Integrated health care organizations: guideline for analysis

There has been a tendency recently to abandon competition and to introduce policies that promote collaboration between health providers as a means of improving the efficiency of the system and the continuity of care. A number of countries, most notably the United States, have experienced the integration of health care providers to cover the continuum of care of a defined population. Catalonia has witnessed the steady emergence of increasing numbers of integrated health organisations (IHO) but, unlike the United States, studies on health providers' integration are scarce. As part of a research project currently underway, a guide was developed to study Catalan IHOs, based on a classical literature review and the development of a theoretical framework. The guide proposes analysing the IHO's performance in relation to their final objectives of improving the efficiency and continuity of health care by an analysis of the integration type (based on key characteristics); external elements (existence of other suppliers, type of services' payment mechanisms); and internal elements (model of government, organization and management) that influence integration. Evaluation of the IHO's performance focuses on global strategies and results on coordination of care and efficiency. Two types of coordination are evaluated: information coordination and coordination of care management. Evaluation of the efficiency of the IHO refers to technical and allocative efficiency. This guide may have to be modified for use in the Catalan context.     

Employment-at-Will: guidelines for health care managers

Employment-at-will is a doctrine that allows an employee or employer to terminate the employment relationship at any time for any reason. This doctrine has eroded over time with the enactment of federal legislation that gives workers job protection. Moreover, various states recognize 3 major exceptions to the doctrine. This article examines the historical development of employment-at-will, discusses the pros and cons of at-will employment, describes the exceptions to the doctrine, and discusses at-will employment issues in the health care industry.     

Resource requirements for health care organizations

Decisions regarding resource requirements are often based on single-factor decision rules. Although the use of such rules will simplify the decision process, these rules ignore the multiple consequences of each decision. Instead the health care administrator should base a decision on the mix of performance promised by a given resource decision.     

New federal guidelines standardize data collection for health organizations

Some tips on using sharing data under new HIPAA rules.     

Scenarios: a planning tool for health care organizations

An organization's strategic planners require an understanding of future developments in the environment in which their decisions will be made. However, there is increasing recognition that there is no single predetermined "future." Therefore, the use of alternative future scenarios can be helpful. Scenario construction is a technique for combining possible environmental developments in a systematic way to help managers assess the potential consequences of alternative decisions. This article discusses the scenario technique and shows, as an example, its application to one organization in the health care field.     

Preventive health care strategies for health maintenance organizations.

This paper reports the results of a study of preventive health care services offered by Health Maintenance Organizations and other health care deliverers in the U.S. Nine areas have been selected for review — initial and periodic screening, health hazards appraisal, health education, chronic disease prevention, the maternity cycle and the neonate, childhood and adolescence, mental health services, drug abuse and alcoholism, and preventive dentistry. Recommendations are made as to how preventive health care services might be provided by an HMO with suggestions for appropriate medical histories to formulate a baseline health profile of each participant.     

Discussion of patient-centered care in health care organizations

The tradition of inherent knowledge and power of health care providers stands in stark contrast to the principles of self-determination and patient participation in patient-centered care. At the organizational level, patient-centered care is a merging of patient education, self-care, and evidence-based models of practice and consists of 4 broad domains of intervention including communication, partnerships, health promotion, and physical care. As a result of the unexamined discourse of knowledge and power in health care, the possibilities of patient-centered care have not been fully achieved. In this article, we used a critical social theory lens to examine the discursive influence of power upon the integration of patient-centered care into health care organizations. We begin with an overview of patient-centered care, followed by a discussion of the various ways that it has been introduced into health care organizations. We proceed by deconstructing the inherent power and knowledge of health care providers and shed light on how these long-standing traditions have impeded the integration of patient-centered care. We conclude with a discussion of viable solutions that can be used to implement patient-centered care into health care organizations. This article presents a perspective through which the integration of patient-centered care into health organizations can be examined.     

Cross-functional teams in health care organizations

Cross-functional teams in health care organizations provide a comprehensive view of problems and are highly useful in designing and implementing improvements in work processes. Several potential obstacles may impede team progress, but these can be overcome. Cross-functional teams must develop norms that guide the interactions of team members. Individual team members must display behaviors that serve task accomplishment and team spirit. The promise of cross-functional teams for health care organizations is great. These promises, however, will not be fulfilled without the positive support of health care supervisors.     

Creating customer-focused health care organizations

Most health care organizations are operating under an "old paradigm" wherein the needs of physicians and third party payers drive the organization. In the current hypercompetitive health care markets, executives need to focus more directly on their increasingly assertive and knowledgeable patient customers. This article describes practices of the best guest-services organizations that may be transferable to health services organizations. It also proposes ten principles that constitute the "new paradigm."     

Mergers and health care organizations

The concerns over ever-rising health care costs has motivated physicians, hospitals, and insurance carriers to search for ways to increase efficiency, decrease costs, and maintain or improve quality. Mergers have been recognized as having the capability to accomplish all three goals-but not without some concerns. This article's intent is to provide the reader with basic knowledge that will assist in understanding the discussion regarding the appropriateness of mergers in health care. It reviews issues raised by mergers and examines a few case studies of merged health care organizations.     

Preparing for networking information systems in health care organizations

Because the health care administrator faces unprecedented demands concerning information, well-designed and carefully selected information systems have become a critical factor in the viability and survival of health care institutions. Local area network systems are having a significant impact in this regard. Among their advantages are flexibility, dependability, low cost, and modularity. Health care facilities, have found networking to be a simple, cost-effective solution to collecting, processing, and distributing large volumes of data. The keys to a successful implementation recommended in this article should assist health care professionals once they have made the hard decision to use a local area network to process their day-to-day transactions.     

A framework for cultural competence in health care organizations

Increased racial and ethnic diversity in the United States brings challenges and opportunities for health care organizations to provide culturally competent services that effectively meet the needs of diverse populations. The need to provide more culturally competent care is essential to reducing and eliminating health disparities among minorities. By removing barriers to cultural competence and placing a stronger emphasis on culture in health care, health care organizations will be better able to address the unique health care needs of minorities. Organizations should assess cultural differences, gain greater cultural knowledge, and provide cultural competence training to deliver high-quality services. This article develops a framework to guide health care organizations as they focus on establishing culturally competent strategies and implementing best practices aimed to improve quality of care and achieve better outcomes for minority populations.     

Education for social work in health care organizations.

The American health care delivery system stands on the brink of major change and reorganization. There are many opportunities for the social work profession to increase its influence and expand the scale of its activities within health care. These opportunities represent a challenge to the vision, creativity, and flexibility of social work educators. This article discusseses educators' roles within the context of a system conceptualization of the inputs throughputs, and outputs of education for social work in health care organizations.