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After reading your textbook and power points (Chapter 1), paraphrase in your own words and define Excellence in Patient Care and identify and describe the six criteria in the multidimensional concept. (Reminder: the textbook should be used for reference. Use in-text citations and reference list in APA format).

This original post should be no less than 300 words.
No direct quotes. This should be written in your own words of your understanding of the materials. Paraphrasing needs to be referenced with in-text citations and the source referenced at the bottom of the post.
Be sure that you proof-read as you will not be able to edit your post or resubmit your post once it has been turned in.
Failure to use in-text citations and/or list references when using sources results in plagiarism and a zero for the discussion board assignment. Your textbook is your main source
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I’ve uploaded 2 pages of the textbook that answers the questions off. The textbook should be listed on the reference page and this is the name of book is The Well-Managed Healthcare Organization, Ninth Edition.

The Well-Managed Health Care Organization

Foundations of High-Performing Health Care Organizations

Chapter One

Chapter Emphasis
Mission, vision, and values
Understanding and meeting the needs of all stakeholders
A culture that listens, empowers, trains, and rewards
Measuring performance, seeking benchmarks, and negotiating realistic goals
Protecting the corporate capability
2

Health Care Organization
A formal legal entity that reaches across the panorama of medicine, other clinical disciplines, and business to identify and deliver care to its community
Its purpose is patient care – meeting the diagnostic and therapeutic needs of the individual
Stated in the mission statement
3

Contribution
The mission a HCOs fulfills is one of the humanities highest callings to:
Assist in the beginning of life
The end of life
The shadows of life
Viewed as an investment, contributing to national productivity by adding years of quality life and returned to the community through employment
4

Delivery of Care
Caregiving teams
Backed with 3 levels of support
Clinical
Logistic
Strategic
5

Population Health
Many HCOs work to improve the health of patients and communities. A population health requires excellence in patient care for a defined group of individuals
7

Population Health
There are 4 steps to improving health:
Defining the population
Geography, sociodemographic factors, disease state, risk, insurance coverage, or in other defined ways
Measuring the current status of health in the population
Setting goals for improvement
Directing resources toward making improvements
8

EXHIBIT 1.2
Personal Services for Community Health

Healthy People 2020
Improving population health requires identifying and overcoming determinants of health through collaborative efforts
Public health, community development, education, and social services

http://www.healthypeople.gov/

Collaborative, Dynamic Nature
HCO creates, supports and coordinates the caregiving and support teams
Large organizations provide comprehensive individual patient care across the continuum from birth to death including both preventative medicine to extended end-of-live care
Teams grouped in service lines

Service Lines
Patient centered teams organized and coordinated around a similar set of diseases or patient needs
Surgical services
Cardiothoracic services
Cancer services
Women’s services
Children’s services

Dynamic HCO
Large HCOs now provide an array of service lines, coordinating primary care, inpatient and outpatient acute care, rehabilitation, and follow- up care to support treatment
Dynamic in 3 ways
24/7/365 service
Provide latest scientific treatments
Changes to the needs of the community and epidemiology of diseases
13

Stakeholders
An organization serves many masters or stakeholders
Individuals or groups (buyers, workers, suppliers, regulators, and owners) who have a direct interest in an organization’s success

EXHIBIT 1.3 Model of Stakeholder–HCO Interaction

Customer Partners
Patient and families
Important stakeholders
Expect patient centered, quality, cost effective care
Major trust

Customer Partners
Health Insurer and payment agencies
Serve as fiscal intermediary
Provide most of the revenue to HCOs
Payment or management agent for healthcare insurance
Medicare – Federal
Medicaid – State and Federal

Affordable Care Act
Patient Protection and Affordable Care Act (ACA) – a federal law (P.L.111-148) providing for a fundamental reform in the US healthcare and health insurance system
The ACA provides:
Increase insurance coverage
New approaches to support those with chronic disease
Greater accountability for cost and quality of care
18

Affordable Care Act
The Triple Aim (3 goals for transforming the health system)
1. improving the individual patient experience with healthcare
2. improving the health of the population
3. reducing the per capita cost of care
The ACA has created new payer arrangements with value based purchasing
Value-based purchasing links financial incentives to the quality of care

Customers
Buyers – health insurance is provided through employment, making employers important stakeholders
Unions have traditionally played an important role
Federal, state and local governments purchase care for specialty groups
Insurance buyers seek to restrict growth of costs through value-based purchasing
20

Regulatory Agencies
Government regulatory agencies – established authority over healthcare activities; licensing agencies and rate-regulating commissions are examples
External agencies that review the quality of care and use of insurance benefits by individual physicians and patients for Medicare and other insurers

Accreditation
Most payment organizations mandate external review of HCOs performance through accreditation and financial audits. Voluntary but required by CMS (deemed status)
The Joint Commission – a voluntary consortium of professional provider organizations that evaluate and accredit HCOs
National Committee for Quality Assurance – ambulatory care and disease management programs

CON
Certificate of Need – CON – approvals for new services and construction or renovation of hospitals and related facilities

HIPAA
Health Insurance Portability and Accountability Act (HIPAA) – 1996 federal act that establishes standards of privacy for patient information

Protection Laws
EMTALA Law
All HCOs providing emergency care must accept all patients, regardless of ability to pay, until they are stabilized and can be move safely
25

Protection Laws (cont.)
Community Benefits
Provision of the ACA requires NFP HCOc under the 501 C(3) IRS Code to review community need and report the community benefit value of the HCO
The standard addresses charitable care, educational services, and other benefits HCOs provide to their community

Community Groups
Far reaching exchanges with community agencies and groups
Social service agencies
Law enforcement, fire and ambulances
Religious organizations
United Way and other community benefit groups
27

Other Partners
Strategic Partnerships
Commitments with long-term obligations with suppliers and other providers
Joint Ventures
Formal, long-term collaborative contracts usually involving equity investment
Hospice
A model of caregiving that assists with physical, emotional, spiritual, psychological, social, financial and other legal needs of the dying and their families
28

Provider Partners
The second most fundamental exchange is between the HCO and its associates
Institutional and personal caregivers
Associates
People (employees, BODs, volunteers, medical staff members who give their time and talents to the HCO

Provider Partners (cont.)
Licensed Independent Practitioners (LIPs)
Caregivers granted legal status to provide specific kinds of healthcare
Primary care practitioners (PCPs)
Initial contact providers, physicians, peds, OB, psychiatry, NP, Midwives
Referral specialist physicians
Doctors who care for patient’s referred by primary care, likely to manage episodes of inpatient care

Provider Partners (cont.)
Hospitalists – physicians who manage broad categories of hospitalized patients
Intensivists – physicians who manage critically ill hospitalized patients
31

Associate Organizations
Unions or collective bargaining units sometimes represent employees
Monitored by government agencies of various types
Occupational safety (OSHA)
Licensure (State)
Equal Opportunity Agencies (EEOC)
32

Sources of Stakeholder Influence
Ultimate source of stakeholders’ power is the marketplace and the ability to participate
Participation and market pressure
measured by market share, and provider participation
Acquire and retain loyal or secure customers/associates
Negotiation – stakeholders present concerns
Networking
Social controls

Ownership and Centralization
Not-for-Profit
For-Profit
Government Owners
Community Hospital
Healthcare System
A corporate or governmental structure including one or more hospitals and offer other HCO services

EXHIBIT 1.4
Ownership and Specialization of U.S. Hospitals, 2010

EXHIBIT 1.5
Hospital Expenditures by Ownership

Primary Care
Primary care HCOs were traditionally organized around one or a few practitioners – doctors’ offices, or urgent care centers
Many physicians are now direct employed by large HCOs
Community health centers are often FQHCs (Federally qualified health centers) which are NFP clinics which care for the needs of the poor and uninsured
37

Accountable Care Organizations
A set of healthcare providers – including primary care physicians, specialists, and hospitals – that work together collaboratively and accept collective accountability for the cost and quality of care to a population of patients

Patient Centered Medical Homes
A patient-centered medical home (PCMH) might sound like a place, or somewhere you’d go. It’s not. It’s a long-term, team-based approach for your primary health care.
It’s a mechanism for organizing primary care to provide high-quality care across the full range of individuals’ healthcare needs.

Designing Excellence
Excellence is achieved when the needs of both the customer and provider stakeholders are met:
Patient care is safe, effective, patient centered, timely, efficient, and equitable
The HCO participates with other community organizations to meet the population health needs
Caregivers and associates are attracted to the HCO
Expenditures are controlled, cost of care is within the communities reach
40

Designing Excellence
Vertical Integration – the affiliation of organizations that provide different kinds of services, such as hospital care, ambulatory care, long-term care and social services
Horizontal Integration – integration of organizations that provides the same kind of services, such as two hospitals or two clinics
41

Excellence – 3 Major Foundations
Cultural – a commitment to values that attract the respect and support of stakeholders as individuals
Operational – a system that seeks out, evaluates, and implements opportunities to improve stakeholder returns
Strategic – a system that deliberately monitors relationship between stakeholders and responds to challenging needs
42

EXHIBIT 1.6
Foundations of Excellence in Healthcare Organizations

Shared Values
Mission
A statement of purpose – the good or the benefit the HCO intents to contribute – couched in terms of an identified community, a set of services, and a specific level of cost or finance
Vision
An expansion of the mission that expresses intentions, philosophy, and self-image
Values
An expansion of the mission that expresses basic rules of acceptable conduct, such as respect for human dignity or acceptance of equality
44

HCO Baldrige National Quality Award
Organizations everywhere are looking for ways to effectively and efficiently meet their missions and achieve their visions. Thousands of organizations use the Baldrige Excellence Framework and its Criteria for Performance Excellence to guide their enterprises, improve performance, and get enduring results. Areas:
Leadership
Strategy
Customers
Measurement, analysis, and knowledge management
Workforce
Operations
Results
45

EXHIBIT 1.7 Mission and Vision Statements of HCO Baldrige National Quality Award Recipients

EXHIBIT 1.7 Mission and Vision Statements of HCO Baldrige National Quality Award Recipients (continued)
© 2016 Foundation of the American College of Healthcare Executives

(continues on next slide)

EXHIBIT 1.7 Mission and Vision Statements of HCO Baldrige National Quality Award Recipients (continued)
© 2016 Foundation of the American College of Healthcare Executives

(continues on next slide)

EXHIBIT 1.7 Mission and Vision Statements of HCO Baldrige National Quality Award Recipients (continued)
© 2016 Foundation of the American College of Healthcare Executives

(continues on next slide)

EXHIBIT 1.7 Mission and Vision Statements of HCO Baldrige National Quality Award Recipients (continued)
© 2016 Foundation of the American College of Healthcare Executives

Shared Values
Empowerment
The ability of an associate to control his/her work situation in ways consistent with the mission
Communication
Frequent, candid, and useful
Listening
Deliberately soliciting stakeholder input through various communication methods
Surveys, focus groups, direct conversations
51

Shared Values
Negotiating
Major shift in organizational thought
Empowerment, commands used for emergencies
Teaching
Protocols
Agreed-on procedures for each task in the care process
Procedures or processes
Actions or steps that transform inputs to outputs
52

Shared Values
Modeling
Everyone exhibiting behaviors that support the organizations values
Professional actions to personify and implement the mission, vision, and values
Coaching and mentoring to improve skills
Service Excellence
Agency accountability
Service excellence
Rewards for Success
53

EXHIBIT 1.9 Mercy Health System Award/Incentive Programs and Objectives

Operational Foundations of Excellence
Evidence-Based Management
Relies heavily on formal process specification and performance measures
Patient Care Protocols or Guidelines
Formally established expectations that define the normal steps or processes in the care of a clinically related group of patients at a specific institution
Functional Protocols
These determine how function elements of care are carried out

Evidenced Based Management
Boundary Spanning
Establishing and maintaining effective relationships with all stakeholders
Knowledge Management
Maintaining a detailed data warehouse, a library ow work processes, protocols, and performance measures
56

Evidenced Based Management
Training
JIT
Coaches, consultants or leaders
Promptly and accurately by various methods
Accountability hierarchy
A reporting and communication system that links each operating unit to the governing board, usually by grouping similar centers together under middle management

Scorecards
Operational scorecard – performance report for a single work unit or an aggregate of several related units
Strategic scorecard – also called balanced scorecard, measures the organization as a whole or in large components of the organization, especially those with independent financial structures
58

EXHIBIT 1.10 Operational Scorecard: Performance Measures for Individual Teams and Work Units

EXHIBIT 1.11 Template of Strategic Measures of HCO Performance

Continuous Quality Improvement
Continuous Improvement – continually analyzing and improving all work processes
Benchmark – the best known value for a measure
Opportunities for improvement (OFIs) – measuring an actual outcome against a goal and goal against a benchmark
Process improvement teams (PIT) – that analyzes processes and translates OFIs to performance improvement
Root cause analysis – underlying factors that must change to yield the consistently better outcomes

EXHIBIT 1.12 Process Analysis: Translating OFIs to Improved Performance

Strategic Foundation of Excellence
Strategy – a systematic response to a specific stakeholder need
Strategic positioning – the set of decisions about mission, ownership, scope of activity, location, and partners that define the organization and relates it to stakeholder needs
Strategic protection – safeguards the assets of the organization
63

EXHIBIT 1.13
Competitive Tests for Investment Opportunities

EXHIBIT 1.14
Strategic Positioning and Monitoring Processes

Audits
Transparent performance review
Open review of reports within the units and other units with 90 day plan for goal achievement
Internal audits and review
Process that ensures reliability of quantitative reports and discourages any misrepresentation
External review, audits, and oversight
Customers and stakeholders regularly evaluated by the Joint Commission, financial auditors, and other agencies
66

EXHIBIT 1.15 Foundations That
Reinforce Agency/Accountability Relationships

Correction
Warning and discussion of causes and corrections
Consequences of continued failure
Written record is created
Continued failure leads to termination or reassignment
Monitoring and maintaining the foundations is a strategic activity of the senior leaders and the BODs
68

Thank You
69

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