Health Care Organizations: Structure & Functions

Instructor: Maya Shapland

Maya has worked in the clinical, education, and management sections of healthcare for over 25 years and holds bachelor's degree in Speech and associate degree in Nursing.

This lesson embarks on the journey of transition in healthcare's organizational structure, management, government, and global changes now reshaping the nation's healthcare.

Healthcare Organizational Structures

Kelly is a Chief Nursing Officer. Her healthcare team is in a transition that requires more focus on improving patient experience and reducing errors and the cost of services provided. These challenges are met with Kelly's capable team of creative leaders.

Kelly has transitioned out of an older structure to a fresh merging of physicians, business partners, and patients into positions on the board of directors, and departmental meetings on patient safety and quality. This change in climate is helping to bring partnerships closer to meeting the goals of today's healthcare. In the past, most of these principle players would be left out of such decision-making opportunities.

Structures are becoming more centralized as larger health systems are partnering with smaller rural hospitals for education, management, and cost savings on supplies and services. The larger system then takes more of a supportive, management role and many services that were once spread out over an area are moved to the larger organization.

One of the most recent changes includes the hiring of physicians into chief officer positions such as Chief Executive Officer (CEO) or Chief Operating Officer (COO). This brings clinical experience into leadership with a fresh perspective in patient care.

Management

Kelly's management focus is on quality of patient care and her team is embracing the goals of improved patient experience and safety. One change involves inviting former patients or community patient representatives to the management team. This is called patient engagement, as the patients can provide valuable feedback that managers and leaders may use to improve the patient experience.

Emerging management techniques and changes include:

  • Building trust by communicating with transparency to all providers and staff.
  • Building a strong management base in the organization with leadership training.
  • Build trust and creative ideas with leadership listening.
  • Bringing data forward for staff to see the results of improvements.
  • Rounding (regularly updating) in patient care units with physicians and the healthcare teams including patient and families.
  • Team-building for solutions to include staff and physicians.
  • Sharing positive and negative patient experiences for learning.
  • Rounding by senior and departmental leadership.
  • Senior leadership sharing of vision, goals, and support of patients, staff, and other managers.

The community is responding positively to Kelly's efforts to bring patients to the forefront of everything her organization does.

Healthcare Governing Presence

Kelly answers to many stakeholders, the investors who expect accountability. Current healthcare stakeholders include patients, insurance companies, governmental regulatory bodies, the staff, and the communities in which they serve.

Currently, there are healthcare laws in place that Kelly must make sure the organization follows. Government is also a payor source. This creates a need to measure performance as healthcare is being paid by the quality, safety, and patient experience of the care given.

Regulations are in place covering privacy, information technology (such as the medical record), research on human subjects, medical billing and coding, reporting communicable diseases, and more.

Healthcare is governed in three principle areas
Governing

  • The Health Insurance Portability and Accountability Act (HIPAA) requires privacy and security of the healthcare record.
  • The Health Information Technology for Economic and Clinical Health Act is an amendment to HIPAA that covers the confidentiality and security of the patient's electronic healthcare records.
  • Medicare and Medicaid or Centers for Medicare and Medicaid Services (CMS) provide coverage for those who qualify to receive healthcare. The healthcare organization must comply with rules and regulations to receive payment and are subject to loss of certification for infractions.
  • Regulated reporting to public health and Centers for Disease Control (CDC) are mandatory for certain communicable diseases.

Thinking Globally

Kelly is investigating partnerships with the international community for projects assisting both facilities. Many healthcare organizations are partnering with global healthcare systems to share information, education, and work on projects together to improve quality of care.

Here are a few countries that are partnering with U.S. based organizations:

  • Liberia
  • Dubai
  • Saudi Arabia
  • China

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