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Bradley Williams2-6-15Anaya 1st hour Code Blue Discussion QuestionsChapter 1From what you have read in chapter one complete the following personality profile for Hap Castleton and Del Cluff.AttributeHap CastletonDel CluffFocuses on detailsxxFocuses on the big picture xxMotivated by factsxMotivated by feelingsxFocuses on the possible xMotivated by dreamsxAnalyticxxSympathetic xInterested in things xInterested in people xInclined to gather a lot of information before making a decision.xxInclined to decide quickly based on emotion rather than facts.xWhy is it important to understand the values, personalities, and decision making modelOf a person you wish to communicate with?This is important so then you can understand a person better and to know how to talk to them about important things when trying to prove a point.It is obvious Del Cluff has not established a good rapport with his boss Hap Castleton. To what do you attribute the problem?This problem is most likely caused by how they don’t see eye to eye on certain situations and how they are different in the case of one believing one thing will work and how the other believes it won’t.What are the differences in the ways Del Cluff and Hap Castleton process information, and therefore make decisions?The difference in the ways they think is that with Hap he thinks of others first and then decides to do something to try and help them. Del thinks about what will happen to the big picture and them tries to make decisions to try and support the main thing even if some people don’t like it.Given the differences in personality, values, and decision-making style, how could Del Cluff be more efficient in communicating his concern about the hospital’s financial condition to his boss Hap Castleton? Del could be more efficient by explaining some of the numbers, such as how much debt the hospital is in and how the hospital’s new budget would help it stay afloat financially.Writing Exercise Assume you are Del Cluff. From what you know about Hap Castleton, prepare a written memo explaining your concerns about the hospital’s losses. Explain why you will not oppose Edward Wycoff’s efforts to cut the hospital budget.To Whom It May Concern, this note is to anyone wondering about if I will oppose Edward Wycoff’s effort to cut the hospital budget. The truth is that I will not be opposing Mr. Wycoff’s decision. Even with the recommendation to do so by Mr. Hap Castleton, I will not oblige to his ways. This is due to the fact that I believe Mr. Hap causes more problems than he fixes and doesn’t have a mind for finances. With that said, I will stand behind Mr. Wycoff’s decision so then we will be able to help ourselves with our own finances. –Del Cluff Chapter 2 What are the advantages and disadvantages of selecting an interim administrator?Some of the advantages include that they can help a hospital in a crisis and they can also help with immediate financial trouble. They can also be a disadvantage by not being able to stay for long periods of time, it is hard to find a temporary one with a lot of experience, and then workers have to deal with two administrators. Chapter 3Edward Wycoff felt Hap Castleton and Wes Douglas would make a good team, as each would complement the strengths and weaknesses of the other. What are the strengths and weaknesses of Hap and Wes?Edward Wycoff related the story of several vice presidents of a large fortune 500 company who were successful while holding important jobs within the company, but lost their fortunes when they tried to go into business for themselves. Why did this happen? What can a supervisor learn from this experience?This happened because they did not form a functional team to help lead their businesses. A supervisor could learn in this experience the way to build an effective team to run a business.Why did Wes accept the offer to serve as interim administrator of Brannan Community hospital? What did Wes Douglas have to win by accepting this offer, and what might he have to lose? Place yourself in the role of Wes Douglas. Would you accept the job?He accepted it to increase his visibility in Park City. He could win more popularity and a bigger business. He could lose whatever small reputation he has, and he could be left with less money. I would not accept the job because I would already have a good paying job and even though I wouldn’t get as popular, I would still have a guaranteed income. It has often been said; how someone does something is as important as what he or she does. If you were chairperson of the board, would you have fired Selman? Is there anything you would have done differently? I would not have fired Selman. I would have blamed him partially for the financial trouble, but I would keep him for his experience and knowledge. Also I would not have displayed the same actions in the meeting as Wycoff in the meeting.Assuming it was necessary to fire Roger Selman, What do you think of Wycoff’s timing? ‘Wycoff’s timing is completely off. He fired someone of great importance in a great time of pressure and anxiety. This combination does not go well together in the sense of moral and good hope. Wycoff single handedly caused a ginormous amount of unneeded and unwanted stress.What was the response of hospital employees to the appointment of Wes Douglas as administrator? What might the board have done to ease his transition? Most of the board is surprised about Wes’s new position as administrator. They are mostly surprised about how he has never worked in a hospital before now, and that his only experience is in financing. They could have eased the transition by being more open to him, and by welcoming him more than worry about him. So long as the board does the right thing, does it matter what the employees or the medical staff think of their actions?Yes, the employees should still care about the actions of the board. Say if the board cuts workers rates or hours to save money, there will be a benefit to saving some money. Still the employees should care because that would affect their lifestyles. Where does authority come from: a title or credibility?Authority most likely comes from a title, but usually people prefer authority to come from someone who is credible and responsible. What will Wes Douglas have to do to to build his credibility with the board, the medical staff, and the employees?With the board he will have to show them that he can get his work done and have the responsibility to maintain his position. As for the medical staff and employees, he will have to get to know them and communicate to them as if he truly wants to help them and not speak from a higher up position and deliver fake promises. If an allied health employee has good technical skills, why is it important for him or her to have political savvy and good communication skills as well? This is important because if a person has these technical skills he or she can be very good at communicating with many people in a short amount of time. This can help the flow of work and overall help greatly in the flow of everything around the work place. Birdie Bankhead, Hap Castleton’s secretary, believes Edward Wycoff may have hidden motives in selecting Wes is there to take the blame and is there to insure the success of the hospital.Cystitis-Gingivitis-Hematology-Histology-Hypodermic-Liposuction-Necrophobia-Necrosis-Ophthalmologist-Orthodontist-Tracheoscopic-Assuming you are a healthcare practitioner talking to someone with no medical training about a loved one who has been admitted to the hospital. Translate the following into simple English the family can understand. A. B.C.D.Assume you were asked to fire Roger Selman. Prepare an outline of what you would say. Role-play the situation with another student in front of the class, showing courtesy and kindness. Chapter 4The first meeting of Wes Douglas with Elizabeth Flannigan, director of nursing, didn’t go well. If you were the new administrator, explain how you might have established rapport with your new nursing director before exploring a controversial topic such as cost reduction. I would have explained the tight belt around our cash at that point in time. I also would have explained how I would work to help reduce cost and increase efficiency in that field. How can Planning for an important meeting with a supervisor, coworker, or subordinate raise your chance of success? What issues might you want to include in such a planning session? Planning can always help for any occasion it helps plan for your tactics you are talking about in your meeting. It helps you be prepared for any questions that may arise and any other issues you may have. Some of the issues you may have is when people are concerned about their work such as pay, hours, and working conditions.Emil Flagg, the representative of the medical staff on the board of Trustees, is an important stakeholder in the operation of the hospital. What would have been your approach in defusing Dr. Flagg’s anger during his first meeting with the new hospital administrator? I would have talked about the different plans I had made for all the different staff groups as of the moment. I would also have addressed any questions that any medical staff employee would have thought to ask me like all of the other questions I answered.From the conversations of hospital employees Wes Douglas monitored in the hospital cafeteria, it is obvious the employees have a negative impression of their new administrator. List possible reasons for this. If you were interim administrator, how would you address this problem? Some reasons for this is that there are probably doubts about how I could turn the situation around when the hospital is in such a deep amount of debt. Another reason is that I was hired by Wycoff, this could lead the staff members to believe I wouldn’t be a good candidate for the position seeing as how Wycoff wants to run everything himself. Sometimes, people jump before they think. Wes Douglas, for example, is having second thoughts about accepting the job of administration. Given that he has accepted the job, what do you think is his best course of action? Should he bail out, walking away from the commitments he has made to the board, or hang in there and try to salvage the situation?Wes should hang in there because while it may not provide as much money as his other job, this is a guaranteed salary. He also realizes how much this hospital means to the community and he would like to see it saved. Hank Ulman, president of the employee council, thinks he sees a vacuum in leadership—one he is eager to fill. What are his motives? Does he have the best interests of the hospital at heart? List several alternative courses of action Wes Douglas might take in neutralizing Ulman’s efforts. List the advantages and disadvantages of each course of action, telling what you would do if you were the interim administrator. Wes needs to talk to all employees to find out their concerns and possible solutions to their concerns. An advantage of this would be gaining the employees trust and insight into the issues. A disadvantage to this would be you can’t always guarantee that every request can be fulfilled. This could lead to hard feelings from some. According to Wes Douglas, what is the role of the board, and what is the role of the hospital administrator? Wes Douglas canceled the meeting with Hank Ulman at the Union Hall. Why did he take this course of action? How would you handle the situation?During a telephone conversation between Wes and Edward Wycoff, Wycoff expressed his wish to involve himself in solving the hospital’s operating problems. What are the advantages and disadvantages of having a board member involved in daily operations? The advantages to having a board member involved in daily operations is that he or she can be recognized and truly known for who they are. In Wes’s case this can be good because he has good intentions for the hospital and the more people that know who he is and how helpful he is, the better.Why are elevators and hospital cafeterias a good place for reconnaissance by attorneys who have malpractice suits against the hospital? What ramifications does this have for patient privacy? Is there a lesson for hospital employees?Elevators and hospital cafeterias are a good place for reconnaissance for attorneys and mal practice suits against the hospital because these are places for gossip and socializing. To this, the employees can talk about the patients in both of these places and that would be a violation of privacy toward the patients. A lesson for the hospital employees is that they should learn to talk about something different and make sure to respect patient’s privacy. What do employees think of Edward Wycoff, chairperson of the finance committee? Why do they think Wes Douglas is in Wycoff’s camp? Should Wes Douglas distance himself from Wycoff? Employees think that Wycoff is a person who doesn’t have the best interests in the hospital. He just wants the hospital to last long enough to earn his fill of money or to make sure that he doesn’t go under himself. People think that Wes is in Wycoff’s camp because Wycoff hired him, and people think that Wycoff hired someone just like himself to fill the position that was needed. Wes Should try to distance himself from Wycoff to make sure people don’t think that he is just like Wycoff, because almost nobody likes Wycoff for what he’s done and what he is like. If an employee believes she has two bosses, is there a possibility she will play the one against the other? This is a possibility, and she might do this to somehow benefit herself. She could also do this to see the reaction with the two to see how one will effect the other, and to see how one will act to the response of the other boss. By telling Wycoff to stay out of operations, Wes offended one of his few allies on the board. Was this the right action to take?This was the right action to take because if the way Wes wanted to do his job, he couldn’t do it because Wycoff would just get in the way of it and try to stop him.What do you believe Wes Douglas’s purpose was in meeting with the employees this early in his administration? What message would you have sent to your employees in your first meeting?The purpose of Wes’s meeting this early in his administration was to show his personality and what he intended to do to help the hospital. The message I would have sent to my employees is that I was here to help and that I intended to do my best to provide my services where they would be needed. List five characteristics of successful teams. Common Goals An understanding of the role of each team memberAn ability to meet the needs of each person on the teamTrustGood communicationList four ingredients of good communications. The sender The messageThe receiver Feedback Chapter 5Some patients feel admission to a hospital is a dehumanizing experience. Explain how hospitals strip patients of their personal identity. Can you think of examples not cited in the textbook/novel? Why is it important to treat patients as individuals, instead of numbers or diagnoses? Hospitals can strip a person of their identity by just ushering them into the crowd that is just a mass of patients. Also, even though it helps people identify the patients, the clipboards at the end of each bed show that the patient is just another body waiting for treatment and that they are not an actual person with a personality and life.Traditionally, patients were not allowed to review the information in their medical records. Do you think this was for the benefit of the patient or the healthcare practioner? Why do you think this policy was changed in the Patients’ Bill of Rights? I believe this was for the benefit of the patient because the patient probably has the right to know their condition and how they can be treated. Also, they most likely would like to know their medical records. Use a search engine on the Internet to find the American Hospital Association’s Patients’ Bill of Rights. Compare this to this to the Patients’ Bill of Rights as written by the Administrative Council. Can you think of additional rights you might add to the list submitted by Elizabeth Flannigan? You should also have the right to end your own life when facing a terminal illness. There might also be an addition added for those who abuse the system, that those who purposely cause themselves bodily harm (drug abuse, physical torture, etc.) no longer qualify for medical assistance therefore freeing up medical care for those more deserving. Write a memo to a hospital supervisor about your concern that your hospital is not giving enough attention to preserving the dignity of their patients. Propose several programs the supervisor can adopt to create less dehumanizing hospital care?Care should be taken to understand the varied needs of individual patients. Sometimes these needs are overlooked. Elderly and not so elderly patients are hard of hearing and miss information that is given to them by hospital personnel. Also in times of stress/illness patients might not be hearing all that is stating by hospital personnel in the few moments allotted during rounds. All information given to patients should be detailed in a written summary to be sent home with caregivers or the patient to review once at home. Like it or not, sooner or later there will be rationing of healthcare services. Otherwise, the United States will eventually spend 100% of its income on healthcare. A difficult question is how these resources will be rationed. For example: Assuming two people need a transplant, and there is only one organ available, what should be the rationing criteria? Possible criteria include: How important is the Person to Society? The problem with this approach is deciding what we mean by “important.” Who is more important, a 65-year old politician, or a 24-year old mother of four? Ability to Pay: Do the rich have a greater right to life than the poor? Age: Should an organ be given to the person with the most years left to live? Probability of the Best Outcome: If one person has a 50% chance of living with the new organ, and the other a 75% chance, should the second person be given the organ? Personal Responsibility for the Illness: Two people need a lung transplant. One developed cancer from smoking, the other developed cancer from a genetic defect. Should personal accountability be considered? Required: Assume you have been appointed Secretary of Health and Human Resources and have been asked to come up criteria you think would be fair. Remember, in the real world there is sometimes no “right answer.” What this book tries to do is help you recognize the difficult decisions healthcare policy makers face, and provide experience in approaching difficult issues. The purpose of this question is to get you to think. Certainly there are people more deserving of an organ. Those on death row should be excluded from the organ transplant list. If you take a life, obviously, your life should not be spared at the risk of another’s. A politician should not be higher than a PTA mom who has done more for her community. Organs should be given out by best match, likelihood of success and the benefit to society if the person were to live. It is a package deal. Form the class into groups and, using the following form as a basis for discussion, review each of the actual case studies presented at the end of this chapter. Use the guidelines presented, and others you may think of to determine what the ethical issue is, who the stakeholders are, and whether the concerned parties acted ethically. Have a representative from each group report on their conclusions. Guidelines for Answering Bioethical QuestionsFree AgencySelf-determination and freedom. The right of a rational person to self-rule and to generate personal decisions independently. Questions to Ask:Answers from Group Discussion: Is the patient mentally and legally competent?Is there any evidence of incapacity?If competent, what is the patient stating about preference for treatment? If disabled, who is the patient’s proper representative? Has the patient expressed prior preferences through advanced directives? Has the patient expressed prior preferences through advanced directives?Is the patient’s right to choose respected?Has sufficient time been given for the patient to discuss and evaluate outcomes?EqualityThe health care system must treat all patients equally.Questions to Ask: Answers from Group Discussion: Are there biases that might prejudice the provider from giving a proper evaluation of the patient’s quality of life?Are their family issues that might influence treatment decisions (exhausting the estate through medical bills)?Are there other financial factors that might influence a proper evaluation of the patient’s quality of life?Are there conflicts of interest with the provider (doctor or hospital payment for example) that might influence the decision to withdraw life support?Other questions the group may raiseKindness/Duty to do GoodDeeds of mercy, kindness, charity and consideration for the welfare of other people.Questions to Ask:Answers from Group Discussion:What are the prospects with or without treatment for a return to a normal life?What physical, mental, and social shortfalls is the patient likely to experience if the treatment succeeds?Are providers or others influencing decisions about treatment trying to see the situation through the patient’s eyes?Is the provider giving the care that provides the most benefit to the patient?Other questions the group may raise:Obligation to do no HarmDon’t hurt the patient – the overriding principle for everyone that undertakes the treatment of patientsQuestions to Ask:Answers from Group Discussion:Is there a plan with a justifiable reason to forgo treatment?If the treatment is experimental, has the patient been forewarned of the possible adverse effects?Are there plans for comfort and the relief of pain?Other questions the group may raise:HonestyIs the health-care worker telling the truth?Questions to Ask:Answers from Group Discussion:Has the patient been given a clear understanding of his or her diagnosis?Is the patient aware of the different treatment options?Does the patient know the potential benefits and dangers of each treatment option?Is there any reason the patient should not be told the truth about his or her condition?Other questions the group may raise:LegalityAre the actions of the health-care provider consistent with state and federal laws?Questions to Ask:Answers from Group Discussion: Has the patient left a living will or health-care proxy?If there is a living will, do the instructions clearly cover treatments the patient does not wish to receive such as his or her wish not to receive CPR, respiratory or chemotherapy? Are there directives being followed?Does the living will descriptive conditions (i.e. terminal illness, permanent coma) for which the patient would refuse treatment or interventions. Are these directives being followed? Other questions the group may raise:Chapter 6 Questions Some patients feel admission to a hospital is a dehumanizing experience. Patients may feel like they are only a number or a bed to be filled and not an individual person. They are a temperature or a blood pressure to be taken and not a person with real feelings and a story. Caregivers are overworked and get tired of hearing the moans and groans of the truly sick. Using the internet, define the term “quality assurance.” How does the term apply to healthcare? “Quality assurance” is defined as the maintenance of a desired level of quality in a service or product especially by means of attention to every stage of the process of delivery or production. In a hospital this should be one of the first priorities because it relates to the treatment of patients and their environment. What is “peer review?” How does it work and in what ways is it an important component of quality assurance? Others working in the same field define “Peer review” as the evaluation of scientific, academic or professional work. In a hospital setting this means that those working closely with you will evaluate you and your skills. You should hold their opinion in high regard, as this is how your skills will develop over time. What is the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and what are its objectives? In the US the JCAHO represents quality and certain performance standards, an independent not for profit organization that certifies healthcare organizations.What is patient dumping, and what factors do you think mandated legislators to make it illegal?Patient dumping is when a patient is referred to another hospital without an evaluation. Then the hospital referring the hospital can refer fines up to tens of thousands of dollars. The fact that mandated legislators to make it illegal was that it prevented patients from being referred without first checking their health and condition also it prevented hospitals from getting rid of patients immediately. What steps should the Credentials Committee take when reviewing the application for admissions to the medical staff from a physician? The steps they should take is that they should question the physician about his skill, experience and knowledge of procedures. They should also address any other issues or discomforts in his/her field.What is a case manager and what is his or her responsibility within the hospital?A case manager’s responsibility is to oversee the quality of care provided by doctors. The case manager also visits floors and reviews medical records.Chapter 8 QuestionsDefine the terms culture, ethnicity, race, and cultural blindness. How are they different and how are they the same?Culture-social, artistic and religious belief structures distinguishing a specific society. Values and traditions handed down from one generation to the next. Ethnicity-the unity that comes from a common religion, belief, language, and culture.Race-a classification system based on genetic characteristics such as the color of skin, structure of hair, and so on. Cultural blindness- a situation where people assume cultural differences do not exist. These terms are the same in the sense that they are all closely related when discussing different cultures or races; they are used to generally define large groups of people as well. They are different by being able to also describe a group of people in somewhat greater detail. Holistic medicine believes the whole is greater than the sum of the parts. It teaches that a health practitioner must not limit his or her attention to the biological expression of disease, but must look at the patient as a whole. Holistic medicine considers factors, including the patient’s religious beliefs and emotional state. How does consideration of one’s culture fit into holistic medicine? The consideration of one’s culture fits into holistic medicine by factoring in a persons beliefs and current state. This can include how their religion affects their lifestyle and how they think, to this care can be given in an appropriate manner to the patient.List several guidelines for communicating with people from different cultural groups.When someone communicates with people from different cultural groups one should speak clearly, show respect, never yell, verify the patient understands what is being said, use gestures, summarize, and find an interpreter (maybe a family member) if the patient doesn’t speak English.Review legislation and court rulings on gender-based discrimination. In 1920, congress approved the 19th amendment giving women the right to vote. In 1940, congress outlawed sex-based wage discrimination for firms with federal contracts. In 1963 the Federal Equal Pay Act was passed and it made it requirement to pay men and women the same for the same job. From the Title VVI of the Civil rights Act of 1964, women where not allowed to be fired if they were pregnant and it outlawed the practice of reserving a specific job for men or women. The Title IX of the Education Amendment of 1972 outlawed sexual discrimination by universities and colleges that receive federal funds. Finally, The Supreme Court has ruled women must get the same fringe benefits as men, including social security, welfare, and workers compensation.What is the purpose of the Americans and Disabilities Act of 1990?Its purpose was to ensure the prevention of discrimination towards employees with disabilities who were qualified from employers. Chapter 9 Questions Place yourself in the position of Wes Douglas, administrator of Brannan Community Hospital. If the bank cancels the hospital’s line of credit, the hospital will close. Assume you are preparing for the meeting. Write a brief statement of your goals for the meeting, and what your approach will be. My goals are to try my best to keep the hospital up and running in good condition. My approach will be to try and reason with the bank in the fairest way possible that will benefit both sides of the agreement.Place yourself in the position of Arnold Wilson, vice president of Park City State Bank. Assume you are preparing for the meeting. Write a brief statement of your goals for the meeting and what your approach will be.My goals would to ensure the bank isn’t digging itself a hole with the hospital’s loans, or at least make sure the bank gets collateral for the loans. My approach will be to inform the hospital chair members that they don’t have an option to not try and pay the bank back or come up with a solution that will favor the bank.Sometimes people criticize banks for not loaning money to organizations with bad credit. Where does the money loan come from? Do banks have responsibilities beyond profit?The money from loans come from what the bank has in its deposits, they borrow it from their customers. The banks also have the job of making sure that they still have their customer’s money.Why was it important to the bank that the hospital installs an accounting system?This was important for the bank because then the hospital could start to try and get a grasp on their spending’s and funds that they actually have.Does Edgar Wycoff have the interests of the hospital employees in mind with his offer? Is it ethical for Wycoff to profit from the death of the hospital?Wycoff does not have the best interests of the hospital employees, he is trying to buy time in order to make it seem like he is trying to help but actually wants the downfall of the hospital to happen so he will somehow profit. This is not an ethical decision for Wycoff, this is because he is purposely trying to get gain for himself at the downfall of several hundred employees and patients. Chapter 10 QuestionsAre the problems raised by the hospital department heads problems, or merely symptoms of a larger problem? If they are symptoms, what might the larger problem be?These are merely symptoms of a larger problem. The larger problem is that all the forms and tasks that are required of hospitals are very difficult to understand and there is not enough formal training to understand how to fill them out or do the proper task.Wes has received a long list of complaints from his first line superiors. He can’t solve them all immediately. Assume you are the interim administrator. Set priorities for the problems presented according to your opinion of their importance. Write brief justifications of your priorities.The Priorities are as follows: Managed care and budgeting systems are first because they are the subjects that the employees don’t immediately understand. The next in line is the reports; this issue needs to be resolved because there needs to be immediate focus on the subject. The reports need to be in on time to maximize efficiency and money. Finally, the poor service communication and unresponsive controller’s office is last. This is because while there may be confusion on how to do things around the workplace, it can be fixed somewhat easily and it is not the most pressing matter at hand.Several departments complained the accounting department was not helpful. The department didn’t have a service orientation. Who are the customers of the accounting department? Is accounting there only to crunch numbers, or does it have other obligations?Communication is of limited value if the receiver doesn’t understand it. One of Wes’s department heads complained accountants use technical terms non-accountants have trouble understanding. Is accounting the only department in the hospital where this is a problem? How can hospital employees be more sensitive in the way they communicate with the patients and the non-technical employees?The other department that there is a communication error is in the nursing department, many of the nurses complain that the doctors are very hard to understand most of the time. The employees can be more sensitive towards how they communicate with patients and non-technical employees by being kind and explaining what the terms mean in words they can understand.If you were the supervisor of a department, and your employees didn’t have a service orientation, how might you train them to be more sensitive to their mission?I would train them by having mandatory sessions during or after work for about an hour at a time trying to teach them the proper way to be sensitive to how they teat their mission.6. All of the following quotes by successful leaders follow one central theme. Taking these ideas, write a one-page paper on failure as a stepping stone to success Chapter 11 Questions NoneChapter 12 QuestionsNoneChapter 13 QuestionsOne reason healthcare costs have risen so dramatically over the past three decades is the cost of technology. Name one action that health care professionals can take to help contain technology costs. One way the cost can be reduced is by not buying so much new technology at one time. If there is enough equipment to suffice treatment of patients, then there is no immediate need to buy new equipment. According to Dr. Herb Krimmel, why did the administrator of St. Joseph’s Hospital build a cancer treatment unit when there was an identical one right across the street from her hospital? What impact did her decision have on the costs of healthcare in her community?The administrator did this to try and increase the quality of the hospital. The impact of her decision on the community was that it greatly increased the price of treatment because both machines cost two million dollars each, and that has to be paid off.What is a free market and what are the conditions for its survival? Does the healthcare industry compete in a free market? A free market is a market system in which there is a balance in why people need to buy things, the cost of those things, and how many of those things are made at a time. In a normal free market the consumer and the dealer of that product can manage things like the price and come to an agreement. The healthcare industry doesn’t compete in a free market because the provider of the services and products they supply, the consumer doesn’t know much about and this and can’t bargain the price of what he or she needs like at some other industry.When you are shopping for a new pair of running shoes, how do you compare the quality of the various brands you are considering? Do quality and price influence your decision? Why is it healthcare consumers have difficulty judging the need for, and the quality of, the services they receive?I do lets these factors help influence my decisions when I make these types of decisions. Healthcare consumers have difficulty judging the service they need because they don’t know the information about the quality of the service they are being given. The doctors and healthcare employees know all the facts about what you need and you don’t have a clue.According to Dr. Herb Krimmel, some hospitals don’t think the patient is their primary customer. Who do they think the customer is and why? They think the customers are the doctors; this is because the doctors always want something new or want something else. With these wants and needs, the doctors become a primary source of getting the hospital new things and that then brings in new patients.In 1972, health professionals could order diagnostic tests, laboratory tests, x-ray studies and so on without significant review by insurance companies, employees, employers, the government, and so on. The emphasis was on quality. Today the emphasis is on quality and cost. What caused the change in emphasis to occur?This change occurred because now we have to think about how the cost of something will affect the hospital in time. Too much spending could cause a very big issue today, but back in 1972 the most important thing was quality no matter how much it cost.Accessibility to healthcare for all people has become an important discussion topic in the United States. Is there a fallacy in focusing solely on quality, If no one can afford the product offered by the hospital? There is not a fallacy on focusing on quality, this is because if hospitals focus solely on quality the price will go through the roof and nobody would be able to receive care since the price would be so high.Chapter 14 Questions Why would the ownership of a laboratory or x-ray unit by a doctor influence how many lab or x-ray tests he or she orders? Should a doctor own laboratories and x-ray units? The ownership of a laboratory or x-ray machine by a doctor can cause them to ask for more tests or x-rays than necessary, and this causes the patient to pay more than necessary. Doctors should not own this kind of equipment because then they control everything with them, including how many unnecessary tests and scans have to be done.What is a director of reimbursement? Why is this person an important part of the administrative team? What do you think the training requirements should be for a director of reimbursement?A director of reimbursement is a person who controls the reimbursing of employees. He is important in the administrative team because he controls a lot of the money being handled. The training one should receive to take this position is courses in how money should be transferred to people on how well they work.Chapter 15 QuestionsBefore 1984 how did most insurance companies pay hospitals for the services they provided? They paid the hospitals by reimbursing them.If you were the administrator of a hospital that received full costs plus a profit of 3% for the services your hospital provided, what is one way you could raise profits? How strong are the incentives under cost reimbursements for the hospital to be efficient? I could raise profits by slightly increasing the costs of treatments for the patients to help compensate for the costs and to increase profits. Reducing staff would also create an increase in profits. Increasing costs to patients will have to be done cautiously so that the hospital does not lose patients due to high costs. Also the reduction in staff should not affect patient care, which could also result in losing patients. Give a one-paragraph history of Blue Cross. Why did Justin Ford Kimball, the founder of Blue Cross, feel hospitals should be paid under a cost reimbursement system?Justin Kimball felt that hospitals were at risk of financial failure because they were locally funded. Meaning that they did not receive funding from the government. He felt that this made hospitals vulnerable to financial risk. By reimbursing hospitals under a cost reimbursement system, this helped hospitals to be able to afford the costly equipment required for patient treatment. Why were most hospitals formed as nonprofit organizations? Did this influence the type of payment received?Hospitals were originally formed as a place to help people and not as a money making business. Payment received varied from month to month, making it difficult to run the hospital. Define cost reimbursement and prospective payment. Are the incentives to control costs the same under each of these systems? Why?Cost reimbursement is when a price for a product or service is not finalized until after the work is done. In prospective payment the payment is worked out ahead of time. No, there is not the same incentives to control costs within both systems. Under the prospective payment system controlling costs would be more important or hospitals could lose money. Before setting up prospective payment the federal government tried to control the rise in healthcare costs through regulation. They reasoned they could control costs by forcing hospitals to seek approval for all rate increases, similar to the practices used at that time to regulate utilities. Why didn’t this work?This method did not work because unlike utilities, hospitals have a variety of treatments and variables with each patient. This causes the approval of rate increases to be difficult to manage. Define the word” system” and give several examples of systems.A system is an orderly and complex arrangement of parts. Examples: physiological, economic, computerWhat are the four components of a system?Input, throughput, output, feedbackExplain what “backwards thinking” is, as it relates to systems.Start with goal and work backwards to see how the goal can be accomplished. The healthcare delivery system is like a mobile. Pressure or movement exerted on one component exerts pressure on others. Give an example.Hospitals want the high tech equipment which costs money to treat patients which causes an increase in cost to patients. Briefly review the attempts by governmental agencies to implement a form of universal healthcare. “Bill for Benefits of the Indigent and Insane” began to be introduced in the 19th century. This was the beginnings of universal health care. This bill was introduced by many but never passed until 2010 and is now called “Patient Protection and Affordable Care Act”.What is an Accountable Health Organization (ACO) and what are its objectives? This is a group of physicians that have come together to provide coordinated care under the Affordable Care Act. They may be paid on prospective or capitation payment plan. Who are the stakeholders in the Patient Protection and Affordable Care Act? Those who provide services, those who receive care and those who pay for healthcare services.List the objectives and possible adverse consequences of the Patient Protection and Affordable Care Act. The objective of the Affordable Care Act is to change the way healthcare is provided. Some adverse consequences are lower compensation, shrinking independence, greater regulation and increased paperwork will lead to physician shortages. In fact, some physicians have already announced retirement due to the Affordable Care Act.How does pay for performance differ from other forms of incentive payment?Pay for performance in the medical field requires that patients get better. There are more circumstances on a patient’s outcome that can be regulated by the doctor. Living environment, mental and family background, financial resources, etc. Chapter 16 questionsMost Blue Clross organizations were established by hospital administrators to assure hospital bills would be paid. Before the 1970s, the Board of Trustees of most Blue Cross plans was mainly composed of hospital administrators. How might this arrangement have discouraged programs like Blue Cross from challenging hospital costs?What incentives are there for a health maintenance organization doctor to provide adequate healthcare services? What is to keep the doctor from withholding needed treatment?What is the downside to providing incentives for healthcare workers to cut healthcare cost? Is it possible to control costs, while still providing a high quality of healthcare? One of the healthcare revolutions Stoker mentioned was the consolation of independent hospitals into large corporate-style hospital chains. What do you think might be the advantages and disadvantages of this consolidation?Chapter 17 QuestionsIn her conversation with Wes Douglas, Emma Chandler, Acting Controller had this to say: “It’s a different game today. In the old days, the purpose was to heal the patient, regardless of the cost or the patient’s ability to pay. Hospitals were often inefficient and sometimes outright wasteful, but they cooperated with each other in achieving their goals. Today the goal for many administrators is to cut and save money, even when the doctors, employees, and patients are treated less than honorably.”Assuming her observations are correct: (1) what contributed toe this change in attitude, and (2) do you think it is possible for the healthcare industry to find a middle ground?As he becomes more familiar with the issues facing Brannan community Hospital, Wes Douglas is less inclined to view many issues in black-and-white terms. Castleton, Wycoff, Brannan, and the other wants quality and compassion. What viewpoints do you agree with, or like Wes Douglass, do you find some merit in each argument? Explain your positions.Refer to question 2 above. How might each viewpoint, taken to an extreme, violate ethical standards? Chapter 18 Questions 2. Wes Douglas tells a story about a request to raise nurse staffing in his newborn nursery. After witnessing a situation where a baby nearly died, he concluded: When you’re faced with that situation, cost suddenly doesn’t seem that important. Is he right of is he just getting carried away with his emotions? Wes is right in this kind of situation because when there are lives on the line the cost for some things don’t seem important. Several years ago, an administrator in a metropolitan hospital was proposing the purchase of fetal heart monitors for the Department of Obstetrics to his board of Trustees. The equipment, maintenance, and training of the personnel would amount to many hundreds of thousands of dollars. One astute businessperson, who was serving as a trustee, asked how many babies the monitors would save. The administrator replied “maybe two or three a year.” The board members then pulled a calculator from his shirt pocket and determined the cost was about $50,000 a baby. The board then discussed the question: “Is a baby worth $50,000?” The answer they settled on explains the difficulty facing most healthcare workers. “Probably not,” they said, unless it’s my baby.” Why are the daily operator’s questions facing allied health workers different from those facing employees in many other industries? Can you run a hospital like you would a bicycle manufacturing plant? His questions are different because his questions can decide people’s lives. You can’t run a hospital like a bicycle manufacturing plant because unlike a hospital, the plant doesn’t deal with lives and how you can save them while juggling financial costs. All the plant is worried about is making bicycles and gaining a profit, while the hospital is concerned with lives and how to just make it by with the money they have.Chapter 19 Questions We live in a society that equates wealth with success. Given this value system an outside observer might assume Edward Wycoff was a successful man. What has Mr. Wyckoff sacrificed to achieve wealth and social prominence? Do you think it was worth it? Is it possible to be financially successful and still have a rewarding family and social life? What might Wycoff have done differently? Wycoff had sacrificed his family to gain his financial success, he had no time for them and they were separated because of his work. His success was definitely not worth his sacrifice, every person needs a family and he just threw it away to get his money and success. I do believe that if your family is loving and helpful enough then you can get have a financially successful job, a rewarding family, and social life. Wycoff could have done less work than he did and tried to spend more time with his family.Chapter 21 Questions One way that a person might judge the efficiency of a hospital is to compare the number of hours of registered nurse time per-patient-day with that of other hospitals. If Community Hospital uses four hours of registered nurse time per-patient-day, and the University Hospital uses six, it is possible the University Hospital is less efficient than Community Hospital? What other explanations might there be for the difference? There is a possibility that University could be less efficient, this is possible because there might be a mistake or error in the understanding of how long each nurse is supposed to visit each patient. Also, this hospital could be bigger and because of this they have more time to spare with each patient.Chapter 22 QuestionsDr. Matt Brannan has made a mistake in the diagnosis of a young child. What duty does he have towards the child’s family, the hospital, the medical staff, and himself?He has the duty of telling the family about his mistake and apologizing to them, he has to admit his mistake to his medical staff so then they can peer review him, and his duty to self is to improve and not commit the same mistake.4. What is the difference between negligence and malpractice?The difference is that negligence is caused by the carelessness of someone not wanting to do something and malpractice is caused when someone does something to get personal gain.Who is responsible for risk management in the hospital?The doctors are responsible.10. List five sources of law in the U.S.The United States Constitution, Individual state constitutions, common law, Statues and ordinances, and Administrative regulations.Give an example of abuse in a healthcare setting.Assault and battery.Chapter 23 Questions NoneChapter 24 QuestionsBriefly discuss the steps that Wes Douglas might take to cut direct materials costs in his hospital?He might order audits of different departments as well as different checkups of all staff and supplies as well. 3. Emma Chandler is also concerned that the pharmacy is not making nightly deposits. What problem might this suggest? This might suggest that different employees could be taking money from the hospital at night. ................
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