Implementing HIPAA security in a membership organization

The upcoming HIPAA security regulations are forcing a change in business and operating procedures that many, if not most, healthcare organizations are ill-prepared to tackle. Of all healthcare organizational structures, membership organizations will most likely face the greatest number of obstacles in preparing for and implementing the HIPAA security regulations. This is because the membership organization as a whole must find a way to accommodate the disparate technologies, business and operating methodologies and processes, and available, limited resources of its individual member organizations, and integrate these into a uniform implementation plan. Compounding these obvious difficulties is the unique challenge of enforcement authority. The individual member organizations are autonomous business entities, whereas the membership organization as a whole merely acts as an advisor or consultant, and has only limited enforcement authority over any individual member organization. This article explores this unique situation in depth. We focus on PROMINA Health System, a nonprofit healthcare membership organization that consists of five disparate member healthcare organizations. We examine the challenges PROMINA has encountered in its quest to institute an organization-wide HIPAA security program and its methodology for accomplishing program implementation.     

Successful healthcare programs and projects: organization portfolio management essentials

Many healthcare organization projects take more time and resources than planned and fail to deliver desired business outcomes. Healthcare IT is a major component of many projects and often undeservedly receives the blame for failure. Poor results are often not a result of faulty healthcare IT or poor project management or poor project execution alone. Many projects fail because of poor portfolio management--poor planning and management of the portfolio of initiatives designed to meet an organization's strategic goals. Because resources are limited, portfolio management enables organizations to more strategically allocate and manage their resources so care delivery, service delivery, and initiatives that advance organizations toward their strategic goals, including healthcare IT initiatives, can be accomplished at the levels of quality and service desired by an organization. Proper portfolio management is the essential foundation for program and project success and supports overall organization success. Without portfolio management, even programs and projects that execute flawlessly may not meet desired objectives. This article discusses the essential requirements for porfolio management. These include opportunity identification, return on investment (ROI) forecast, project prioritization, capacity planning (inclusive of human, financial, capital, and facilities resources), work scheduling, program and project management and execution, and project performance and value assessment. Portfolio management is essential to successful healthcare project execution. Theories are drawn from the Organizational Project Management Maturity Model (OPM3) work of the Project Management Institute and other leading strategy, planning, and organization change management research institutes.     

The comprehensive organizational plan: how a COP can protect and serve your health care organization

In today's hyperturbulent and competitive health care environment, health care organizations must improve operating efficiency, reduce duplication, and compete effectively in the health care market to survive. The comprehensive organizational plan is a 5-stage development tool for health care organizations that is intended to protect and serve the health care organization in its survival efforts. Through its 5 planning stages-competitive, facilities, financial, human resources, and marketing-the comprehensive organizational plan assists the organization in optimizing the goals of cost containment, quality preservation, and universal access.     

Treating information and information technology as true resources

Hospitals and other health care organizations historically have been slow to adopt new managerial techniques. The same holds true for the acceptance of information and information technology as true strategic resources. With so much emphasis being placed on lowering operating costs and increasing the quality of care combined with the information revolution in today's society, the current complacent attitude often displayed toward health information management poses glaring organizational dilemmas for today's health care organizations. As many health care organizations begin to grapple with technical tasks such as developing the electronic patient medical record, they realize that there are many organizational implications to be dealt with as well. Issues such as who has the proper authority and responsibility not only to manage the mainframe and networks but also to correlate the information that all the hardware and technology provide with the strategic goals of the organization present significant hurdles. If these hurdles are not successfully cleared, any attempts at improving organizational strategy and performance via improved management of information resources are inhibited.     

江西省县级卫生监督机构卫生人力资源现状分析

目的：了解江西省县级卫生监督机构的卫生人力资源现状,为今后合理的配置县级卫生监督人员提供依据。方法：采用普查方法对2007年江西省11个地级市的95所县级卫生监督机构进行调查。结果：县级卫生监督机构卫生人员数量不足;整体素质尚可;继续教育比例仅占调查总数的65．61％,但整体培训质量尚可。结论：增加县级卫生监督所的人员配置,科学配置人才队伍。     

基于DEA分层评价的医疗资源配置研究

目的：根据对主管层及各医疗机构的决策有效性进行评价的结果,确定各机构医疗资源配置的有效性对整个医疗系统有效性的贡献大小。方法：系统考虑各医疗机构之间协调性及医疗机构与上级主管部门的主从关系,运用DEA分层系统评价方法测算卫生人力总数、床位数、医疗设备总值、药品支出等医疗资源配置情况。结果和结论：系统配置效率为有效的前提下,主管部门可根据各医疗机构对系统有效性的贡献大小有侧重地采取措施,提高医疗机构的配置效率。     

Preparing for the strategic planning process helps ensure implementation success

Strategic planning in many organizations has been less satisfying and useful than these organizations had hoped. We believe these outcomes may be due to a limited view of planning and the implications of the planning process for the organization. Our belief is that these organizations were not genuinely "ready" to engage in the kind of thinking and work required for strategic planning. Therefore, we propose a model of planning readiness consisting of seven components. Each component offers the organization leader an opportunity to achieve improved levels of planning readiness within the organization.     

The challenges of implementing quality improvement in small rural hospitals

In the five years since launching its QI initiative, Mason General Hospital has dealt with many of the challenges that commonly arise in healthcare organizations during TQM implementation, including involving physicians and training staff. It also had to address a host of issues common to small rural organizations. At first glance, one might suspect that the move toward QI would be easier in a small organization because there are fewer leaders to orient, fewer people involved in work processes, and fewer levels of management. In fact, the small organization presents special challenges, including limited staff and financial resources, high turnover rates in key medical staff leadership positions, and small sample sizes. The strategies used by Mason General Hospital to respond to these and other challenges provide a model for small rural healthcare organizations.     

Leaders who create change and those who manage it. How leaders limit success

There is no formula for either leading or managing change. Every organization and leader is unique. Leading change, however, is more art than science. Managing change is more science than art. Leading change is not simply a matter of a leader's style or personality; it is a leader's philosophy of how to generate and mobilize the total resources of an organization to enable it to be its best. Managing change, on the other hand, is focused on maintaining stability in an organization and containing the effects of unwanted and unexpected change. Leaders set the limits of success in their organizations by how they manage change. The different approaches of 2 leaders who have created change to correct problems in our health care delivery system are discussed.     

Small-grants programs: lessons from community-based approaches to changing nutrition environments

Providing small grants to community organizations can be an effective way to encourage changes in the environment that support better nutrition. This is effective because these organizations can provide insights into their communities, ready-made relationships with community members, and the trust of the community. Small-grants programs are more likely to be successful when they are tailored to the needs of individual communities, led by organizations that have established reputations with the community, fully supported by the lead community organization, and engage local partners that complement the skills and resources of the lead organization. An evaluation of a small-grants program, Grants for Healthy Youth, found that grantees developed unique approaches to improving their community nutrition environments, gained experience and skills in program development, built partnerships, and received recognition for their project work. Grantees faced some common barriers, especially with program evaluation. Small-grants programs can be an effective way to improve community nutrition environments, but granting agencies need to provide effective technical assistance to communities throughout the process.     

Paying the piper: investing in infrastructure for patient safety

BACKGROUND: Although the best allocation of resources is unknown, there is general agreement that improvements in safety require an organization-level safety culture, in which leadership humbly acknowledges safety shortcomings and allocates resources at the patient care and unit levels to identify and mitigate risks. Since 2001, the Johns Hopkins Hospital has increased its investment in human capital at the patient care, unit/team, and organization levels to improve patient safety. PATIENT CARE LEVEL: An inadequate infrastructure, both technical and human, has prompted health care organizations to rely on nurses to help implement new safety programs and to enforce new policies because hospital leaders often have limited ability to disseminate or enforce such changes with the medical staff. UNIT OR TEAM LEVEL: At the team or nursing unit level, there is little or no infrastructure to develop, implement, and monitor safety projects. There is limited unit-level support for safety projects, and the resources that are allocated come from overtaxed department budgets. ORGANIZATION LEVEL: HOSPITAL LEVEL AND HEALTH SYSTEM: Infrastructure is needed to design, implement, and evaluate the following domains of work-measuring progress in patient safety, translating evidence into practice, identifying and mitigating hazards, improving culture and communication, and identifying an infrastructure in the organization for patient safety efforts. REFLECTIONS: Fulfilling a commitment to safe and high-quality care will not be possible without significant investment in patient safety infrastructure. Health care organizations will need to determine the cost-benefit ratio of various investments in patient safety. Yet, predicating safety efforts on the mistaken belief in a short-term return on investments will stall patient safety efforts.     

Hospital data center delivers computing services via network of printers

A group of 23 Virginia health care organizations has pooled their resources with a not-for-profit, shared-service organization that provides them with an extensive series of business and clinical data processing systems. This article is followed by a series of brief reports on other installations.     

Management theory and applications

Management is critical as an organization pursues its mission. There are many theories of management, but all agree that an effective organizational structure can facilitate the operation of a company. The author describes the typical functional areas found in most organizations (finance, operations, marketing, information systems, legal, and human resources); examines how the organization of tasks and people are inter-linked; and shows that administrators who have a working knowledge of management theory tend to be effective in the performance of their jobs.     

Success and failure: a case study of two rural telemedicine projects

We studied two rural telemedicine projects in the state of Michigan: one that enjoyed success and steady growth in activity, and one that experienced frustration and a lack of clinical utilization. Multiple data collection strategies were employed during study periods, which lasted approximately one year. Both projects enjoyed a grassroots approach and had dedicated project coordinators. However, the more successful project benefited from resources and expertise not available to the less successful project. In addition, the more successful project possessed a more formalized organizational structure for the telemedicine application. A comparison of the two projects leads to a simple conclusion. Telemedicine programmes are positioned within larger health organizations and do not operate in a vacuum. It is crucial that the organization in which it is intended to launch telemedicine is examined carefully first. Each organization operates within a larger environment, which is often constrained by fiscal, geographical and personnel factors. All these will affect the introduction of telemedicine.     

2008年我国省市两级健康教育机构能力建设现况调查

目的了解2008年省市两级健康教育机构能力建设现况。方法采用《2008年全国健康教育业务工作调查表》对全国省级和市级健康教育机构进行问卷调查,调查内容包括机构设置、人员构成和能力建设等。结果全国34个省级健康教育机构中,有13个省级健康教育所为独立建制;428个地市级地区中,419个设有健康教育机构,机构设置率为97.89%。省市两级健康教育专职人员共2695人,其中省级616人,市级2079人。两级健康教育机构共培训4576次,执行国际合作项目、国家级和省级项目共计679个,在国家级和省级期刊上发表学术论文730篇、发表科普文章2605篇。结论健康教育能力建设是长期的任务,需政府和健康教育机构的不懈努力,要不断加强机构建设、优化健康教育人力资源配置,提高整体素质。     

A vision for older adults and health promotion

Our rapidly aging population is expected to place heavy demands on all segments of society, particularly the health care resources needed to attend to health concerns associated with aging. Is this a looming crisis, as some predict, or a challenge to use resources more wisely and to help older adults and their caregivers share in the responsibility for health promotion and chronic disease self-management activities? Community-based organizations serving older adults are uniquely positioned to augment health care providers' health promotion counseling activities and to bridge the gap between the research and practice of health promotion in older adults. They already play a crucial role by providing appropriate health promotion education, screening and referral, service planning, and reinforcement to facilitate self-care activities and behavior changes that promote healthy aging. By increasing teamwork across the network of services for the aging, the health sector, public and private organizations, and academe, there is a great opportunity to enhance the health and well-being of all older Americans.     

社会组织参与卫生政策过程的思考

社会组织是政党和政府以外的民间性组织,一般具有非政治性、非营利性、自发性等特点。在本文所关注的广西壮族自治区内的三个与妇女健康相关的政策个案中,不同层级、不同类别的社会组织都参与其中并发挥了重要作用。社会组织在人力资源、技术能力、投入热情等方面的优势是其得以参与并发挥作用的基础,而政府与社会组织之间的平等和信任关系则是维系这种参与的关键。今后政府应为社会组织提供更好的参与空间和平台,发挥其自身优势,在一个多元治理体系下形成政府和社会组织的良性互动,进而有效的推动政策目标的实现。     

Tools for novice health care clinical administrators

With the face of health care changing at a blistering pace due to shrinking resources, advanced technology, and growing consumer demands, organizations, for-profit and nonprofit alike, have responded by flattening organizational hierarchies. Consequently, it is not an uncommon practice to promote "successful technical experts" to clinical administrator positions. Ill-prepared, rookie clinical administrators are often left struggling to manage an organization with little experience and training. Fortunately, there is help. This article will identify and apply internal and external tools that newly promoted clinical administrators can use to hurdle potential pitfalls.     

Assessing the implementation of clinical process innovations: a cross-case comparison

Clinical process innovations (CPI) are central to the ability of organizations to negotiate the challenges of cost containment and quality improvement, yet many CPI have not met expectations. Perhaps most alarming is that the dissemination and implementation of CPI is not well understood. This is the second of two articles addressing the dissemination and use of CPI in integrated delivery systems. This article discusses those factors that have been identified as either facilitating or impeding the various stages in implementing CPI and suggests some intervention strategies to enhance opportunities for continuous CPI. Identifying the process and the factors driving the implementation of CPI is only part of the challenge. The development of CPI adequate to fully meet current challenges will require managers to re-examine existing paradigms and values influencing their actions to date. Within this context, the necessary staging of the innovation process within the life cycle, developing partnerships both within and outside the organization to gather the necessary resources and support, and multidimensional performance monitoring and feedback can prepare organizations and managers to better face the reality of managing the innovation process.     

Special Section: Breaking Bad News: Current Best Advice for Clinicians

Today's healthcare executives face challenges that their predecessors have never known: bioterror events. To prepare their organizations to cope with new and emerging strategic threats of bioterrorism, these executives must consider preemptive strategies. The authors present courses of action to assist executives' internal, external, and cross-sectional organizational preparedness. For example, stake-holder groups, internal resources, and competencies that combine and align efforts efficiently are identified. Twelve preemptive strategies are provided to guide healthcare executives in meeting these formidable and unprecedented challenges. The reputation of the healthcare organization (HCO) is at risk if a bioterror event is not properly handled, resulting in severe disadvantages for future operations. Justifiably, healthcare executives are contemplating the value of prioritizing bioterror preparedness, taking into account the immediate realities of decreasing reimbursement, increasing numbers of uninsured patients, and staffing shortages. Resources must be focused on the most valid concerns and must maximize the return on investment. Healthcare organizations can reap the benefits of a win-win approach by optimizing available resources, planning, and training. Bioterror preparedness will transcend the boundaries of bioterrorism and prepare for myriad mass healthcare incidents such as the looming potential for an avian (bird) influenza pandemic.