Transcript HEALTH SYSTEMS ORGANIZATION - DR

Nurses
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Registered Nurses - real nurses
LPN - licensed practical nurses
Nurse Practitioners
non-licensed caregivers
Nurse-Patient Relationship
• Nurses are independently licensed
• Nurses have an independent duty to patients
• Nurses exercise independent judgment
Independent Nurse Practice
• Nurses may open an office and do wound
care and nutrition advise
• Nurses may not open an office and practice
medicine even if they are nurse practitioners
• Nurses may not be hired by a hospital to set
up a medical practice
Nurses in Institutions
• Nurses in hospitals and clinics are generally
employees of the institution
• The institution is generally responsible and
liable for what they do.
• If a physician hires a nurse, the physician
takes on these responsibilities
Nurse-Physician Relationship
• In most settings, nurses are absolutely
subservient to doctors
• A nurse may refuse an order but may not
change an order
• Nurses may be protected from bad orders by
the practice acts or the rules of the hospital
Nurse Extenders
• lower level care providers
• medical assistants, surgery technicians, lab
technicians
• on the job training vs certification
Nurse Extenders in Institutions
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need to be carefully screened
need to be carefully supervised
institution has all the responsibility
cannot rely on the license or certification
Other Providers
• Many other health care professionals
• Doctors
– physicians, psychologists, dentists
– independent – some with limitations
• Technicians
– x-ray, laboratory, pharmacy
– legally and administratively similar to nurses
Administrators
• great responsibility - little authority when it
comes to patient care
• laws forbid corporate practice of medicine
• need good contracts and institutional rules
so they can control what goes on
• some states license or register
administrators
STRUCTURE OF HEALTH
SYSTEMS
20 February 2009
WHAT IS HEALTH ?
• A STATE OF COMPLETE PHYSICAL,
MENTAL AND SOCIAL WELL-BEING,
NOT MERELY THE ABSENCE OF
DISEASE
• WORLD HEALTH ORGANIZATION
WHAT IS HEALTHCARE ?
• HEALTH CARE IS THE TOTAL
SOCIETAL EFFORT FOCUSED ON
PERSUING HEALTH
• MAY ACT ON INDIVIDUALS OR THE
ENVIRONMENT
• EXPANDED GREATLY OVER THE
LAST 40 YEARS
PUBLIC HEALTH VS
PERSONAL HEALTH
• PUBLIC HEALTH - TO IMPROVE THE
HEALTH OF A POPULATION
• PERSONAL HEALTH - TO IMPROVE
THE HEALTH OF THE INDIVIDUAL
US PUBLIC HEALTH SYSTEM
• Local System – very political
• Governed by Boards of Health
• Health Officer/Director
HEALTH DEPARTMENTS
• Environmental Management
– Vectors
– Water quality
– nuisances
• Disease Control
– Clinics
– Epidemiology
• Personal Health Services
PREVENTION
• PRIMARY - PREVENTION OF DISEASE
• SECONDARY - PREVENTION OF
CONSEQUENCES OF DISEASE
• TERTIARY - PREVENTION OF DEATH
OR DISABILITY
HEALTHCARE ORGANIZATIONS
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Hospitals
Residential Care
Home Services
Physicians’ Offices – 37%
Dentists’ Offices – 20%
Other Practitioners Offices
Ambulatory Care Centers
Other Outpatient Services
Lab, Xray, & Other Diagnostics
Day Care
INTEGRATED
ORGANIZATIONS
• HOSPITALS, PHYSICIANS, INSURERS,
AND PURCHASERS FORM
VERTICALLY AND HORIZONTALLY
INTEGRATED ORGANIZATIONS
• IN OTHER CONTEXTS THESE ARE
CALLED MONOPOLIES
HORIZONTAL INTEGRATION
• LINKING ORGANIZATIONS OF THE
SAME TYPE TO INCREASE MARKET
SHARE
• MEDICAL EXAMPLE
– BUYING ALL THE NURSING HOMES
• MONOPOLY EXAMPLE
– AT&T, Cox Cable
VERTICAL INTEGRATION
• LINKING ORGANIZATIONS SO THAT
SUCCEDING TRANSACTIONS STAY
WITHIN THE SYSTEM
• MEDICAL EXAMPLE
– OCHSNER CLINIC
• MONOPOLY EXAMPLE
– STANDARD OIL
HIGHLY INTEGRATED
HEALTH SYSTEM
• VERTICAL INTEGRATION AND AN
INSURANCE CONTRACT
• BIG MOVE TOWARD THIS IN THE
1980s AND 1990s
• TREND IS NOW AWAY FROM
VERTICAL INTEGRATION
TRIAD OF GOVERNANCE
• Governing Body
• CEO
• Professional Staff Organization
Hospital Medical Staff
• Bylaws are the structure
– Not like corporate bylaws
• Licensed Independent Practitioners
– Their contract with the hospital
Practitioner Relationship with the
Hospital
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1) simple privileges
2) contractor – radiology
3) employee – medical director
4) employee/learner – residents
5) extenders – any of the above
Credentialing
• Prove training and experience
• National Practitioner Data Bank
• Major liability for the hospital
Impaired Practitioners
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8 to 15% of physicians
10% of nurses
Required reporting
Formal rehabilitation programs
Used to be handled by the medical staff
Now the hospital’s problem
Management Skills
• There is special training for healthcare
administration
• Getting an MD or a BSN does not make you
too stupid to learn this