C429 Topic 1 Study Guide and Practice Questions with

pg. 1 C429 Topic 1 Study Guide and Practice Questions with Correct Verified Answers. Graded A+ Health Operations Management C429 Study Aid - Topic 1 Organizational Culture Chapter 1 – Foundations of High Performing Healthcare Organizations

• What is the role and commitment of the healthcare organization to the population and how do

healthcare organizations work to fulfill that commitment? (Topic 1 and 3) The health-care organization (HCO) creates, supports, and co-ordinates those teams. It is a formal legal entity that reaches across the panorama of medicine, other clinical disciplines, and business to identify and deliver care to its community.

• The HCO constantly responds to the changing array of patients and their changing needs. This makes

most HCOs a 24/7/365 operation.b.The HCO evolves as medicine and management change, reflecting both the latest scientifically proven treatments and new developments in management practices and information technology.c.The HCO adjusts to the changes in its community’s need

• What are stakeholders and how do stakeholders influence the actions and decisions of the healthcare

organization?Stakeholders- Individuals or groups (buyers, workers, suppliers, regulators, and owners) who have a direct interest in an organization’s success.. Sources of Stakeholder Influence The ultimate source of stakeholders’ power is the marketplace—their ability to participate in the exchange. Influence is exercised through on-going negotiation rather than discontinued participation. Stakeholders form coalitions (alliances) and networks to enhance their influence and facilitate negotiation. The results of negotiation are embedded in marketplace contracts and reinforced through government regulation. Ultimately, but rarely, the courts resolve disputes in relationships 1 / 3

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a) Participation and Market Pressure- Successful HCOs work steadily and systematically to

increase the loyalty of their stakeholders. Their efforts are proactive and extensive. Their goal is to identify stakeholder needs and design effective responses before unmet needs become points of contention. Stakeholder participation is carefully measured. Customer participation is measured by market share, and provider participation is measured by retention and shortages. Satisfaction of participants is also monitored. The goal here is to acquire and retain loyal or secure customers and associates

b) Negotiation- Rather than discontinue their participation, stakeholders usually present their

concerns for negotiation. The stakeholders’ desires frequently conflict and can easily become adversarial, as in the traditional relationship between unions and management.Successful HCOs strive to minimize adversarial relationships by building a record of responsiveness and truth telling, making a diligent effort to find and understand relevant facts, maintaining respect and decorum in the debate, and searching diligently for solutions.The goal is to have the stakeholders leave the discussion feeling that their concerns were heard that the decision was fair, and that no realistic opportunity to improve the decision exists. “My (or our) concerns have been heard and met as well as possible” is the feeling that results from successful negotiation.

c) Networking and coalition Building- Each exchange partner of the HCO has relationships with

exchange part-ners of their own. Individuals and families affiliate with employers, businesses, schools, churches, and community groups. Stakeholder coalitions form among these relationships based on shared values or common needs. Many are permanent, while others are temporary alliances to forward a specific goal.Similar networks exist for other social issues. They are the essence of “community” because they facilitate our living together harmoniously. Nur-turing these networks is fundamental to the social fabric.11 HCOs that deal effectively with these networks contribute to their communities in two ways: (1) they provide and improve healthcare, and (2) they strengthen the social fabric.

d) Social control- Stakeholders can imbed their viewpoint into law, regulation, and contract.

Theycan also sue in courts. These actions are social controls on HCOs. They create the various regulatory mechanisms. For example, The Joint Commission has been given extraordinary power by Medicare and Medicaid, which withhold payment unless its standards are met. As a result, it can effectively shut down any HCO by denying accreditation. Medicare and private insurance programs now use the NQF measures in pay- for-performance programs to improve quality,14and The Joint Commission has added the measures to its criteria.Social controls almost always reflect good intentions—safety, quality, individual rights, equity, and efficiency. Accomplishment is another matter. It is fair to conclude that both the regulatory agencies dealing with healthcare delivery and the contracts of the health insurers and intermediaries have generally fallen short of expectations. Safety, quality, healthcare disparities, and cost remain problems despite decades of activity in these areas. In part, this reflects the complexity of the goal and the difficulty of measurement. In part, it reflects the limitations of the 2 / 3

pg. 3 market and governmental systems. The use of objective measures of performance may provide an improve-ment. Many observers agree that “The U.S. health care delivery system is in need of overhaul. Care is fragmented, unsafe, and inefficient. . . . [S]tronger organizational capabilities and supports are urgently needed to achieve high levels of performance.”16 Pressures to build these capabilities and achieve The Joint CommissionA voluntary consortium of HCOs and professional provider organizations that ensures a minimum level of safety and quality in

HCOsSocial Controls Chapter 1: Foundations of High-Performing Healthcare

Organizations13performance are likely to mount. By the start of the Obama administration, many experts argued that broad changes in the overall system of healthcare are essential. One group of experts from 13 different stakeholder organiza-tions advocated “to create a national center for effectiveness research, develop models of accountable healthcare entities capable of providing integrated and coordinated care, develop payment models to reward high-value care, develop a national strategy for performance measurement, and pursue a multi-stake-holder approach to improving population health.”17 The model described in this text is consistent with such a program. It is based on actual HCOs that have documented their success in meeting multiple stakeholder needs.Provide 5 examples of stakeholders and the significance of each.

• Associates- People (employees, trustees and other volunteers, and medical staff

members) who give their time and energy to the HCO

• Primary care practitioners- Initial contact providers, including physicians in family

practice, general internal medicine, pediatrics, obstetrics, and psychiatry; nurse practitioners; and midwives.

• Equal employment opportunity agencies Government agencies that monitor the

rights of associate groups; these are among those entitled access to the HCO and its records.

• The Joint Commission - A voluntary consortium of HCOs and professional provider

organizations that ensures a minimum level of safety and quality in HCOs

• Customers- whose opinions of the organization are so positive that they will return

for further interaction and will recommend or refer the organization to others

• How do healthcare organizations address and prevent stakeholder conflict? What is the significance of

prevention of stakeholder conflict?

• Stakeholders can imbed their viewpoint into law, regulation, and contract. They can also sue in courts.

These actions are social controls on HCOs. They create the various regulatory mechanisms. For example, The Joint Commission has been given extraordinary power by Medicare and Medicaid, which withhold payment unless its standards are met. As a result, it can effectively shut down any HCO by denying

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