Essay Instructions: Assignment:
In this paper, begin to put the final project together. Be sure that your paper includes discussion of not only the information from earlier 3 papers listed below but also the following:
A. The obstacles, barriers or pitfalls (legal, ethical, personal, etc...) to success in resolving the earlier identified problem
B. Describe the factors that may influence those obstacles, barriers or pitfalls
Assignment#1:
My occupation in the military is a field medical assistant which is a general term used for all medical service officers. My specialty is a health care manager. The occupation of a health care manager can include many different responsibilities in a military hospital. Health care managers are necessary in many organizations, from hospitals to HMOs and other insurance programs. A health care manager in a small clinic may have very different responsibilities than a health care manager at a huge hospital, and both deal with very different issues than a health care manager that works for an HMO. However, the qualifications are very similar. To be a health care manager one must have a degree in health care management (or be a doctor with experience and training in management) and be able to organize and oversee aspects of management and patient care. The responsibilities also have one thing in common: a health care manager is someone other than a patient?s personal physician who has the difficult task of deciding what kind of care is appropriate and arranging circumstances so that can be provided. ?Health care managers play essential roles in keeping the business of health care running smoothly. They plan, direct, coordinate, and supervise the delivery of health care.
Within the military hospital setting, a health care manager has a number of roles. The primary health care manager is responsible only to the hospital commander, though indirectly one could say that they also answer to Tricare and insurance companies because they have to juggle their demands and conditions in order to be financially reasonable. The health care manager is the one to whom doctors and nurses must go for direction, and to whom they are answerable regarding the financial aspects and some of the organizational aspects of their job. Daily duties in a large military hospital are primarily delegatory so that subordinate health care managers do more of the paperwork, but in a small clinic, the health care manager is actively responsible for the record keeping involved with filing medical charts and organizing patient records. They also must answer patient questions about insurance, process insurance claims and take charge of the billing, collections, and other financial concerns such as taxes. Health care managers also oversee personnel development, such as hiring of civilians and organizing employees and soldiers, evaluating the performance and financial intake of civilian doctors, enforcing work schedules, and making general goals for the hospital. The health care manager may also be in charge of expenditures on equipment, and upgrading or maintaining the facility.
As can be imagined, there are a nearly infinite number of things that can go wrong for a health care manager. Two common problems are worth some attention. The first deals with the ubiquitous staff problems that arise in any managerial position. Doctors and nurses may have interpersonal conflicts. Certain doctors may not feel comfortable with the appropriate profit-consciousness and resent the interference of a manager. Budget concerns may mean that everyone has to work long hours, and complaints may arise regarding lack of flexibility or inhospitable working conditions. Poor relations within the staff and resentment between levels (like nurses who resent the doctors, or doctors who resent the interference of management) can represent a real problem with a huge scope. This problem may seem like it represents insurmountable difficulties, however, it is possible that such tensions can be reduced not by making significant changes that would threaten the hospital?s basic profit margin and management, but by implementing more personal attention would make everyone comfortable with the status quo.
On the other side of the problem that arises when staff resent the pressures placed on them from above is the problems that arise when the hospital commander or staff decide that the profit margin is not high enough. The health care manager may be asked to find a way to reduce costs, or to be more efficient, or even to reduce the number of patients. Figuring out how to balance the neat for a trim budget with the doctors need to feel that they have freedom in their treatment options can pose difficulties. Raising the profit margin, balancing the books, and assuring that the hospital is a viable business first and foremost is the biggest problem faced by health care managers in the army. Possible solutions may lie in a variety of fund-raising techniques, cutting waste, reducing unnecessary procedures on the under-insured, and trimming personnel expenses while attempting to assure quality so that the hospital can best attract patients with the willingness and ability to pay for high quality treatment. This is the problem I would prefer to investigate further, since it seems to be the most pressing for most health care managers. ?A 1988 survey of 1,400 general acute-care community hospitals found that the administrators of 700 of the hospitals feared that their institutions would be forced to close in the next five years because of financial problems.
Assignment #2:
As a health care manager, the reason for choosing this profession and the day-to-day activities, which fill my schedule, are often vary different. As a health care professional, I entered this profession to make a contribution to the health and well being of my fellow soldiers. I chose to become a part of the support system, which keeps the military functioning, and able to freely commit themselves to the defense of our country. As a health care manager, my time is filled with responsibilities, which revolve around 4 categories that have little to do with the daily care of the soldiers and civilians who use our facilities. My job responsibilities focus on the Administrative, financial, legal, ethical, and financial aspects of keeping the medical care facilities operational (so that the other health care staff, such as doctors and nurses, can tend to the medical well being of the patients.
Administratively, I am responsible to keep the diverse staff functioning as a team. A multicultural mindset has taken hold in most professional environments, including the armed services. This has created a diverse set of attitudes, and talents within the team operating in the medical facilities. While the military chain of command remains strong, as a health care administrator I am continually challenged to creatively assist my staff to work together. We see changes in demographics of staff and those we serve, and changes in technology, which create a flood of, increased demand on our resources. The multicultural mindset may be a positive paradigm to assist staff to accept the difference between us, but the increased number of differences demands increased management and problem solving time. These changes are occurring at a time when changes in financing and care management create an earthquake of system instability. (Kirkman-Liff, 2002)
Driving the financial changes in the health delivery system is raising health care costs in the public and private care sectors. The military health care systems cannot remain unaffected to the rising costs because we are interrelated. We purchase medicines form the same sources, and we purchase the same diagnostic machinery. While military wages are not as volatile as in the civilian world, the cost of health care is rising due to other factors, such as those mentioned above. In order for the health care facilities to stay in operation, I am responsible to balance needed care options with the most economical methods for delivering those health care services. In the civilian world, nearly one third of health care expenditures are spent on hospital care. When patients, employers, insurers, and the government worry about rising health care costs, they put pressure on hospitals to provide more efficient care. This pressure lands on the shoulders of the health care administrator. (Shah, Reed, Francis, Ridley, and Schulman, 2003) Unfortunately, these choices can lead to legal issues, and further to ethical considerations. Health care premium rose 13.9 percent this year, according to a recently released survey of more than 2,800 companies by the Kaiser Family Foundation and the Health Research and Educational Trust. (Knight-Ridder, 2003) This reflects the rising costs of health care. When faced with the daily decisions of operating the hospital or field medical office within budget, and providing the best medical care for my patients, I am often faced with a decision with no good options. If the treatment cost exceeds the likelihood of successful treatment of illness of injury, then my responsibility to the patient is opposed by my responsibility to the hospital. These ethical issues can lead to legal ramifications if a hospital unit is operating with it?s eye only in the bottom line, and chooses to limit care for financial reasons. These choices are not representative of the reasons I became a health care professional.
Keeping a military unit operational in the highest level of readiness is a combined effort that requires dedication from many disciplines. Medical services are one of those areas, which must serve the needs of the patient, and the overall military. We must balance the needs of today with those of tomorrow within a changing world.
References
Kirkman-Liff, Brad. Keeping an eye on a moving target: quality changes and challenges for
nurses. Nursing Economics. 11/01/2002;
South Florida Employees Face Higher Health-Care Premiums, Fewer Benefits. Knight
Ridder/Tribune Business News. 10/12/2003
Shah, Bimal R Reed, Shelby D Francis, Jennifer Ridley, David B Schulman, Kevin A
The cost of inefficiency in US hospitals, 1985-1997. Journal of Health Care Finance.
10/01/2003
www.netlibrary.com
Assignment #3:
Today, health care management for the Department of Defense is handled by TRICARE, which is a regionally managed health care program, for all active duty and retired members of the armed forces, their families and survivors. TRICARE meshes the health care resources of the Army, Air Force and navy plus the abilities of civilian health care professionals. This network has been established to provide the utmost quality care plus access to a wide variety of professionals to meet the needs of the military.
Health care management in a military setting differs from the professional who serves in a small clinic or large hospital. Although the rigors of the job can be the same because the responsibilities, i.e., to help determine and administer the appropriate care, the role of a military medical assistant is under further stringent guidance from TRICARE.
Within the confines of a military environment, the healthcare manager must also handle insurance and financial aspects of patient care. They play an evolving role in the patient?s well being that goes beyond the daily care routine.
Any number of problems can arise from a healthcare management perspective, but the majority of problem concern interpersonal conflicts and the pressures associated with healthcare profit margins. Both of these problems are compounded by the fact that health care management in any setting is under a high degree of scrutiny.
Personality conflicts abound in an environment where volatility and pressures are part of the every day routine. The key is to reduce the tensions between the staff by ensuring that there is awareness on everyone?s part of the role that each member plays and the nee for teamwork. Long hours and tension about profit margins can create a highly charged atmosphere. It is up to the delegating staff members to remove potential threats and implement a system that acknowledges individuals, their achievements and their needs. The business of caring for people has to begin with the staff.
As for profit margins, healthcare has become a business. Reducing costs and saving money are part of the health care managers responsibilities, particularly in the armed force. The objective is to cut costs but not at the expense of quality care. The solution may be to implement a variety of procedures that can substantially reduce costs while not negatively impacting healthcare. Evaluating budgets and trimming excess costs, reducing unnecessary costs, eliminating unnecessary procedures, and cutting personal expenses can provide a way to increase profit and continue to provide quality healthcare.
A revolution is taking place in the healthcare industry with the emphasis on profit. Rising healthcare costs in the private and public sector is changing the health care delivery system. Even the military health care system is being affected by the rising cost of pharmaceuticals, diagnostic systems and hospital costs.
As a health care manager it is my responsibility to insure that military personnel and their families receive the best health care options while minimizing the financial burden on the system. Ethical issues arise on both ends, as my duty is to implement the best possible solution for the patient and the system.
It is imperative that improvements continue to be made in health care to strengthen the existing system and improve the infrastructure. Healthcare services globally need to benefit from the talented resources available as demand for services increase. Medicine cannot continue to be commercialized by malpractice, misconduct and negligence.
In order to satisfy the growing needs associated with the healthcare system, initiatives need to be put into place to focus on the critical issues the industry is facing:
? In some instances, existing hospitals need to be upgraded to provide the expected level of care
? Teaching medical ethics is imperative and there needs to be a comprehensive revision based on the standards now provided through the healthcare management system
? Healthcare managers must be aware of their obligation to ?serve? to masters---the patient and the hospital. In the case of the military, that also needs to be taken into account.
? Laws regarding healthcare services need to be basic knowledge for all healthcare personnel
These recommendations still require the healthcare manager to keep the objectives of their job in view. Careful consideration needs to be given to each case and the best possible solution implemented that would satisfy all.
Amid the turmoil of constant change that surrounds the healthcare manager, rarely is there a simple solution to meeting both the patient?s needs and needs of the business. In the book, The Tracks We Leave Behind, Ethics in Healthcare Management, the author provides some expert advice on dealing with competing values and the moral issues that are part of healthcare.
With the cost of healthcare premiums rising (13.9 percent in 2003), healthcare managers are faced with the daily decisions of cost effectively running a hospital or field medical office. As a healthcare professional in the military, I realize the importance of keeping a military unit in operational readiness through the administration of quality medical services. My duty is to make sure these men and women are receiving the proper care?providing quality care in an efficient and effective manner. The business of healthcare is to cure and care and healthcare managers are the first line of defense in insuring that happens.
Bibliography
Kirkman-Liff, Brad. ?Keeping an eye on a moving target: quality changes and challenges for
Nurses.? Nursing Economics. November, 2002.
Shah, Bimal R Reed, Shelby, D. Francis, Ridley, Jennifer, Schulman, David B. ?The cost of
inefficiency in US hospitals 1985-1997. Journal of Healthcare Finance.
Perry, Frankie. The Tracks We Leave: Ethics in Healthcare Management. Healthcare
Administration Press. Chicago: 2001.
?South Florida employees face higher healthcare premiums, fewer benefits?. Knight
Ridder/Tribune Business News. October 10,2003.
