principles of healthcare management exam 2

donabedian structure

quality personnel and facilities

donabedian process

quality processes in both management and production of healthcare

donabedian outcome

quality resulting from the application of structural and process variables

donabedian four parts

technical management, interpersonal relationships, amenities of care, ethical principles guiding care

PDCA

plan, do , check , act

FOCUS

find, organize, clarify, understand, select

Toyota production - Lean

relentless pursuit of removing waste (inventory, transportation, defects, waiting, overprocessing) from the system

DMAIC

define, measure, analyze, improve, control

6 sigma

data driven quality methodology that seeks to eliminate variation from a process, large HR component

misuse

risk service is provided badly reducing benefit to patient

underuse

failure to provide a service whose benefit is grater than its risk

overuse

use of service is provided badly reducing benefit to patient

5 guiding principles of high reliability organization

preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, deference to expertise

process mapping

flowchart, workflow diagram, value steam mapping, geographic mapping

fishbone diagram

visual tool to identify problem resembling a fish skeleton with problem at head

pareto chart

bars and lines showing relative importance of problems

force field diagram

planning when and where to act to achieve a change

statistical process control focuses on

variation

EMRAM stage 0-1

very basic automation of individual areas

EMRAM stage 2

ability to start bringing disparate data together

EMRAM stage 3-6

implementation of advanced clinical systems

EMRAM stage 7

ability to share or exchange data with external entities

electronic medical record

computer application with clinical data, clinical decision support, medical vocab, physician order entry, used across in and outpatient areas to document, monitor and manage health care delivery

PHI

protected health information, any information in the medical record that can be used to identify an individual used in course of diagnosis

HIPPA

health insurance portability and accountability act, 1996, measures to protect personally identifiable health information

NOPP

notice of privacy practice, how practices use information to provide treatment to you, explains an individuals rights related to PHI

what methods defined by HITECH to increase EMR adoption in hospital

financial incentives for early adoption

fee for service

payment model where providers are reimbursed for each service separately rather than the overall care

prepaid health plan

pay medical service providers a fixed amount based on the number of people enrolled regardless of services received

indemnity policies

fixed benefit or fee for service insurance provides financial protection against unexpected losses, often covers specific expenses

best type of health insurance

different for each person usually better to get employer coverage so you dont have to pay

medicare vs medicaid

medicare - elderly coverage, medicaid- low income families

medicare parts

A : hospital insurance, B : supplemental medical insurance, C : medicare advantage plans, D : prescription drug benefits

CHIP

childrens health insurance program, for kids in families that earn too much money to qualify for medicaid

military healthcare coverage

DOD, VA medical facilities, TRICARE plan and CHAMPVA

ACA

affordable care act, Obamacare, 2010

ACA challenges

high premiums and out of pocket costs, rise of high deductible plans, limited provider networks, coverage gaps, medicare expansion

private health insurance benefits

protection from high costs, wider network of providers, customized coverage

healthcare finance

financial aspects - cost control, capital budgeting, funding for operations and growth

allocating costs

identifying, accumulating, assigning costs to specific products, services, departments to make informed financial decisions

third party payer

organizations that contract to pay a patients healthcare expenses rather than the patient paying out of pocket

variable costs

expenses that change based on amount of goods produced or services provided

semi variable costs

expenses that contain both fixed and variable components, partially constant and partially fluctuate, mixture of fixed and variable

different types of budgeting

master budget, operating budget, expense budget, revenue budget, capital budget

working capital in healthcare

increase revenues and reduce expenses by making capital assets, ensuring ability to pay expenses, managing liquidity - to enhance good will toward organization

attaining state licensure for physicians

premed students go to medical school after competitive schooling and MCAT testing, then go to residency (3-10) years

attaining state licensure for nurses

physician credentialing

process of verifying information that a physician supplies on an application for privileges at a hospital, must be repeated every 2 years

core privileges vs specific privileges

core - cover multitude activities a physician is allowed to do in organization

specific - activities outside core and require documentation of additional training and expertise

National practitioner data bank

web based repository used to improve healthcare quality, protect public, reduce healthcare fraud by collecting and storing information on medical malpractice against professionals

international medical graduate

must redo education and pass english clinical and written exams to apply for residencies

what population do international medical graduates serve traditionally

where US medial graduates wont go

why is there fewer foreign nurses and physicians in the US

stringent requirements - specific certification, 1/3 nurses pass NCLEX

Sunshine Law

regulations that promote transparency and public access to government proceedings and records to prevent corruption and ensure accountability

advance practice registered nurse

registered nurse with advanced education (masters or doctoral) who provides wide range of healthcare services

certified registered nurse

degree based settings, earning associate in 2-3 or bachelor in 4

licensed practical nurse

1 year training in state approved program then pass NCLEX

certified nurse assistant

complete state CNA training 75-150 hours, pass competency exam and background check

workforce planning/recruitment

determine future staff needed and acquire them

employee assistance programs

workplace benefit that provides employees with counseling, support and resources to address work related challenges

employee suggestion programs

formal system that encourages employees to submit ideas for workplace improvement

base compensation programs

fixed salary or wage for employees forming foundation of comprehensive compensation plan including benefits and bonuses

HSOs

health service organization, highly specialized providing range of care using individual employee expertise

big data in health service organization

the collection, analysis and utilization of vast amounts of health related data to enhance patient outcomes, reduce healthcare costs

HR in health service organizations

ensures quality patient care, navigates regulatory complexities, recruitment, training, employee relations