Medical Management PDF

Medical Management Mariam Ambroladze  Medical Menagment  Health, Healthcare, and Healthcare Organizations  Health and What Determines It  The Force Field Model of Health  Health Services  Healthcare Organizations  The Environment of Healthcar...

Medical Management Mariam Ambroladze  Medical Menagment  Health, Healthcare, and Healthcare Organizations  Health and What Determines It  The Force Field Model of Health  Health Services  Healthcare Organizations  The Environment of Healthcare Organizations  Healthcare Issues, Trends, and Future Developments  Healthcare Management Jobs and Careers Mariam Ambroladze  What is health? health A state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1  Public Health Defined “The science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.” —CEA Winslow Photo: IF Fisher and EL Fisk Mariam Ambroladze  The Mission of Public Health “Fulfilling society’s interest in assuring conditions in which people can be healthy.” —Institute of Medicine “Public health aims to provide maximum benefit for the largest number of people.” —World Health Organization Mariam Ambroladze  Public Health Key Terms clinical care: prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by medical and allied health professions; also known as health care. determinant: factor that contributes to the generation of a trait. epidemic or outbreak: occurrence in a community or region of cases of an illness, specific health- related behavior, or other health-related event clearly in excess of normal expectancy. Both terms are used interchangeably; however, epidemic usually refers to a larger geographic distribution of illness or health-related events. health outcome: result of a medical condition that directly affects the length or quality of a person’s life. Mariam Ambroladze  Individual health Hco physical ability, emotions, socialization, blood pressure, and absence of pain Population Health birth rates, life expectancy, death rates, prevalence of diseases, and group averages for individual health measures  Managers of HCOs historically focused on the health of their individual patients. Now they also are addressing the health of their local populations Managers must strive to improve health at both the community population level and the individual person level. You will have to do the same when you are managing an HCO. Determinants of Health Genetics is the starting point of health. Genes and characteristics inherited from parents make a person more likely or less likely to develop certain health problems, such as heart disease or cystic fibrosis. For now, managers have to modify the other four determinants to improve health Healthcare services exist for all ages and stages of life, from womb to tomb. Managers can improve people’s health by helping to ensure people’s appropriate use of quality healthcare However, other determinants, such as behavior and social environment, often have a larger effect on health Individual behaviors, such as smoking, seat belt use, diet, flossing, handwashing, and exercise, strongly affect health. For example, heart disease has been linked to behaviors that include smoking, eating unhealthy foods, and not exercising. Healthcare managers can improve people’s health by helping them improve their lifestyle and behavior. Some HCOs offer smoking cessation programs, nutrition classes, and fitness walks. Physical environment is the physical setting (natural and built) in which someone lives. Many elements of the physical environment affect health, such as sanitation, climate, parks, nighttime lighting, forests, safe roads, and air pollution. We can understand the importance of the physical environment by considering the health problems caused by floods and hurricanes. Healthcare managers can improve people’s health by helping them improve their physical environment. For example, HCOs have helped their communities reduce air pollution, build parks, and remove garbage. The social environment includes factors such as socioeconomic status, availability of fresh food, job opportunities, social interaction and support, discrimination, education, language, poverty, prevailing attitudes, and neighbors. Many of these factors vary based on location. The effect of these factors on health has gained recognition in recent years. Healthcare managers can improve people’s health by helping them improve their social circumstances. Healthcare providers are entering more of this information into patients’ medical and health records to monitor and address it with patients https://5mgame.lxp.academy.who.int/game/ https://www.youtube.com/watch?v=8wi8gYBSq1Q health disparity A health difference that is closely linked with social, economic, or environmental disadvantage. Health disparities are common among groups that face barriers based on their gender, race, e ethnicity, disability location, and other factors. The US population is becoming more diverse, and many healthcare managers are striving to reduce disparities so that everyone can live healthy lives. You too will do that in your career. how can healthcare managers use determinants of health to improve people’s health? Realize that factors other than healthcare are important. What have HCOs done there (besides delivering medical care) to improve health  healthcare and health services. Which ones have you heard of? Some prevent problems, some diagnose problems, some treat problems, and some support people at the end of life. Some are short-term; others are long- term. The many kinds of healthcare and health services can be grouped into categories, such as preventive, diagnostic, curative, rehabilitative, and so on. Yet most types of care occur in more than one kind of HCO. For example, diagnostic care occurs in freestanding diagnostic centers, outpatient clinics, physician practices, hospitals, urgent care centers, and other HCOs. Healthcare and health services together can be thought of as a continuum of care (CoC) or care continuum with a range of services needed to care for a person or population CoC begins with prenatal care, ends with palliative end-of-life care, and includes all other health services in between that people might use during their lifetime. Some HCOs extend the CoC into the community and call it a “health continuum” to more fully improve the population health The health continuum extends beyond direct healthcare services to include housing, food support, employment, and other social determinants of health that come from outside the usual healthcare system a continuum of care (CoC) e “womb-to-tomb” Smaller CoCs exist for particular kinds of patients or stages of life, such as CoCs for obstetrics, HIV, rehabilitation, or behavioral health. A CoC shows in a typical sequence the types of care and services needed for a specific patient population. Health professionals use CoC models as tools to plan how to meet the healthcare needs of a person or population in the most cost-effective way. managers of HCOs must consider their place in their patients’ CoCs and form effective links with other services and organizations in those CoCs. In a global effort to raise awareness on breast cancer, October has been designated as the Pink Month. The Pink Month is a month where efforts to educate those concerned about the disease, including early identification and signs and symptoms associated  What HCOs have you heard of, worked at, or volunteered at? Some HCOs, such as large general hospitals, provide a wide range of services spanning many parts of the CoC. Other HCOs, such as hospices, specialize and provide only a narrow range of services in one part of the continuum. Hospitals may also specialize, such as hospitals for only psychiatric care or for only rehabilitation services Telehealth and virtual care methods have expanded the range of health services delivered in people’s residences.  Healthcare Organizations Ambulatory HCOs provide healthcare services to people who obtain care but do not stay overnight They might offer: diagnostic testing, on-site therapy services, outpatient surgery, lab tests, medical imaging, and other services to diagnose health problems. mental health clinics ambulatory surgery centers counseling offices sports medicine businesses public health agencies urgent care facilities Telehealth and virtual care dental practices Home care organizations provide an array of nursing care, therapy, and health services in people’s homes. Association improve people’s health by funding research, developing educational programs, reducing risk factors, and assisting people who need treatment Medical supply firms and pharmaceutical as Johnson & Johnson produce and distribute supplies, drugs, and equipment that other HCOs use for their healthcare Philips make complex medical equipment. Some companies make catheters, intravenous solutions, antibiotics, bandages, and many other daily supplies. Health insurance companies, such as Blue Cross, are another type of HCO. These businesses assist in the financing of and payment for healthcare services Colleges and universities educate people to work in dozens of types of healthcare jobs. Professional and governmental organizations such as The Joint Commission and the Ohio Department of Health accredit, license, and regulate HCOs. Philanthropic organizations such as The Commonwealth Fund and the Kaiser Family Foundation provide research, education, and financial grants to improve health. The External Environment of Healthcare Organizations An HCO exists in an external environment of people, organizations, industries, trends, forces, events, and developments that are outside of the HCO. These other organizations, forces, and people affect HCOs in many ways An HCO exists in, and is influenced by, a larger world. The HCO must be open to its external environment and interact effectively with it To paraphrase an old saying, no HCO is an island unto itself. An HCO depends on people and organizations in its environment just as a person does  When you are a manager, pay attention to your external environment Thinking about each of these sectors helps managers analyze their external environment and more fully comprehend how it affects their HCO. 1. Industry sector—related businesses and competitors that offer products and services similar to what your organization offers 2. Raw materials sector—suppliers, manufacturers, and service providers, from which your organization obtains needed supplies, equipment, and services 3. Human resources sector—employees, labor unions, schools, colleges, employment agencies, and labor markets, from which your organization obtains human resources (employees) 4. Financial resources sector—banks, lenders, stock markets, and investors, from which your organization obtains loans, credit, and other financial resources (not customers and insurers who pay your organization for products and services) 5. Market sector—actual and potential customers, clients, and users of your organization’s products and services 6. Technology sector—science and technological methods of producing products and services, some of which your organization uses 7. Economic conditions sector—levels and rates of employment, inflation, growth, investment, and other economic circumstances in which your organization exists (not financial resources or money for your specific organization) 8. Government sector—laws, regulations, court rulings, political systems, and governments at the local, state, and federal levels, some of which affect your organization 9. Natural sector—natural resources, the green movement, and forces for sustainability 10. Sociocultural sector—characteristics of the society and culture (e.g., education, values, attitudes) in which your organization exists 11. International sector—globalization, and other countries and their customs, industries, businesses, and people, some of which might affect your organization  Managers of HCOs should realize that their organizations must interact with many others to produce a CoC and healthcare services for their population.  Managers must develop good relationships between their HCO and the external environment  Healthcare Trends and Future Developments Managers can use the methods, tools, principles, and techniques in this book to help their HCOs monitor and adjust to these changes. Thus, managers should know “how to create a healthcare organization that can succeed in an unpredictable future” Workforce. Many HCOs are striving to develop a diverse workforce that better matches the diversity of the population they serve. Managers are more concerned about workers’ engagement, safety, joy, human interaction, and overall work experience. Employers are striving to reduce employees’ fatigue, stress, burnout, and turnover while improving work flexibility, rewards, development, work space, well- being, feedback, and support. Continual training, upskilling, and development of workers are essential. Payment Healthcare payment is increasingly based on value of care rather than volume of care. Payments are being tied to performance as measured by Population health. The benchmarks and standards for healthcare system and HCOs quality, patient experience, are giving more attention to clinical outcomes, and best population health and healthy practices. Payment may be based communities through increased patient experience All that a on bundles of services for use of epidemiology and public patient experiences and perceives episodes of care, or on care that health services to address risk while interacting with the is accountable for keeping factors healthcare system, healthcare people healthy. organizations, and healthcare workers Connectedness. People and organizations are becoming more connected locally, regionally, nationally, and globally. Consolidation. HCOs continue to consolidate into a variety of larger organization forms Health science and technology. Continual Big data and predictive analytics. Clinicians and advances in science and technology enable managers are developing systems to use big new approaches to health prevention, data from all aspects of people’s lives to predict diagnosis, and treatment future health problems of individuals and populations Some of these trends and developments are included in the Triple Aim that many HCOs have been working toward. The Institute for Healthcare Improvement advocates :  improving the patient’s experience of care (including quality and satisfaction),  improving the health of populations, and  reducing the per capita cost of healthcare. stakeholders For a designated organization, people and other organizations who have a stake (interest) in what the organization does. stakeholders are people or groups of people (inside and outside the organization) and other organizations (outside the designated organization) that have a stake (interest) in the designated organization Types of Healthcare Organizations and Jobs New graduates should expect to begin their careers in entry-level jobs. From there, promotions can lead to middle-management and then upper-management positions. After gaining some experience, you will be able to move between different types of HCOs, such as from a hospital to a health insurance company or a primary care network. There are many opportunities for students to develop exciting, rewarding healthcare management careers, Interested in the future of healthcare and healthcare jobs? You can access trends and data at the US Bureau of Labor Statistics healthcare occupations website (www.bls.gov/ooh/healthcare/ home.htm). Trends and data for management jobs are at www. bls.gov/ooh/management/. Check it out online and see what you discover—now and throughout your career Health is more than the absence of disease. It includes complete well-being—physical, mental, and social. People’s health is determined by five broad forces: genetics, healthcare, individual behavior, physical environment, and social environment. Although healthcare managers can’t improve heredity, they can improve all the other forces to boost a population’s health. Healthcare services range from prenatal care to end-of-life palliative care, and they form a womb-to-tomb continuum of care. Many kinds of healthcare organizations exist to provide these services. Some directly provide health services in the CoC. Others (e.g., suppliers, insurers) do not directly provide health services but perform other essential services, such as manufacturing healthcare supplies and financing healthcare. HCOs interact with each other and with many other elements in their external environment. All HCOs depend on many other organizations and their environment. When the external environment changes, those changes often affect HCOs. Thus, HCOs must monitor and adapt to changes in their environment. Healthcare managers work in a wide variety of jobs and HCOs throughout the CoC and health sector.  Five determinants of health model Continuum of care External environment divided into sectors QUESTIONS Mariam Ambroladze 1. Based on what you learned in this chapter, discuss the determinants that affect health and well-being in the community where your college is located. Give an example of each determinant. Which determinants do you think healthcare managers can change the most to improve population health? 2. What are disparities in health? Give examples. Why must healthcare managers understand these disparities? 3. Why is the external environment so important to healthcare organizations? Which sectors of the environment do you think are most important for HCOs? Give examples. 4. Discuss several trends and issues presented in this chapter. Which of these trends and issues do you think are the most challenging for specifi c types of HCOs? 5. 5. After students graduate with degrees in healthcare management, what are some HCOs and jobs that they could work in? Which of these are you interested in Suppose you are asked to serve on a college task force whose mandate is to recommended what the college should do to help students improve their health. Using what you have learned in this chapter about the determinants of health, suggest how students’ individual health and population health can be improved. Discuss your ideas with other students. You can also see early work on developing objectives for the 2020– 2030 decade. https://sdgs.un.org/2030agenda  THANK YOU! Contact if you have questions [email protected] Tel:574004032 Mariam Ambroladze