Healthcare Jamie Phillips, FACHE Vice President, Operations Nationwide Children’s Hospital.

HealthcareJamie Phillips, FACHE

Vice President, Operations

Nationwide Children’s Hospital

Highlights

Healthcare• 24 questions for 14% of exam• 8 knowledge areas

Knowledge Areas

Healthcare & Medical Terminology Healthcare Trends Managed Care Models, Structures & Environment

(Group, Staff, IPA, PPO) The Acute Care Sector The Ambulatory Care Sector Interaction & Integration Among Healthcare Sectors Ancillary Services (Lab, Radiology, Therapies) Nursing, Physicians & Allied Health Professionals Roles

This section will focus on your knowledge of the:• Key components of healthcare delivery systems• Roles and relationships of the principal professionals

involved in healthcare delivery• General education and training requirements for major

healthcare professions and occupations• Primary professional associations with which healthcare

professionals are affiliated• Principle types of healthcare delivery settings in which

inpatient and ambulatory care is delivered• Differences in ownership, mission, service specialization,

and other important features among hospitals• Vertical and horizontal integration in recent years

Healthcare

This section will focus on your knowledge of the:• Different types of ambulatory care settings and how they

differ in structure and operations• Varied configurations of physician practice arrangements• Major types of managed care organizations and the

products they offer• Managed products and contracting arrangements• Purchaser and consumer preferences have shaped

managed care markets and how they may be changing over time

• Managed care organizations may differ in terms of ownership and affiliations

• Consumerism affecting healthcare organizations and professionals

Healthcare

Healthcare straddles science, commerce and many other aspects of human behavior and draws on several different bodies of knowledge.

• Clinical

• Administrative

• Rapid pace of technological advances

• Policy changes

Healthcare

Traditional healthcare delivery system is a “sickness system”

• Focused on clinical interventions

• Treated patients after they presented to the healthcare system

Healthcare

As the scarcity of limited resources in healthcare has grown, executives are expected to become even more directly involved in RESOURCE MANAGEMENT and ALLOCATION DECISIONS.

Healthcare

Efforts are made to re-orient the attention of healthcare systems more toward

• Health

• Health promotion

• Disease prevention

• Customer service

• Patient involvement in their care and decisions

Healthcare

Understand the continuum of care:

• Acute

• Curative care

• Long-term rehabilitative/custodial care

• Palliative care

• Outpatient/ambulatory

• Inpatient/institutional

Healthcare

Settings of outpatient care

• home

• physician offices

• clinic-based settings

• outpatient departments of a hospital

• emergency departments of a hospital

Healthcare

Implications of types of inpatient care

• Service complexity

• Specialization

• Medical staff membership

• Ownership

• Breadths of ancillary services

• Level of acuity

Healthcare

Alternatives site of care

• Satellite facilities

• Joint venture partnerships with physicians

• Freestanding facilities

• Sub acute care

• Post-acute care

Healthcare

Horizontal vs. vertical integration

Vertical – expanding services up and down the continuum of care

Horizontal – increasing and integrating points of care

Healthcare

Understand the rise and “fall” of managed care

• Purpose of managed care

• Risk based compensation – capitation

• Focus on wellness & care management

• Operational efficiency

But why did it not succeed?

Healthcare

Need more in-depth resources?Delivery Health Care in America, 2nd ed. By Leiyu Shi and Douglas A.

Singh

Essential in Managed Health Care, 4th ed by Peter R. Kongstvedt

Health and Healthcare in the United States, by Michael J. Long, Ph.D.

Introduction to Healthcare Delivery Organizations: Functions and Management, 4th Ed, by Robert M. Sloane, FACHE; Beverly LeBov Sloane; and Richard K. Harder

Understanding the U.S. Health Services System, 2nd Ed by Phoebe Lindsey Barton, Ph.D.

Healthcare

Healthcare

Ready for some test questions?

An efficient Formulary and Therapeutics Committee in many hospitals evaluates all of the following except?

1. Symptoms of adverse reactions.2. Patients’ current medication effectiveness.3. Contraindications.4. Specific drugs in terms of appropriateness to caseload.

Healthcare Test Questions

Which of the following would represent the most common cause of adverse drug events?

1. Lack of standardization.2. Lack of knowledge of drug.3. Preparation errors.4. Transcription errors.


Participating providers in the federal Medicare program must:

1. Be accredited by the Joint Commission.2. Serve Medicaid beneficiaries.3. Meet the Conditions of Participation.4. Be in compliance with state Certificate of Need laws.


Which physician organization is responsible for accrediting residency training programs?

1. ACGME

2. AAMC

3. CAT

4. BPQA


According to CMS Conditions of Participation, under what circumstances, if any, is it permissible to deny a patient access to his/her medical record?

1. The information requested consists of psychotherapy notes.

2. The request comes from the patient’s personal representative instead of directly from the patient (if allowed under state law).

3. The provider organization will incur significant costs in copying or forwarding the requested records.

4. It is never permissible to deny a patient access to his/her records.


Communication Health Intranet Networks (CHIN’s) were developed for what purpose?

1. To provide a platform for an electronic medical record.2. To provide a way to disseminate community level health

data.3. To provide an inexpensive way of sharing health

information.4. To provide a community-based hub for sharing health

information.


In planning for future community health services, it is important to understand population health needs. Which ethnic category tends to proportionately use physician services the most?

1. African American.2. Asian.3. Latino.4. White.


Which of the following limitations would cause a hospital OB unit to see no change in volume over a four year period?

1. Organizational.2. Market.3. Financial.4. Clinical.


The overall goal of the HIPAA Act of 1996 is:

1. To insure the privacy and confidentiality of patient medical records.

2. To standardize the sharing of clinical and administrative information.

3. To strengthen healthcare data security standards and practices.

4. Improve portability and continuity of health insurance, and to combat fraud.


The four important aspects of clinical support services are technical quality, patient satisfaction, continuity of integration and:

1. Cost-benefit analysis.2. Outcome.3. Appropriateness.4. Health promotion.


Medicare Conditions of Participation for hospitals require that a prescribing practitioner authenticate a verbal order within ____, if not defined by the state.

1. 24 hours.2. 48 hours.3. 7 days.4. 30 days.


What is true about the relationship between acute care hospitals and long-term care organizations?

1. Hospitals and patients frequently have difficulty arranging for nursing home care services.

2. Hospitals generally do not want to refer patients to nursing homes since part of the patient care revenue must be shared.

3. Nursing homes generally do not want to refer patients to hospitals since this interferes with state or federal length of stay requirements.

4. Nursing homes are generally thought to be superior to hospitals at chronic disease management.


Under HIPAA, Congress required the Secretary of HHS to adopt standards to:

1. Create Pay-for-Performance Standards for CMS.2. Provide for standard data elements and code sets.3. Require electronic health records by 2010.4. Publish clinical outcome results on Medicare patients.


The principle goal of a Health Services Organization’s medical /hospital model is:

1. Security.2. Disease treatment.3. Quality of life.4. Comfort.


Which of the following regulations exempted self-funded employer-sponsored health insurance plans from state insurance regulations?

1. BBA.2. TEFRA.3. COBRA.4. ERISA.


The single most important way patients can help prevent medical errors from affecting them is to:

1. Interact with their caregivers.2. Research medical error rates among organizations.3. Read and understand consent forms.4. Chose large, reputable healthcare providers.


In a hospital setting, a critical pathway is beet described as

1. A document that focuses on efficiency and describes a standard set of activities to be performed for a defined category of patients.

2. A set of guidelines that focus on identifying those decision points which should lead to the consistent provision of appropriate clinical practice.

3. Any attempt to standardize clinical activities based upon diagnostic categories and projected outcomes.

4. Decision tree that focuses on physician decision making.


Under a capitated payment system, the risk sharing arrangements involve which parties?

1. Insurers and patients.2. Physicians and purchasers.3. Hospitals and patients.4. Hospitals and patients.


Management

& Business

Highlights

Management• 19 questions for 11% of exam• 6 knowledge areas

Business• 20 questions for 12% of exam• 7 knowledge areas

Knowledge Areas - Management

Implementation Planning (e.g., operational plan, management plan)

Contingency Planning (e.g., emergency preparedness) Organizational (systems) Theory & Structuring (e.g.,

span of control, chain of command, interrelationships of organizational units)

Management Functions (e.g., planning, organizing, directing, controlling)

Leadership Styles/Techniques Mediation, Negotiation, Dispute Resolution Techniques

Knowledge Areas - Business

Basic Statistical Analysis Strategic Planning Principles Basic Business Controls (e.g., legal and financial

implications) Marketing Principles & Tools (e.g., market analysis,

market research, sales, advertising) Techniques for Business Plan Development &

Implementation Principles of Public and Community Relations The Functions of Organizational Policies & Procedures

• Management or managing is a process comprising interrelated social and technical functions and activities.

• Establishing organizational objectives• Providing organizational context within which

direct and support work can be performed effectively

• Preparing an organization to deal with the treats and opportunities in its external environment

Management & Business

The five management functions:

1. Planning

2. Organizing

3. Controlling

4. Directing

5. Staffing

All are connected by decision making – problem solving


Managing vs LeadingManaging –

caretaking maintaining status quotransactional

Leading –visionarydynamictransformational


Managerial skills• technical• conceptual• interpersonal

Senior managers make greater use of conceptual skills

Middle/entry level managers tend to have a more even mix of the three


Mintzberg’s research – managerial roles • Interpersonal

– Figurehead– influencer

• Informational– Monitor– spokesperson

• Decisional– Entrepreneur– negotiator


Managerial competencies• Conceptual• Technical managerial/clinical• Interpersonal/collaborative• Political• Commercial• Governance• others


Management’s authority or power• Legitimate (formal)• Reward• Coercive• Expert• Referent

Understand the risks and benefits of each


Leader traits and skills• Assertive • Cooperative• Decisive• Dependable• Intelligent• Conceptually skilled• Creative• Persuasive


Leadership styles (Likert)• Autocratic• Benevolent• Consultative• Participative/democratic


Designing Formal Organizations• Genesis in the planning function• Authority and responsibility relationships• Departmentation• Coordination and relationships of components


Levels of Organization• Health systems composed of health service

organizations– Health service organizations

• Clusters of workgroups (clinical groups)–Workgroups (departments, teams)

»Individual positions


“Organization” within an organization• Formal structure and formal organization• Informal organization – dynamic behavior and

activity patterns• Combination of both the formal and the informal

are the actual organization


Strategic Planning & Operational Planning• Strategic planning addresses the longer-term

direction and goals selected by the governance and management

• Operational planning focuses on the direction and activities of individual units and departments of the organization. The operational plan must be coordinated with and is subordinate to the strategic plan


Contingency planning• Anticipating the unknown• Mitigating the potential negative implications• Turning the unknowns into economic or

competitive advantages• External disasters• Internal disasters


Managers as Negotiators• Know the art of negotiating• Conflict in negotiations

– how resources are to be divided– resolving psychological dynamics and

satisfying the personal motivation of those involved


Resolving Disputes• Alternative dispute resolution (ADR)

– binding finding and nonbinding arbitration

– mediation– mini-trials– neutral fact

• Legal action



Need more in-depth resources?Haimann’s Healthcare Management, 7th ed by Rose T. Dunn, FACHEHealthcare Strategic Planning: Approaches for the 21st Century by Alan M.

Zuckerman, FACHE, FAAHCHealth Service Management: Readings and Commentary, 7th Ed., by

Anthony R. Kovner, Ph.D. and Duncan Neuhaser, Ph.D.The Leader’s Change Handbook, by Jay A. Conger, Gretchen M. Spreitzer,

and Edward E. Lawler IIILeadership for the Future: Core Competencies in Healthcare, by Austin

Ross, LFACHE; Frederic J. Wenzel and Joseph W. MitlyngManaging Health Services Organizations and Systems by Beafort B.

Longest, Jr., Jonathon S. Rakich, and Kurt J. Darr, J.D., Sc.D, FACHEMastering the Negotiation Process: A Practical Guide for the Healthcare

Executive, by Christopher L. Laubach

*The Well-Managed Healthcare Organization, 5th Ed, by John R. Griffith FACHE and Kenneth R. White, Ph.D., FACHE


Ready for some test questions?

Hospitals pursuing strategic alliances are faced with issues of vertical integration. One example of vertical integration is:

1. Acquiring a long-term care facility.2. Creating a “super” physician-hospital organization.3. Developing a system of local hospitals.4. Outsourcing laboratory services.


Test Questions

The concept of demand management consists of:

1. Concurrent review.2. Risk assessment.3. Disease management.4. Chart review.


Test Questions

You are planning to conduct an assessment of the utilization patterns in your organization’s emergency department over the past three years. Which of the following techniques would be most appropriate? (186)

1. Strategic Planning.2. Trend Analysis.3. Situational Analysis.4. Survey Research.


Test Questions

Which of the following is not an example of a marketing function?

1. Promoting the organization.2. Convincing patients to select the organization.3. Managing external relationships.4. Reviewing organizational costs.


Test Questions

The arrival of women for obstetrical deliveries or patient flow in an emergency department can best be analyzed through the use of which technique?

1. Pert Charting.2. Stochastic Modeling.3. Gant Charting.4. Monte Carlo Simulation.


Test Questions

All of the following are essential components of strategic planning except:

1. The corporate mission statement.2. Timetables for activity completion.3. Competitive analysis.4. Assessment of the external environment.


Test Questions

Operational planning can be correctly defined as:

1. A function of establishing the annual budget by accumulating departmental information.

2. The process by which short range objectives and actions are established and implemented in accordance with the strategic plan.

3. An annual process of developing, evaluating and implementing goals based on community needs.

4. Determining the major types of services offered based on profit margins.


Test Questions

Which of the following statements best defines increased productivity?

1. An increase in productivity occurs when the number of units of service rendered in a given year increases over the number rendered in the previous year.

2. An increase in productivity occurs when an increase occurs in the volume or number of units of service rendered.

3. An increase in productivity occurs when a reduction occurs in the ratio of hours worked to the number of units of service rendered.

4. An increase in productivity occurs when an increase occurs in the revenue from a given number of full-time equivalent employees.


Test Questions

Materials management can best be defined as a system of effective:

1. Purchasing of materials at the lowest possible cost.2. Distribution of materials on a scheduled basis.3. Allocation of materials.4. Control of inventories.


Test Questions

Before submission of the annual business plan to the governing authority, the plan should be developed by:

1. Recommendations from the finance committee, on the basis of its estimate of income for the budget year.

2. The heads of the profit centers, considering each center’s anticipated revenues and expenses, with the CEO collating.

3. Key executives, after receiving recommendations from the head of operating divisions.

4. The heads of the operating divisions, with the CEO collating.


Test Questions

From a marketing viewpoint, the development of the standards of practice, clinical pathways, clinical guidelines and protocols can all be viewed as efforts to deal with which unique aspect of delivering services:

1. Inseparability.2. Intangibility.3. Heterogeneity.4. Perishability.


Test Questions

The master site plan (or master facility plan) for a healthcare organization:

1. Describes future facility needs (either renovation or new construction) necessary to meet strategic and operational needs.

2. Provides detailed design documents for all construction programs along with specific costs for each project.

3. Must be prepared by an outside planning or architectural firm to ensure sufficient objectivity.

4. Is necessary to ensure that the organization complies with certificate of need and other regulatory requirements.


Test Questions

A master patient index (MPI) can best be described as:

1. A relational database containing all identification numbers assigned to patients.

2. A system for converting social security numbers to medical record numbers.

3. A system for converting medical record numbers to patient account numbers.

4. A longitudinal record of all patient encounters for a fixed period of time.


Test Questions

A bar chart format, with the items rank ordered on a dependent variable, such as cost, profit, or satisfaction that examines the components of a problem in terms of their contribution to it is known as:

1. A run chart.2. A frequency table.3. Pareto analysis.4. Deming cycle.


Test Questions


Test QuestionsThe best way to reduce/contain the costs of distributing supplies throughout an organization is to:

– Purchase the most modern supply distribution system for your organization

– Minimize the number of times an item is handled from the time it is received by the organization to the time it is used

– Utilize a computerized materials management system that allows the organization to minimize inventory levels

– Negotiate a contract with an outside vendor who specializes in supply distribution to provide these services


Test Questions

• To guard against the loss of assets, an administrator should do which of the following?

a. Encourage off-site storage of equipment

b. Allow service directors to determine the frequency of asset inventories

c. Implement detailed procedures, risk control and annual outside audits


Test Questions• Medicare DRG payment is highly dependent

upon a hospital’s case mix index. This index represents the average relative weight for all Medicare patients treated in a:

a.Specific nursing unit or specialty area

b.Specific period

c.Common geographic market

d.Specific facility

What is the first effect of demographic trends on a health service organization’s strategic planning process?

1. Appraising financing sources and payment levels for programs.

2. Establishing future staff by type and estimating staffing levels.

3. Determining the locations of delivery units for the next period.

4. Determining the range and types of services to be offered.


Test Questions

Healthcare Jamie Phillips, FACHE Vice President, Operations Nationwide Children’s Hospital.

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