a person with an illness or disability. They can be taught how to help a patient get better if possible. If a person can be cared for away from a medical facility, the cost is much cheaper. Home care is thus another way an HCO can provide service to a patient.

Answer 118

Clinical support services (CSSs) cannot function without employees and they are responsible for finding and educating new employees on the specific job functions expected. Because-customer service is such an important aspect of the CSS, it must be part of the training program. Education does not stop after new hire training. CSSs must keep updated credentials, which often require further schoolwork. Current employees who can be educated in more than one field are valuable assets to the CSS because they can fill multiple roles within the organization. Part of cultivating a positive work environment goes beyond paying employees a high salary. Employees need to know that their managers recognize good job performance and good managers will make positive employee feedback part of their overall management strategy. Financial incentives should be used in conjunction with feedback, and managers should avoid using one form of incentive but not the other.

Answer 119

Some patients have received all of the medical treatment available and are still going to die because of an illness, but still need care called end-of-life (EOL) care; EOL care can be either palliative or hospice care. Palliative care is provided when there is no way to make a patient better physically. Instead, healthcare specialists can be supportive emotionally and reduce the physical suffering of the patient through the use of medication. Because some people with life-ending illnesses are in a healthcare facility, while others are in their homes, palliative care is available for both. Hospice care is available for those people with imminent life-threatening illnesses that cannot be cured. Once the patient is no longer receiving medical attention to alleviate a disease, Medicare and most insurance companies will pay for hospice care. Many untrained people who want to give their time to help ill people are part of hospice care programs. The goal is to make the patients happy and at ease during the last moments of their lives.

Answer 120

People working for clinical support services (CSSs) need to feel like they have a secure and long-term employment and if they do not believe that, they may look for a company who can provide it. The number of customers a CSS services drives the amount of employees who are needed. When the amount of customers using clinical support services increases or declines there must be a change in the number of employees. A CSS can meet the change by finding better practices so employees can do their job faster. The people working for the CSS who are not full-time, permanent employees can be increased or reduced to meet the need of the CSS. The CSS can lay off workers or allow them to work extra hours to meet a changing demand for service. Firing current employees or brining on new employees will adjust the number of employees. Temporary companies can be contacted to meet a temporary demand.

Answer 121

The financial management portion of a healthcare organization (HCO) is responsible for locating and tracking any financial dealing that has bearing upon the HCO--which is called transaction accounting. There are many transactions that affect an HCO financially, including employees, furniture for a waiting room, and technology. Every item has a cost and transaction accounting keeps track of every item and cost. Most paper money is collected by an HCO when employees are providing medical assistance, or service to patients and their loved ones. The people working for the HCO and the equipment bought that cannot be sold, but is necessary to the HCO, make up resource transactions--which are also tracked in transaction accounting. The information is input and displayed in cost ledgers. If the transaction occurs within the HCO, it is referred to as a general ledger transaction. The cost associated with each type of transaction can be determined either bY concrete method or an educated guess based on previous experience

Answer 122

One healthcare organization (HCO) cannot provide for all of the medical needs of a community. Even if the HCO employs every type of specialist available, they will not be able to employ enough people to meet the entire demand of the community. The HCO should meet with other service providers and make sure all community needs are met. The role of an HCO in meeting with different types of medical service providers and agencies is difficult because there are many agendas represented. Not all want to talk to an HCO and some even feel that the HCO has the same types of customers and therefore could be taking customers away if the agency decides to work with the HCO. These issues cannot deter the HCO from its goal to make sure the community needs are provided for, but the HCO must realize potential problem areas and have a response when the issues arise. The HCO can use money to accomplish its goals by either partnering with an agency to provide a needed service or by giving money to an agency for the same purpose.

Answer 123

Nurses create unique patient care plans which respond to the needs and symptoms of the individual patient while following set protocols whenever possible. Sometimes a patient's illness cannot be treated based solely on a protocol and the nurse must adapt the protocol in those cases. The nurse must assess the patient based on medical history and by listening to input from the people caring for the patient. Most patients are not cared for by just one doctor, so the nurse should communicate with all of the patient's doctors to determine the best course of treatment for the patent. The care plan needs to include communication with the patient's family on what circumstances the patient will be faced with after leaving the hospital and take into account any special needs. The nurse should also evaluate the financial status and needs of the patient and how treatment will affect the patient's finances. The patient care plan should have a discharge plan which details when the patient will leave the healthcare facility.

Answer 124

Physicians who are part of a physician's organization often face conflict with the organization, Conflicts arise around the fact that doctors have to follow certain rules set forth by the physician organization but may feel that another way is better. The doctor may want to work beyond the organization's guidelines if they feel their patient will benefit. Many physician organizations encourage compliance by streamlining conflict resolution. If the doctors understand that whenever conflict arises the organization will react in the same manner, they can more easily accept the resolution. The physician can remain confident in the fact that protocols are developed with the patient's interest in mind and that as long as the HCO is following protocols, quality patient care is being delivered apart from any agenda the physician's organization may have. The physicians can rely on standard ethics committees to ensure that the organization is overseeing compliance. The physician organization attempts to come to resolutions that are equitable to everyone whenever possible so no one doctor is treated better or differently than another. If a physician still disagrees with a resolution, he or she can enter into an appeals process to fight the decision.

Answer 125

A doctor may decide that a clinical support service (CSS) is appropriate and will ultimately help the patient, but a doctor cannot force a patient to use the CSS. Many factors can stop a patient from choosing a CSS. If the CSS is providing poor technical quality, the physician and patient may decide that using the CSS is too expensive or not worth the effort. CSSs become expensive when mistakes are made in testing or reporting results and if the CSSs are too expensive, the patient may refrain from using them. If the patient is unhappy with the service they receive from the doctor or the CSS they may ignore the doctor's advice and not use the CSSs. If a doctor or patient is unaware that a CSS is available, they will not take advantage of the service. Therefore, the CSSs must advertise their services.

Answer 126

Clinical performance is a term used to describe how well a healthcare organization (HCO) is caring for patients, while taking into consideration the level of resources the HCO has at its disposal. A community hospital may not have as many resources available as a private hospital, but clinical performance is based on the performance of each in providing medical services using what they have available. In order for clinical performance to be considered good, the healthcare organization must follow the needs of the population it services, thus allowing the people served to establish the level of economy. Good clinical performance requires the HCO to listen and follow the recommendations of the physicians providing the medical services. All departments within an HCO are interrelated and must work together for good clinical performance. If there is a weak link among the departments, the clinical performance will suffer.

Answer 127

Because patient's information is now frequently kept within a computer system, the information can be manipulated and tracked easily. The reports that can be generated provide management the opportunity to measure almost anything they can imagine. The problem with having a wide variety of reports available is that the healthcare organization (HCO) can draw incorrect conclusions from the results. For example, the HCO may be measuring how well a new type of pacemaker works for heart patients. The results may show that 75% of the people who got the pacemaker had further heart problems and may decide the pacemaker is ineffective. The problem could be that half of the patients receiving pacemakers were also smokers, which really caused the further complications When creating areas of measurement, all factors should be accounted for, including a patient's medical history, and considered before drawing a conclusion

Answer 128

A clinical quality improvement program involves creating best practices for healthcare, The theory is that money will be wasted on experimenting with different treatment programs, so best practices should be used the first time. In order to achieve clinical quality each patient's symptoms must be considered and the most efficient treatments must be determined. For example, if a patient comes in with chest pain, the doctor must decide the cause of the problem The physician can do this based on symptoms or order an x-ray, An x-ray is an expense and the price of the x-ray must be weighed against the positive result of having it. If an x-ray is ordered when it is not necessary, good clinical performance is not achieved. The more complex the procedure is which a physician is considering, the more time the physician should take to weigh the price of the service against the benefit. Mathematical probability equations can be applied to determine the benefit of a complex procedure.

Answer 129

A healthcare organization (HCO) can never remain stagnant. The healthcare field changes and the atmosphere created by management within an organization must reflect their acknowledgement of change, which creates an evidence-based continuous improvement culture. Management should create objectives, use financial resources to obtain the objectives, let their team know how close they are to achieving an objective, and recognize the employees' roles in achievement of an objective. Employees should feel confident that if they are working hard towards a task, management will do everything possible in overcoming problems that may arise. The team must feel like management cares about their project as much as, if not more that the team itself. When process improvement teams (PITs) are created to resolve a problem, they are led by performance improvement councils (PICs). The PIC should manage the progress of the PIT and should aid the PIT whenever necessary.

Answer 130

In order for a healthcare organization (HCO) to maintain success, it needs patients. Patients want to know that the healthcare organization they choose will provide a safe and pleasant environment. Many insurance companies offer their customers choices of healthcare organizations, creating a competitive atmosphere. The competitive environment means that leaders of an HCO must communicate to the population that surrounds the HCO the reason they should choose their organization over another similar organization. Accidents and lawsuits will occur surrounding an HCO, so the leaders must find a way to maintain confidence with their organization. The media is a communication avenue where leaders can reach a great number of people with a positive message Speaking and partnering with groups that serve the community is another way to strengthen an image. Making patients happy so they tell others of their positive experience is the most powerful way to bring in customers.

Answer 131

Most nurses have a bachelor's degree, but they can earn a masters to become advance practice nurses (APNs) who can take leadership roles or specialize in a specific area of nursing. Nurse practitioners perform many of the functions of a doctor and can see patients full- time unless a specific problem arises in which the patient needs a physician's care. Babies can be born with the help of nurse midwives. Anesthetics can be administered by nurse anesthetists, a process that is covered by Medicare. Some nurses with advanced education become case managers. Case managers investigate a person's illness and treatment options to determine the least expensive way for the patient to receive quality care. Nurses can work in management of a healthcare organization. The nurse's on- the-job training and advanced education prepare him or her to meet the demands of nursing management

Answer 132

The people in charge of assignments look at the nursing schedule and make manual adjustments based on needs of the hospital and problems with staff, including unforeseen circumstances like when personnel calls in sick. Nurses who are overworked because there are staffing problems are generally unhappy with their work environment. Part of a quality healthcare organization includes keeping employees happy, so staffing problems should be met with an increased staff whenever possible. If there is a need for more staff in one department that can be fulfilled by another department that has few patients, nurses can move over to cover the need. Many staffing systems can provide this service and can recognize the best placement of patients based on their medical needs and staffing available. If all else fails, there are groups of nurses who have the ability to work in many areas who can be called upon in a time of need. Nurses can be paid overtime or outside vendors who keep a nursing staff can be called upon. Any of those alternatives becomes an extra expense for the healthcare organization and the people being called in are often not as skilled as the normal nursing staff.

Answer 133

A well-managed healthcare organization (HCO) will evaluate how many doctors are needed to successfully service a population of people and create a physician supply plan. This plan also makes sure that there are not too many doctors servicing the same customers, which can cause them to make less money. Specific areas of the healthcare field that see many patients in a given year should be analyzed annually to determine how many doctors are needed and those who see few patients should be analyzed to determine the necessity of keeping the areas of specialty. Because healthcare is dynamic and constantly changing, the HCO has to consider what circumstances may affect future demand. The governing board has the ultimate say on how many doctors will remain on staff and how many will be brought on staff. The HCO should also decide how many patients will be referred rather than serviced by the HCO and how these referrals will impact their overall income.

Answer 134

Insurance companies have set payment schedules that they follow for patient care. These are negotiated either with individual doctors or in the case of a patient-hospital organization, a large group of doctors. The insurance company and physicians are limited in how much they can charge in hopes of making more money by the Office of the Inspector General of the U.S.Departments of Health and Human Services. The Current Procedure Terminology (CPT) is a system where physicians who are not under a specified medical plan enter the medical procedures they perform to determine an acceptable price. If there is a service not in the CPT, a doctor can keep the extra money. A withhold contract exists when an HCO keeps part of the fees earned by a doctor and only releases the portion of fees if the doctor meets quality goals. Another way physicians get paid is through the use of capitation, where they are paid based on a set number of patients they provide medical care for. Sometimes a plan will not cover a procedure or type of care and physicians can be paid separately for the care.

Answer 135

Healthcare organizations (HCOs) must balance the number of doctors they have working within their facility against the number of total physicians needed by the community. If there are too many doctors, some will go out of business because there are not enough patients to service. If there are too few doctors, the patients will not get quality care. HCOs use a conceptual planning model to determine the number of physicians required. The model multiplies the number of people in the community who will potentially have a medical problem by the number of illnesses or treatments and divides that number by number of treatments completed in the previous year. To determine how many potential doctors need to be hired, a model is used that takes the previous problem's solution or the number of doctors required and subtracts how many doctors are already working for, and will continue to work for the HCO.

Answer 136

The limited number of physicians on the governing board must represent the needs and important issues of the staff as a whole. The HCO's goals and overall evaluation of the way the HCO is functioning is looked at every year to determine areas for potential improvement. The physicians on the board and other physicians who are held in high esteem have input in the board's meetings. All fields of medicine are represented in a hospital and each specialty has different needs. It is important that all fields are represented in developing the strategic plan for the HCO. Some specialties need more money to buy up-to-date equipment that is necessary for quality care. The physicians therefore need input in the budgetary process of the HCO. If an HCO is contemplating providing a new clinical service for patients, the physicians can provide input into how the implementation will affect the HCO both financially and otherwise. Because a physician can make payment arrangements with a patient that includes personal rather than insurance payment an agreement must be made between the HCO and physician about possible nonpayment that will affect the HCO. Physicians should have input into the types of payment arrangements they want to accept.

Answer 137

Because there are so many preventative healthcare strategies available, the healthcare organization (HCO) should establish a plan for which strategies they will adopt and will be most effective for their organization. The HCO must consider the people the strategies they enact will affect and determine which will be most effective and important to that group of people. This opinion of the people the primary and secondary prevention strategies will affect should be weighed against the costs to the HCO. If a plan can be easily implemented, affect a large group of people, and the cost of implementation is low, the plan should be ranked as first on the list for implementation. The HCO should look for groups within the population they service that will help spread the prevention plan to as many people as possible, thus reducing the cost of communication for the HCO. There are many community groups with similar agendas to the HCO, including helping the general public and the HCO and these community groups can work together to better the community as a whole.

Answer 138

Doctors are evaluated based on a system called privileging. The goal of privileging and credentialing is to ensure physicians are qualified to provide medical care. Once qualified, the physician can make medical decisions and provide service to patients. The NCQA, JCAHO and legal cases have determined what is required of doctors to become privileged. The bylaws of the privileging agreement were set forth by doctors who agreed upon guidelines that all doctors must follow. The physician organization through the bylaws determines standards for care, salary, and other requirements that can be legally upheld if a source of conflict arises. Once a doctor decides to become a part of a physician organization, they are rewarded with privileges as detailed in the privileging agreement These privileges include the physician becoming part of the organization sometimes referred to as attending physicians Physicians within the organization are part of a review process by which their medical colleagues evaluate their fellow physicians in cases where patient care is questioned

Answer 139

Strategies must be established for a healthcare organization (HCO) to reach the population they service when it comes to leading healthier lifestyles to avoid sicknesses. The goal of the HCO is not to see people in the community for preventable illnesses and because of this the HCO must somehow communicate the message outside of the walls of the organization. By using a decision theory model, the HCO weighs the price of care for an illness against the expenses used to help the person avoid the illness. The HCO looks for ways to provide the community with services to prevent illnesses that make the most financial sense to the organization and that can affect the largest number of people--a process known as optimization of preventive activity. The HCO reduces its expenses by finding and using tests that generate high accuracy, because if a preventive test is wrong, the HCO wasted money.

Answer 140

The roles of nurses in the healthcare industry are diverse, but overall nurses are meant to provide patients with extended quality care. The American Nurses Association (ANA) has set forth what type of characteristics nurses should possess, beginning with the fact that nurses are meant to develop interactions with patients that help the patient feel better emotionally and physically. People are different and will react differently to health problems and nurses should be able to respond appropriately. The nurse should be able to provide healthcare based on medical knowledge as well as the unique situation of each patient. The nurse should be able to use education and apply it in medical situations to figure out what is wrong with a patient and administer appropriate care. A nurse should be part of some type of continuous education program. The nurse should be an advocate for the population as a whole when it comes to medical care.

Answer 141

Nurses have a variety of skill levels and many areas of nursing should be represented at any given time in a hospital. The nurses take part in determining how many and what type of nurses are necessary. The nursing budget includes the wages of the nurses employed, which is a flexible number. The variation of nurses working at a given time includes nurses in a managerial role who oversee people who are caregivers, but they are not nurses that can provide basic care. A table is used, which is typically on a computer program that requires input and will output the staffing needs of nurses for a given time frame. If there are a lot of people needing care or there are many with serious illnesses, staffing decisions must reflect the patients' needs. When using a staffing model, people with serious illnesses are designated a higher number than regular patients so the system will recognize the need for increased staffing.

Answer 142

Certification, or the path to receiving certification, is a general requirement to become a privileged member of a healthcare organization (HCO). Some HCOs require doctors who work in a specific area of the healthcare industry to have a certification unique to their field of work. If the HCO cannot provide the necessary support of a specialized physician's work, they may not privilege the doctor. The HCO may require the doctors to service a set amount of patients so their abilities remain well honed. If a doctor wishes to become privileged in another area of practice, he or she must prove that he or she has received the training necessary to perform the extended function. Because privileging can be general or specific, there is some debate as to how much it is necessary to have experts work on cases. Doctors in general practice feel they can treat most patients where specialists feel they are necessary to providing the best care. Another area of concern is that if a specialist is the only person privileged to perform care to a specific patient group, he or she will be the only person who can profit from caring for the patients, which excludes general practitioners or other specialists.

Answer 143

Doctors often have different viewpoints and agendas that are specific to their area of expertise. The bylaws should set forth how to handle disputes, including the creation of committees to make general decisions for the healthcare organization (HCO). If physicians do not feel like they are being heard, they may leave the HCO; so communication is very important. It will not benefit the HCO to ignore the needs of doctors; but a strategy that includes going to the physicians and asking what concerns they have, is a better, more proactive approach. It is less necessary to form committees, create plans, and document activity if an atmosphere of trust between physicians and the management of the HCO is formed. An HCO can create this relationship by taking the time to talk to the doctors within their organization and respond to their needs whenever possible. Some doctors within the HCO are on the governing board and they provide the closest link between healthcare management and the actual issues that practicing doctors face.

Answer 144

The privileging committee bases their review on 4 set standards. The doctor must have up-to-date training, proper certification, and ongoing experience in his or her field. The doctor must demonstrate that he or she is doing his or her job correctly and according to set protocols established for his or her area of expertise. The physician must have the general public's interest in mind and serve the people seeking medical attention as effectively as possible. The doctor must not do harm to or abuse other physicians or the people he or she serves. If the doctor meets all of the requirements he or she will be privileged. If the doctor is not effectively treating patients, his or her credentialing can be taken away by the healthcare organization (HCO).

Answer 145

Physician-hospital organizations (PHOs) were created as a partnership between physicians and hospitals and, in order to get physicians to participate, healthcare organizations provide monetary and other benefits that entice doctors to join. Because many insurance companies are now charging a fee per service rendered, called capitation, the practice has required the healthcare organization to come up with new integrated healthcare models that will earn money for the organization and physician while maintaining quality care. One strategy is to help patients control their illnesses so they do not end up hospitalized for long periods of time. Another strategy is to have a patient's care, both initial and ongoing, in one healthcare facility. HCOs have spent money developing computer systems so hospitals and doctors can communicate and share data effectively. Another model encourages patients to be involved in the direction of their healthcare.

Answer 146

Part of clinical performance includes developing strategies to help people avoid getting sick and developing strategies that encourage good health. Most healthcare organizations (HCOs) exist to help the people they service, so prevention of disease and the healthy lifestyles of people they serve are fundamentally important to the HCO's cause. People see healthcare providers when they need care and will listen to the healthcare provider. Even though preventing disease will stop the people from needing future healthcare services, HCOs continue to make prevention a priority. There are 3 types of prevention of illnesses: primary, secondary and tertiary. When a shot is given to stop a person from getting sick or any action is taken to avoid an illness, primary prevention is applied. Once an illness has already been established in a patient, secondary prevention is used to lower the negative effects caused by the disease. In order to stop a sickness from happening again or to avoid unnecessary side effects of the disease, tertiary prevention techniques are followed. When establishing protocols, the HCO should make sure that prevention and healthier behavior is part of the long-term plans.

Answer 147

One model that has been used to arrange the medical staff within a healthcare organization (HCO) occurs when the HCO maintains a medical staff. The medical staff works under structures provided by the HCO but are not paid by the HCO and still work individually for themselves. The HCO can monitor the physician's results, allow the physicians to make recommendations for the HCO and provide training to those on the staff. The problems with the system arose because primary care physicians began to maintain private facilities and no longer needed the hospital to provide care for patients. Patients who needed more complex care were referred to experts in their condition who could use the HCO on a case-by-case basis. The medical staff was not required to pay the hospital to use the facility and could not under law discuss payments. Another model occurs when the HCO actually hires and pays a medical staff. A drawback is that the HCO is responsible for the salary of the physician as well as providing equipment and facilities so the physician can do his or her job effectively. Because the physician knows he or she is earning a salary regardless of how many patients he or she sees, members of the physicians. medical staff are not as customer oriented as private practice physicians

Answer 148

Accepting a protocol as the standard for a healthcare organization (HCO) requires careful consideration of all potential protocols available. An HCO cannot rush to pick a guideline, but should meet as a group and determine what will happen once a protocol is accepted. Different opinions from experts who will use an established guideline should be heard and considered. A new protocol will have to be prepared for and the new guidelines taught to the medical staff, both of which should be considered by management before accepting a new protocol. Because people have unique medical problems, protocols cannot be rigid or unchanging. Management should monitor the effectiveness of protocols and change them when better guidelines are established or new medical technology is developed. If a medical expert decides that a specific patient needs different care than the protocol defines, he or she should have the ability to use his or her judgment to determine the best course of action.

Answer 149

Doctors get paid from a variety of sources and in a variety of ways If a physician organization hopes to keep quality doctors on staff, they must develop strategies that help physicians get paid as much as possible. Contracts regarding a physician's income are diverse. One contract deals specifically with how much the HCO will pay the physician to be on staff. Another contract an HCO can negotiate is with insurance companies. The more insurance companies that approve their members to use a facility, the more the HCO and physicians will get paid because their will be a higher volume of patients. An HCO will provide many administrative functions for the physicians so the physician saves in the cost of maintaining records Physician organizations can negotiate the sale of an individual doctor's office so the physician can begin working for the physician's organization. A physician's organization can enter into a contract with the physician to invest with the organization so both can profit.

Answer 150

In times of severe illnesses, the person a nurse is caring for has family members at his or her side through the process. Because the nurse has so much interaction with a patient, the nurse will often be questioned as to the direction of care a patient is receiving. Nurses should be effective communicators, easing the mind of family members when possible and providing quality care to the patient. The nurse has to be able to educate the family about the specifics of an illness, tell the family or patients what administrative tasks must be completed, and give details about future care, which is all known as cognitive support. A nurse must also have the ability to perform emotional support to a family. The nurse needs to communicate with the person or persons who will be providing the most support for the patient and should be able to look at a family and find this person, or persons. The nurse should anticipate and respond to the needs of the family. Protocols are created to help nurse provide emotional support.

Answer 151

A group of people, called a committee, who can evaluate physicians fairly and without bias is formed to review who will receive privileging credentials. Privileging is an important responsibility and the most trusted physicians should be part of the committee. The bylaws set forth should be followed in picking who will be credentialed. Following bylaws ensures there is no special treatment afforded to any physician up for review. An executive is in charge of overseeing the meeting and ensuring rules are followed. The doctor being evaluated has input into the process. He or she can view the same information the committee views and make written statements about the information. If there is a dispute between the committee and physician, attorneys for both sides should be present. To ensure that all people in the medical community can be made aware of someone who has his or her credentials removed, the Health Care Quality Improvement Act created in 1986 requires the removal to be reported to the federal government.

Answer 152

A healthcare organization (HCO) that employs a staff is responsible for ensuring they are receiving up-to-date training and education. Each HCO follows unique protocols that are constantly updated and part of the education process requires teaching the staff how to follow set protocols. Training about business-related functions is important for an HCO to provide to its physicians. Putting a physician through training requires paying for the training and paying for the time the doctor must spend away from treating patients, known as opportunity cost. The JCAHO has stated that HCOs should provide their doctors with monthly training to ensure they are performing at an expected level. Not only doctors, but other healthcare staff should be continuously trained. Postgraduate education is often paid for by an HCO for new doctors called residents and fellows, who are trying to become specialized in a specific area of medicine. The Accreditation Council for Graduate Medical Education (ACGME) evaluates and accredits postgraduate schools.

Answer 153

The privileging agreement details the relationship between the physician and patient. The independent physician-patient relationship portion of the agreement is meant to define the primary relationship between the medical provider and the person he or she is providing treatment to, understanding the relationship takes priority over the relationship between the medical provider and healthcare organization (HCO), a methodology known as agency The doctor is expected to provide the same level of service whether being paid by the patient or the HCO. A major goal of any HCO is to monitor its performance and make modifications that will better the organization and doctors working for the organization are held to the same standards. This is detailed in the continuous quality improvement and peer review section of the privileging agreement The peer review portion describes how medical colleagues will evaluate each other.

Answer 154

The physician recruitment plan requires careful consideration by the healthcare organization (HCO) because the HCO will have to pay any physicians that it recruits. If the estimations of physicians needed are incorrect, the HCO loses money. The HCO has to estimate how many peopie will need specific types of care, how many and how much care their current physicians will provide, and what specialty physicians will be needed to provide patient care. Groups of doctors meet, debate, and come to agreement on how many and what specialties of physicians to recruit. Once determined, money is spent by the HCO to find good doctors and provide incentives that will make the doctors want to choose their particular HCO. A recruitment group decides on the qualifications required of the person they are seeking, how much they will be paid, where they will find potential recruits, and ultimately who they will choose.

Answer 155

Applying developed protocols to patient care in the healthcare industry is standard and management and healthcare workers find following established standards acceptable in providing quality care. The employees are trained based on protocols and they therefore follow the established guidelines. If a healthcare provider lacks experience in a certain area but needs to care for a patient, he or she can use protocols to provide care. A healthcare provider can deviate from part of the protocol if that will better suit a patient's needs, but he or she should document the deviation. If a deviation is proven to be more effective than the guideline itself, the protocol can be reviewed and adapted. Functional processes are made better by the use of protocols because there only needs to be one right way of providing standard medical care and, once established, everyone can follow the same procedure and everyone will require the same training and equipment.

Answer 156

Information systems are designed to help a healthcare organization (HCO) provide quality care. The computer systems are designed to help healthcare providers by providing information which can direct the user's actions or let the user know when a potential mistake in input has occurred. The systems provide healthcare providers a source of information including the HCO's protocols and other necessary job-related information. The information system is also designed to track data so management can see areas for improvement and ensure expected results are met. The computer systems should be able to process and store information and should be able to provide illness-specific information when requested. Because both requirements are necessary, the healthcare field is requiring the computer to think through diagnoses and treatments and serve administrative functions. Information systems are being developed that can support both functions

Answer 157

Protocols that are established by profession and accepted by a healthcare organization (HC0) as a whole are called patient management protocols. Clinical practice guidelines are established by medical experts and the HCO can choose what guidelines they feel are best suited for their organization. The National Guidance Clearinghouse (NGC) compiled many of the various clinical practice guidelines that can be weighed for selection by an HCO. Guidelines listed on NGC provide details on symptoms and what steps a medical provider should follow when certain symptoms are discovered Where the information came from is also listed within the NGC. Management must respond to the demands the guidelines require The goal of using patient management protocols is successful treatment which is measurable, based on the results of using the guidelines. If the guidelines chosen by the HCO do not give the expected results, the HCO may choose another guideline to follow.

Answer 158

The 3 main sources of medical coverage are employer-sponsored health insurance for working adults and their families, Medicare for the elderly who qualify and Medicaid for the less fortunate of society. Without the use of one of those sources a person can buy coverage from an insurance company privately or can go without coverage. Some companies and Medicare pay for medical coverage for their employees and those covered by their plan respectively. Insurance companies, like Blue Cross and Blue Shield can be used to represent the business or Medicare to make sure doctors are paid correctly. The insurance company is thus a middleman, or intermediary, between the company and physicians. The insurance company also serves as 2 representative of the large company to ensure the company iS paying the best price JOj medical services, which is detailed in the Medicare Act Preamble.

Answer 159

Because government regulations reduced the amount of money medical providers could charge for services, coupled with the fact that the government could not afford to pay for people without insurance, medical providers have had to respond by creating strategies to make money. Medical providers do this by creating criterion to evaluate their services against goals called benchmarks and by weighing themselves against others providing similar services Many banded together in a central location with other providers offering different medical services to create healthcare organizations (HCOs). Centrally locating physician's means they can share expenses and work together to create cost-saving strategies HCOs are convenient to patients, acting as a one-stop shop for medical services Some diversity exists in the success of HCOS because their success largely depends on variables such as the type of customers within the population they service and the HCO's location.

Answer 160

Medical care has become more efficient and successful over time. People within the field have developed new treatments for disease and new ways to prevent disease. As a result, technology has been created to assist in medical care and has evolved with medicine. Older demographics, or the fact that people live longer as a result of better medical care has led to advancements and greater use of medical care. The increased cost of healthcare has resulted in the need for government intervention. When people cannot afford coverage, they look for government assistance. The government could not afford to pay for the gaps in coverage and political dissatisfaction was the result. The solution has been to create set rates on medical procedures so medical providers cannot overcharge consumers and consumers can in turn take financial responsibility for their healthcare coverage--a system known as managed care. The goal has been to achieve the best medical service with the least amount of money being wasted.

Answer 161

The Institute of Medicine's Committee on Quality Healthcare in America looked at the current state of the healthcare industry and developed guidelines of expected behavior for the future. The protection of patient's health at a more efficient rate is an expectation. Use of the appropriate type of medical care the first time a patient visits a medical provider is another goal. This calls for less subjectivity in patient care from physicians and an increased use of evidence-based medicine. Giving the patient all options available for the treatment of his or her medical condition and allowing them to make an informed decision without pressure from a physician is another goal for future HCOs. HCOs should be available for patients at their hour of need. Education of patients on preventable illnesses should be part of an HCO's planning and budget. HCOs should begin considering that both poor and rich people need care and should be able to provide affordable plans so all can access and use their facilities.

Answer 162

A healthcare organization (HCO) has many people who work together to bring the organization success. The happiness of the people contributing to the organization is important for an HCO to consider. Some people are paid to work for the HCO, while others work for free; both groups must be respected so they will work at their optimum ability. When several people come together for a common purpose an associate organization is developed. Internal organizations will communicate the needs of the group with the HCO. The medical technology and materials needed by an HCO come from outside vendors. The HCO needs money to get the merchandise and often makes deals (called strategic partnerships) with outside companies that are mutually beneficial to the HCO and outside company. Because the type of care varies from patient to patient, a physician may need to refer the patient to another physician or care facility. Sometimes an HCO will make deals that benefit both the HCO and the source of their referral. Government oversight of HCOs requires HCOs to give certain private information to the government when requested.

Answer 163

In order for the future of healthcare to run more smoothly, effort must be made on the part of healthcare organizations to develop strategies that will avoid the need for complex and expensive medical procedures. As people live longer, they will need medical care at a greater rate and for a longer period of time. Effort must be made to educate people and encourage people so that they will make better choices when it comes to health. Cigarette use and other harmful activity must be discouraged and those who are already addicted should be helped in quitting. Maintaining a healthy weight should be emphasized. It is much more cost effective for a healthcare organization and the population to avoid medical procedures if possible and maintain healthy lives instead. Both curing diseases as well as developing strategies to help people avoid getting diseases is the goal of an integrated health system (IHS).

Answer 164

The groups or organizations financing an HCO, or stakeholders, must be satisfied because they are responsible for the growth or failure of an HCO. If physicians choose not to be a part of an HCO, the HCO has lost revenue and cannot grow. If people using an HCO's services are dissatisfied and discontinue use, revenue is lost. The more people involved in the HCO the better its success. If there is discourse between stakeholders, the HCO must remain neutral, listen to both sides and come up with the best possible solution that will appease all involved in the problem. The HCO relies on word of mouth of people they service to spread amongst the places and institutions they frequent. The fewer friendships or networks the HCO forms in the local population, the less influence the HCO will have and fewer customers will use their services.

Answer 165

Each year the board of a healthcare organization will meet and determine goals for major areas affecting the overall success of the organization. The board details each area in a balanced scorecard so they can visually track the HCO's success throughout the year. Each area on the scorecard is rated for success and the end result is a clear representation of each quarter's successes and failures. The amount of money an HCO is making is a standard area that is tracked by boards. When the board allocates the budget, it does so on the basis of the different categories on the scorecard. When setting the goals on the scorecard, the board reflects on the HCO's past performance, other HCOs' performance, market performance and areas that are of priority to the HCO; how the money will be allocated, or the budget is created, and the board makes modifications and eventually agrees upon the HCO's budget. Each department is given an operating budget allocating how its resources will be used.

Answer 166

Clinical systems need technical and logistic support from the HCO to function properly. This support includes detailed and up-to-date information on the people needing medical services. The physicians providing patient care need to be informed on best practices or protocols that have been accepted within the industry. The patient's billing and payment status is important to know. Another area of support needed by a clinical system from an HCO involves the personnel involved in the system. The best workers are desired and the system relies on the HCO to find and keep quality employees happy. State of the art technology is used by the best clinical teams which are supplied by the HCO. People who must visit the healthcare organization should have easy access to the building and should be provided with a comfortable atmosphere both of which are provided by the HCO. HCOs use people who form responsibility centers to determine when there is a need for improvement and to discover and implement process improvements.

Answer 167

Healthcare organizations (HCOs) are open systems which can be defined as a group of people who are affected by and communicate with those people whom they represent. An HCO uses their assets both concrete and abstract to care for a group of people. Every part of the system must work together for an HCO to be successful; in turn, the HCO can only be as successful as its weakest component In order for the HCO to function, products--both human and nonhuman--and money must change hands, which are interactions known as an exchange. Some groups of people are required by contract to interact with a company and they are called exchange partners. People who own stock or have a financial tie to an organization are a group of exchange partners known as influential. They can give or withhold resources in order to accomplish a personal goal. An HCO represents the medical providers and the people needing service and must balance the needs and wants of both groups.

Answer 168

A valiant effort has been made to oversee if HCOs are achieving excellence while servicing patients. The Joint Commission on Accreditation of Healthcare Organization and the quality improvement organization were both formed for this purpose but neither has produced long-term positive results. Lawsuits have become a common way for people to seek monetary compensation for poor care. Unfortunately, there are many frivolous lawsuits that have impacted the desire for physicians to take risks that may be beneficial to patients. The National Quality Forum (NQF) has been a more successful tool in the oversight of HCOs. The group evaluates the HCO based on a detached perspective focusing on what the physician is actually doing and comparing that to the end result. Those getting better results are scored higher and subjectivity is removed from the equation. The Agency for Healthcare Research and Quality can be contacted to see how different HCOs are doing, thus allowing people choosing an HCO to see the results.

Answer 169

In order for a mission statement to be fulfilled within an HCO, a strategic system must be followed. A strategic system requires the HCO to respond to the changing climate of the healthcare setting. The people within the organization, those receiving medical service from the organization, and businesses which interact with the organization, will react to changes; the HCO must measure the changes against the mission and make adjustments as necessary. Plans need to be developed to make sure the HCO is in touch with the spoken and unspoken concerns of the people responsible for its financial success. Once the mission is established, plans of action must be defined in a business plan. The business plan should define objectives that can be measured and monitored for success. When and who will be tasked with completion of the items within the business plan should be described. Many HCOs are forming alliances within groups of providers who perform tasks related to a common disease, or service lines, as part of their business plan. The doctors cannot perform medical procedures without available facilities, the facilities are maintained by people providing clinical support services, and the interaction should be addressed in the business plan.

Answer 170

Financial support is needed for a healthcare agency to be successful Debate has existed over who should provide the financial support and how much financial support is necessary. The following questions apply to the debate. Do physicians make enough or too much money? Should patients have to pay more for medical services? Do insurance companies profit too much from premiums? Appeasing all involved in the financial needs of the HCO is difficult because layoffs or degradation in quality may occur. The prospective payment system (PPS) was designed to determine a fee that would be paid per sickness, referred to as a diagnosis-related group (DRG) by Medicare for patients entering the hospital. Doctor's fees were determined by the relative value scale. Insurance companies followed suit and set limits on their payments. Because the various groups adopted the same strategy, HCOs had to accept the terms to remain competitive.

Answer 171

A group of people called a planning staff determines how many physicians for each department in a healthcare organization (HCO) will be required and drafts its findings in a medical staff recruitment plan. The board must agree with the plan for it to take affect. The board considers how many patients will be requiring the services so the doctors can work at their craft, if there is sufficient monetary resources to pay the physicians and if it is worth it to the HCO to spend the money. The board investigates doctors on their staff to make sure they are providing excellent medical care and the board ultimately appoints physicians based on their credentials for a set period of time. The board maintains oversight of any outside agreements made between the HCO and groups outside of the organization. The board and the HCO lawyers review written agreements and decide whether or not the HCO will enter the agreement.

Answer 172

A group of people oversee the entire HCO and are called a governing board. Governing boards are necessary in making sure everyone contributing to the HCO is working together effectively so goals created by the board for the HCO are achieved. The governing board acts as a liaison between the HCO and everyone contributing to the HCO. Without customers, or stakeholders an HCO cannot function and it is up to the board to make sure both groups of people are happy. The overall purpose of board members is to make the most money possible for the owners of the HCO and they are measured by how much money they can make for the organization. If an HCO is designed not to profit, the board members, called trustees, are responsible for ensuring the HCO is financially successful enough to continue to operate. Board members are responsible for oversight and support of the HCO. They make decisions on which departments and who should receive financial support. Some would argue that board members should provide financial support to the HCO so they have a personal stake in the success of the organization.

Answer 173

An information system is so important to a healthcare organization that many levels of experts should be consulted before a decision is made as to what type of system the organization will use. The highest of senior management should have oversight and he or she should develop a workgroup, called a steering committee, to help research and decide on an appropriate selection. The steering committee may be part of healthcare management and should include people from diverse departments who will be able to articulate the capabilities each will require of an information system. The members of the committee should know best what is needed to make their department successful in the overall goals of the organization. The finer details should be left for subcommittees who should have specifically designated tasks, like defining how the network can actually function, and the steps needed for implementation. If necessary, people who are knowledgeable and work in the information technology field outside of the healthcare organization should be brought in to give advice to the committees. Their specialized training in computers and healthcare should be used when considering the choice and implementation of a system:

Answer 174

Both human and non-human resources have to be managed and used effectively by management; a DSS system can help management develop a strategy to best use both resources. By tracking patient volumes, the system can recommend to a manager how many people should be working and at what location at any given time. If more people are needed to provide optimal coverage, the system can recognize the need. A DSS system should have information on how much the healthcare organization is spending on materials and who they are buying the materials from. With that information, the system can make recommendations on the best places and processes available. A DSS system can track how often machines break down and the cause and solution to those problems to determine the best course of action to avoid future problems. A system named CLASSICA has been developed for nurses to oversee and manage resources specific to their job duties.

Answer 175

Part of the planning process for the use of an information technology system should include the format information will take when entered into the computer system. A data dictionary can be created which gives examples of and defines the format of data; when a user needs to enter information, the dictionary can be consulted. Information is exchanged between the departments of an organization and between medically-related businesses outside of the organization. This creates the need for use of the same type of data language, providing the systems with the ability to exchange information. Because this is an important issue for the healthcare industry as a whole, groups like The American National Standards Institute and the Health Industry Bar Code Supplier Labeling Standard have been formed to create common data formats. The recommendations made by these groups are not required for implementation, but can help with data congruency. The Health Insurance Portability and Accountability Act (HIPAA) has made some information formats standard.

Answer 176

Determining the best way to provide services within the healthcare industry while spending the least amount of money is important in any industry. The healthcare industry must determine ways to maximize profits and one area the industry focuses on is operating efficiently. DSS systems with access to the right information can help oversee and maximize operations. A Jacksonville, Florida, Mayo Clinic relies on a system to oversee and manage the use of their surgical facilities. The information communicated to the system has to be detailed and cover the surgery process from start to finish. Profits are important, but quality must not suffer; if quality suffers, less people will use the services, thus reducing profits. DSS systems are being increasingly used to measure if service is provided in the best possible manner.

Answer 177

The role of hospitals has evolved over time. They were first meant to provide medical services to groups of people in a central location, As technology has improved to meet the demands of medical practices, hospitals are needed to house technology so procedures can be performed that require longer term care than a physician's office can provide. Hospitals can be owned by the government, businesses that are paying for the hospital without making money, and companies that are paying for the hospital to make money. Government hospitals are research based and partner with schools or are designed to meet some need within the general public. Government hospitals cannot be tied to a church. Some businesses buy hospitals, called not-for-profit hospitals, which are meant to help a community but are not meant to earn the owners money. Some groups of people or businesses purchase a hospital to make money and they are called for-profit hospitals. Big hospitals located in big cities are the most commonly used hospitals. The effectiveness of the people overseeing a hospital's operation is the greatest indication of the success of the hospital.

Answer 178

The actual implementation and definition of the requirements set forth by the Health Insurance Portability and Accountability Act (HIPAA) have been areas of great diversity and confusion. The Administrative Branch of the federal government is supposed to oversee HIPAA and the result has been a changing definition of HIPAA processes. The healthcare industry has attempted to remain knowledgeable about the changes to keep in line with HIPAA by forming groups of people who are designated to keep up with the ever-changing HIPAA regulations. Oftentimes, healthcare organizations use outside companies to create their computer systems and must rely on the company to protect information by HIPAA standards. The communication that occurs between the healthcare organization and any outside agency accessing the information must also be protected by HIPAA standards. Every person within the healthcare organization and those people otherwise associated with the organization must be trained and knowledgeable about HIPAA standards to ensure they are following the standards in every aspect of their job.

Answer 179

Management can use the information they have gathered to decide what kind of system they will need--whether it be a custom- designed system or one that already exists--in the second step of the life cycle development process. Evaluating price is a major factor in this step. A package that is complete and ready for use may not function exactly the way an organization needs it to and must be altered in some ways. Any alterations cost money in both manpower and technology. The price may seem less than a custom-designed program until the costs of alterations are added in. Making a system that is custom-designed by either people employed within an organization or a company outside of the organization may be a better option. Huge organizations with many departments and employees will have a difficult time finding a preexisting system that meets all of the needs of their organization.

Answer 180

The healthcare industry places huge demands on information technology, because computer systems are used in a variety of departments and locations--both alongside the patient at a facility and away from a facility--either with a patient at an outside location or in a business meeting held away from the office. Management has to develop approaches in a meaningful and direct way to manage and oversee information systems currently in use and those needed for future use. It is imperative for the healthcare organization's management to carefully consider how much money will be spent on information systems and where in the organization will benefit from its use. Another area management must consider is how to integrate different types of systems, thus creating congruency within healthcare systems. Not doing this wastes time and money because input can be duplicated and human resources are required to input potentially unnecessary information.

Answer 181

The third step of the process is to prepare the organization by determining what technology is needed for the new computer system--a process called system design. Whether the organization uses a program that is already developed or one that is custom designed, the system requirements or specifications must be communicated for the system to work. If technicians within the organization are going to create the system, certain areas should be considered. What is needed from the system, how the system should give and receive information (known as output and input), and storage of the information within databases should all be determined. Determining how all system parts will communicate with each other effectively is another part of system design. Being able to show management their money is well spent and gaining their written approval are the last steps of the process of creating a system within an organization. If hiring a company outside of the organization to create the system, a report specifying needs and wants should be created and provided to the hired company.

Answer 182

The four reasons why a healthcare organization should develop strategies regarding the use of information technology include the following: to ensure the information technology is best used to meet an organization's standards, to make sure the computer systems are being used at their optimum value, to manipulate the computer systems technologically to meet the unique goals of the organization, and to determine how much money will be spent on the computer systems. Information technology has always been used to perform functions helping a healthcare organization with normal activities like scheduling appointments. Healthcare managers can use information systems to meet goals such as bringing in more patients or monitoring patient wait times. Because every organization's goals are tailored for their specific organization, the technology needed will vary and should be evaluated to make sure it includes the right systems for the organization. Determining the type of network an organization needs and understanding how to use the network most effectively should be part of the organization's plan.

Answer 183

The use of insurance organizations as a middleman between medical providers, the people they service, and the company who pays for the medical care leads to greater expenses for all involved. A doctor may be prone to adding in unnecessary charges or procedures to get more money for his or her services. The patient will not be as quick to question the procedures because he or she is only paying predetermined co-pays. The price of insurance however increases over time. Strategies have been created by businesses to overcome these problems. One strategy is to require the people working for them to pay for part of their insurance coverage. Co-payments and deductibles have been set up to increase the amount a patient must pay towards his or her medical services. Doctors have been limited as to how much they can charge for a procedure. Insurance companies have created lists of doctors for users of the insurance to choose from called HMOs and PPOs. Some insurance companies pay a predetermined amount based on what is determined to be wrong with the patient, called provider risk sharing. To help with medical progression and to ensure excellent care is being provided, pay for performance (P4P) plans are used.

Answer 184

Healthcare organizations (HCOs) have to listen to the needs and wants of their customers. Consumers want good care at a reasonable price. They want their physicians to be knowledgeable in their service and fair in their pricing. Consumers want every area of their healthcare needs to be covered by insurance and their physicians. A HCO that is well-managed will listen to the needs of their consumers and make the necessary modifications to meet the patient's demands. The care provided will not only include what is necessary while a patient is at the doctor's office, but also include the needs of the patients in the aftermath of their recovery. A well- managed HCO will make an effort to help patients maintain wellness and avoid illnesses. The departments within a well-managed HCO will communicate and work together effectively for the good of the patients. The HCO will combine what is known to work well within the healthcare industry while creating new strategies for the success of the medical providers and the patients.

Answer 185

A healthcare organization (HCO) is constantly changing its strategies so it can function at its optimum capability, which is known as a continuous improvement strategy. A mission statement outlines the fundamental goals of the HCO and declares how it will uniquely strive for excellence within the industry. After reading the mission statement, the reader should understand why the HCO formed. The virtues of the HCO should be detailed in the mission statement. The mission statement should be visible and known by employees within the organization and accessible to those people visiting the HCO. The mission statement should become the standard for the HCO and all changes and modifications to the HCO should be weighed against the mission statement. Employees and anyone else doing business with, or representing the HCO in any way, should be in compliance with the mission statement.

Answer 186

1, 3, and 4 only Item #3, system implementation, typically involves hardware, software, network and training. This would not be performed by a health information management professional.

Answer 187

B. review performance indicators and service metrics along with organizational perception of the team's effectiveness. The review of performance indicators, service metrics, and customer satisfaction validates the staff's concerns.

Answer 188

D. 2 and 4 only A rehabilitation center's (#2) primary service is therapies designed to restore functioning to patients following orthopedic surgery which means a large number of post-operative patients. A home health facility (#4) often receives orders for postoperative services in a patient's home environment.

Answer 189

C. an emergency department and a community health center. Health information exchange is the deployment of systems promoting and facilitating the exchange of healthcare data within a health information network. One role of information exchange is to facilitate longitudinal care between primary care and emergent care. Option "C" is the only pairing that fits this description.

Answer 190

"C" is the correct answer because quality-related data is used to drive clinical improvements and financial performance within the healthcare entity. Quality-related data does not directly determine reimbursement models, making "A" incorrect. Quality-related data is used to drive clinical improvements, not new drug studies so "B" is incorrect. "D" is incorrect because network security is outside the scope of a quality-related data set.

Answer 191

C. Identify opportunities for clinical care improvement. "C" is the correct answer because quality-related data is used to drive clinical improvements and financial performance within the healthcare entity. Quality-related data does not directly determine reimbursement models, making "A" incorrect. Quality-related data is used to drive clinical improvements, not new drug studies so "B" is incorrect. "D" is incorrect because network security is outside the scope of a quality-related data set.

Answer 192

D. medically underserved and uninsured. The main purpose of community health centers is to provide healthcare across medically underserved and uninsured populations.

Answer 193

B. Resolve application tickets

Answer 194

A. medical error

Answer 195

D. project planning

Answer 196

D. ISBT 128 The International Society for Blood Transfusion (ISBT 128) product database defines blood, tissue, and cellular therapy products in an internationally consistent and unambiguous manner. DHCP (Dynamic Host Configuration Protocol) is a protocol used by network devices. Global Standard 1 (GS1) deals with barcodes and identification, but is not specific to healthcare. SPL, Structured Product Labeling, is specific to prescription for drugs.

Answer 197

A. identifiable process that holds a private encryption key Option "B" represents DICOM standards, which are used for imaging and is therefore incorrect. "C" is incorrect because X.12 standards are used for financial information. "D" is not correct because verifying service eligibility is not a standardized process.

Answer 198

A. surgical pause.

Answer 199

C. chief executive officer. The correct answer is "C" because a CEO is the executive officer in charge of total management. "A" is not correct because a CTO is responsible for technology infrastructure and architecture. "B" is not correct because a CIO is a senior level executive responsible for providing strategic direction for IT. "D" is not correct because a CFO is responsible for financial performance and accounting.

Answer 200

B. Reconsile medication between the hospital and physician office. "B" is correct because medication reconciliation is one of the National Patient Safety Goals for the Joint Commission.

Answer 201

D. Provide a risk-managed enterprise project portfolio to inform executive leadership of progress in relation to organizational priorities. The leading purpose for a program management office is to help manage risk and progress in enterprise projects.

Answer 202

C. United Nations

Answer 203

C. clinical protocols for patient treatment.

Answer 204

D. IT steering committee

Answer 205

C. information systems The information systems department assists users in defining scope and requirements. The supply chain department is involved after RFP development. The legal department is involved later, during contract review. The finance department is involved after scope is defined.

Answer 206

C. quantitative statistics

Answer 207

D. uniquely identifies each record stored in the table.

Answer 208

B. represent and share information and knowledge in a standard format. Data standards promote the consistent recording of information and are fundamental to the efficient exchange of information.

Answer 209

B. 1, 2, and 4 only Because monitoring the problem alone will not prevent the problem from occurring in the first place and is not a preventative strategy, #3 is false. This means that the option without #3, option "B" is the correct answer.

Answer 210

c. knowledge base, inference engine, and patient-specific information "C" is the best option because the system is dependent on the ability to reason from a knowledge base. "A" is not the best option because these are simply general features of a clinical decision-support system. In "B", while these items are required, they can exist without a clinical decision-support system. Artificial intelligence is not part of a clinical decision-support system, so "D" is not correct

Answer 211

D. a practice management system. A practice management system is typically used for billing outpatient office visits.

Answer 212

C. CDSS CDSS stands for clinical decision-support systems and is used to aid clinicians in decision making.

Answer 213

B. 1, 2, and 4 only The correct answer is "B" because it does not include option "3 - equipment calibration". Equipment calibration is typically handled separately by medical engineering.

Answer 214

A. video conferencing Via video conferencing, the clinical can see the patient and hear the patient. Seeing and hearing the patient are necessary for a proper psychological consultation.

Answer 215

A. HL7 Health Level 7 (HL7) is a data communication standard for health information exchange. ICD10CM (International Classification of Diseases, 10th Edition, Clinical Modification) is a clinical coding mechanism. CPT4 (Current Procedural Terminology, 4th Edition) is a clinical procedure coding mechanism. SNOWMED (Systematized Nomenclature in Medicine) is a clinical coding mechanism which is a combination of diseases and procedures.

Answer 216

B. IHE IHE is integrating the healthcare enterprise and is an industry initiative to improve the way computer systems share information. DICOM is digital imaging and communications in medicine and is the standard used to transfer images. HL7 is Health Level 7 and provides a framework for the change of textual health information. DICOME and HL7 are comprised within IHE. OSPF is "open shortest path first", which is a networking protocol.

Answer 217

C. Measure workload and activity in order to manage resources effectively. because evaluating the workload and activities within the organization would help in resource planning.

Answer 218

C. functional requirements document. A functional requirements document is the high level document describing what functionality is desired and how it could be delivered. "A" is incorrect because while, sometimes, a functional specification may contain functional requirements, "C" is the better choice. Answer "B" is incorrect because the technical specification is the document that guides the computer programmer. It should not be created before functional requirements and functional specifications are completed. "D" is incorrect because, while a technical architecture document is a very important step if the solution is to be integrated and accessible across the network, the functional requirements document is the first step.

Answer 219

C. form workgroups to conduct a feasibility study. A workgroup should be formed to conduct a feasibility study/needs analysis. Further decisions should be withheld until a report is available for discussion.

Answer 220

A. report turnaround times. Timeliness is critical for a results reporting system. A delay in the report can result in a delay in treatment.

Answer 221

A. 1, 2, and 3 only A systems analysis should be guided by a written definition of the business problem, which defines opportunities, so #1 is true. Exploring the dimensions of the business problem from a user's perspective and specifying user needs by conducting a needs analysis, is an appropriate step, so #2 is true. Once a problem is defined and analysis has been performed, high level functional requirements can be defined, along with dependencies and constraints, so #3 is true. Conducting a prototype indicates an alternative choice, so #4 is false.

Answer 222

A. 1, 2, and 3 only #4 is not correct because a claims management system focuses on fiscal management, not improving patient care. All other options are examples of technology applications directed at improving patient care. Any option with #4 in it cannot be correct.

Answer 223

A. workflow of the caregiver "A" is correct because this is a fundamental aspect of any clinical system. All other options listed are potential features of a system but are not critical.

Answer 224

D. strategic vision. D" is the best option because the organization's strategic vision will be the driving force in the replacement.

Answer 225

C. radiologists.

Answer 226

B. request a root-cause analysis on this issue. "B" is the best option because a root-cause analysis would be the right approach to identify the problem in the current business process.

Answer 227

B. 1, 2, and 4 only Gantt charts are used to show a sequence of tasks that span across time. It is not a continuous quality improvement tool.

Answer 228

A. request the completion of a root-cause analysis. "B" is not adding staff may not be an appropriate solution, unless a root cause has been identified. There may already be adequate staff and less space/equipment. "C" is not correct because benchmarking may be an acceptable solution. It is more of a comprehensive analysis of performance without a reference to possible problem causes. "D" is not correct because this could be detrimental to the business of the organization.

Answer 229

B. histogram A histogram provides a visually understandable way to show differences in data. "A" is not correct because a control chart is a means of tracking data over time with upper and lower control limits that allow the user to distinguish between common cause and special cause variation. "C" is not correct because a distribution curve shows data's relationship to the midpoint. "D" is not correct because a Gantt chart is a planning tool that allows users to list activities over time associated with a project.

Answer 230

C. request a cost/benefit analysis. Capital investments (high dollar items) require a cost/benefit analysis to achieve required return on investment.

Answer 231

D. 4 For vendors, a fee basis contract is the best contracting option. It is risk-free and vendors get a fixed price and a fixed fee for each deliverable task.

Answer 232

A. Create an implementation team of IT, clinical, and ancillary services staff. The best first step is to create an implementation team consisting of representative stakeholders of the project. This team will help define all necessary requirements for implementation.

Answer 233

D. Discuss the steps of a system selection process with the CNO to get the project started "D" is correct because working on a selection process is a collaborative effort between IT and clinical departments.

Answer 234

A. request for information A request for information is sent to vendors asking for general product information and capabilities. Based on the response, the organization will then choose whether or not to keep them in the selection process.

Answer 235

D. HL7 and DICOM HL7 (Health Level 7) are standards for data formatting to facilitate exchange of data among disparate systems within and across software applications. DICOM (Digital Imaging and Communications in Medicine) is the standard for electronic communication of medical images and associated data. NSI ASC X12 (American National Standards Institute Accredited Standards Committee) is the standard for electronic exchange of financial data. DES (Data Encryption Standard) is used to protect electronic data.

Answer 236

C. Create an environment where expectations are defined, met, and managed. The other options may be part of various processes, but are not critical.

Answer 237

A. MPI MPI (Master Patient Index) is the warehouse of patient identification and demographic information. Duplicate patient accounts increases the difficulty of correctly identifying the patient, thus adversely affecting the delivery of services. ADT (Admit/Discharge/Transfer) is a component of a patient management application that uses data from MPI. EDI (Electronic Data Interchange) is the exchange of standardized document forms between computer systems for business use. EDI is part of electronic commerce. HDR (Health Data Repository) is a database containing clinical information.

Answer 238

D. Meet with key users in the ED to hear specific complaints first-hand. Meeting with key users allows IT to identify the specific issues as perceived by the ED staff and provide a common reference point for all parties upon which to investigate those issues.

Answer 239

A. administer medications manually. medication administration timing cannot vary. In case of system failure, there should be policies and procedures in place for contingency management. Manual administration and recording is one of the alternatives.

Answer 240

C. Ensure that the appropriate ANSI standard is being used in the transmission of each transaction. "C" is correct because this is the only standard that could impact the data itself, rather than just the transmission. "A" is not correct because print images are not used in this example. Further, DICOM is a standard typically used for storage of medical images, especially radiology images. "B" is not correct because this is a network transmission protocol. In addition, the scenario indicated that the clearinghouse successfully received the transactions. However, it could not process the data. "D" is not correct because the scenario indicated that the clearinghouse successfully received the transaction. However, it could not process the data.

Answer 241

B. scripted demonstration A scripted presentation is a live example of a future model integrated into the organizational structure. "A" is not correct because an RFP is a proposal for supplying the product or service. "C" is not correct because while an on-site visit provides an opportunity to witness the application involved, it is difficult to find sites with similar operational characteristics so it is not the best answer. "D" is not correct because it is difficult to determine the veracity and objectivity of the information provided on a reference call.

Answer 242

D. Survey the users on their specific issues. Defining the issues from users' perspectives can provide important information to assist in discerning the cause of the problem (e.g. training requirements, system issues, environment).The future solution and alternative should be developed based on the finding of the survey.

Answer 243

C. Ask each vendor for references from similar healthcare systems. Witnessing a software performance in the production environment within a similar healthcare system is the best way to evaluate performance.

Answer 244

B. schedule temporary resources to manage day-to-day operations while staff conduct testing of the new system. Parallel testing is an exercise to test the new system against the old system to compare results. This involves operating two systems and does require additional resources. Ideally, staff that are going to be end-users should participate to gain familiarity with the new system.

Answer 245

A. consider the effect of technology when it is introduced, extended, or modified. B" is not correct, as this is usually done during a selection process. "C" is not correct because this is a required maintenance activity. And, "D" is not correct because this is an applied technique of option "A."

Answer 246

C. escalate the issue using the established escalation procedure holding payment until the problem is resolved.

Answer 247

A. Set up role-based access for users. Role-based access allows users access to only the information relevant to their job.

Answer 248

C. Restrict chart access of using role-based security. Option "C" is active restriction to patient data, and therefore most effective.

Answer 249

B. data circuit backup "B" is the correct answer because having a backup line to a data center is extremely important to data continuity. A" is not correct because an uninterruptible power supply should handle electrical surges due to lightning. Both "C" and "D" should already be components of the disaster recovery plan and therefore are not the best answer.

Answer 250

A. formally assigned security responsibility to an individual. The other options are not correct because while they describe individual components of an overall security plan, none of them would be the first step.

Answer 251

D. Implement role-based authorization role-based authorization provides system access based upon the role the individual plays in the organization. Data access controls using role-based authorization allow users to access information as it related to their specific job duties and responsibilities, but prevents users from accessing data that is not pertinent to their role. Audit data for role-based authorization would clearly show access by an individual and would minimize false-positive results by virtue of eliminating access to data not relevant to the individual's role in the organization.

Answer 252

A. Perform periodic restores from tape for an additional $3,000/month because, in addition to daily backups with offsite tape storage, periodic restores to prove that the backups are successful will help ensure data integrity.

Answer 253

C. 1, 3, and 4 only While #2, offering bonuses for training completion, is a helpful way to encourage training, it does not promote services.

Answer 254

C. mission statement. The mission statement is why an organization exists. The mission of an organization is the most central agreement among the stakeholders, and it tends to be the most permanent. "A" is incorrect because the vision statement is not the basic purpose but rather a future goal. The vision is usually a simple statement of the contribution to universal goals. "B" is incorrect because values statements list the principles which guide actions. The values statement often calls for "respect", "quality", "safety", "honesty." Values statements establish the moral foundation for the enterprise. "D" is incorrect because a strategic plan is a roadmap for accomplishing goals, often spelling out specific tactics year by year.

Answer 255

B. project manager, product manager, software programmer, analyst The project manager is responsible for keeping the project plans up to date. The product manager is responsible for implementing the cardiology information system. The software programmer is responsible for designing the interfaces and user customizations. The analyst is responsible for building the procedure tables.

Answer 256

D. Stakeholder benefits, security risk review, and financial summary. Stakeholder benefits, security risk review, and financial summary will help drive the decision for approval. Mark item for review

Answer 257

A. connectivity Functionality depends on connectivity. If web access is not reliable then cost, standards, and security become irrelevant

Answer 258

C. Perform a cost-benefit analysis. The cost-benefit analysis is the process that uses quantitative techniques to evaluate and measure the benefit of providing products or services compared to the cost of providing them. This would provide information to the CFO for decision making.

Answer 259

A. Invite each customer to participate in a post-service satisfaction survey through an independent process.

Answer 260

B. process and management activity-based costing is a process whereby cost for final products and service lines are established by reaggregating unit costs from contributing services. "A" is not the best option because process and staffing are less important factors in activity-based costing. "C" is not correct because cost and staffing are less important factors in activity-based costing. "D" is not correct because customer and supplier are not factors at all in activity-based costing.

Answer 261

C. Bring functional and operational representatives together to assess the change management process. An operational review and approval of the change seems to be missing or the network would have been strengthened. Bringing together representatives from cross-functional teams allows for defining the change management process.

Answer 262

C. Perform a gap analysis of workflow versus system function. the survey responses indicate that the problem is with workflow and this option will help examine that.

Answer 263

D. 2, 3, and 4 only #1 is not true. Maintenance activities need not go through the prioritization cycle.

Answer 264

A. travel, supplies, salaries and benefits salaries and benefits, including supplies and travel expenses, will need to be budgeted for at a higher level with the addition of the two new sites. "B" is not correct because it includes depreciation which would not be increased unless there was a capital investment. "C" is also not correct because it includes depreciation. While "D" includes many items which would qualify, it does not include salaries and benefits which makes this option less appealing and not the best option.

Answer 265

C. Meet with the patient accounting director to define support expectations. the IT department needs to open up communications with its internal customers to better understand their requirements and expectations

Answer 266

B. Improve business processes. Business process improvement involves best practice processes such as plan, do, study, and act (PDSA.)

Answer 267

A. Develop policies and procedures for the management of network infrastructure across the system.

Answer 268

B. resources to outputs. Productivity is the ratio of input (resources) to output, or vice versa (e.g., cost per discharge, test per worker hour) "A" is not correct because hours per case is a measure of efficiency, not productivity. "C" is not correct because employee hours is not a ratio. And, "D" is not correct because staff to bed occupancy is a measure of efficiency, not productivity.

Answer 269

C. component alignment The component alignment model (CAM) introduced here recognizes the complexity of today's healthcare environment, emphasizing continuous assessment and realignment of seven basic components: external environment, emerging ITs, organizational infrastructure, mission, IT infrastructure business strategy, and IT strategy. "A" is not correct because this is used to identify competitive forces, and the strategies and tactics applied to address those forces. "B" is not correct because this is used to analyze the strategic significance of information technology in the value chain. "D" is not correct because this is used as an annual planning tool to update strategic plans.

Answer 270

C. net revenues minus the cost of operating expenses

Answer 271

B. Document the project budget variance. Documenting the project budget variance is required. The cost overruns on the project because of the scope creep must be recognized and documented. It is important for the board to recognize added costs as they relate to the project and the additional project requirements or increase in scope they requested.

Answer 272

C. $12,600 "C" is correct because $12,000 X 1/2 year = $6,000; $12,000 plus 10% = $13,200. $13,200 X 1/2 year = $6,600. Total for the whole year = $12,600.

Answer 273

D. 2, 3, and 4 only

Answer 274

C. Collaborate with the sites for adoption support. Collaborating with the sites for adoption support includes the other options and provides incentives to the sites. It also is an indicator of organization commitment.

Answer 275

C. 3 to 9 months after project implementation The project takes time to settle in with bugs and learning curves. Three to 9 months allows things to settle in and on-going problems to be identified. The team would have adequate time to collect the user feedback for the lessons-learned process and the formal closeout.

Answer 276

A. Understand the corporate goals and objectives. All planning should begin with an understanding of corporate goals. While understanding information goals and objectives is important, it must be done within the context of corporate goals. Soliciting input is done later in the planning process. Reviewing last year's priority list is important but must be done in the context of corporate goals.

Answer 277

C. cost variance cost variance is the appropriate analysis to determine the financial status of the project. "A" is not correct because there is not enough to determine cash flow. "B" is not correct because there is not enough information to perform a profit-loss analysis. "C" is not correct because there is not enough information to determine the cost-benefit of the project.

Answer 278

B. multiple milestone payments based on explicit vendor deliverables throughout the implementation of the project. By tying the payment plan to the deliverables tends to achieve higher accountability and compliance of both parties. If a deliverable is delayed, the funds are not at risk

Answer 279

D. evaluating the utilization of the service request tracking system. most customer interaction with an IT department is via service requests. This choice offers maximum improvement opportunity. "A" is not the best choice because reducing goals rarely improves customer service. "B" is not the best option as one more drill will likely add little incremental value. "C" is not correct because while knowing how long it takes to resolve a problem can be helpful, requesting only mean time to resolve is too general to guide any significant improvement effort.

Answer 280

D. evaluate actual workload for appropriateness. without a workload analysis, it is impossible to determine if the employee is simply not managing time well, or if there is more work than can be done by one person.

Answer 281

A. share what has been observed with the compliance officer.

Answer 282

C. place critical workstations on uninterruptible power supply units. placing critical workstations on uninterruptible power supply units limits the cost to purchasing uninterruptible power supply units for critical workstations only and allows the organization time to identify and implement long-term solutions.

Answer 283

D. Send the manager to the course this year and half the team leaders to the leadership course this year and the remaining half next year. 8($750) + 1($7500) = $13,500; 4($750) + 1($7500) = $10,500. The math works for this option and it is the best solution to the CIO's training dilemma.

Answer 284

C. compensated absences Any time off with pay is by definition compensated absence. Other examples include sick time and vacation time.

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