EXTERNAL FORCES

We are learning what is externally driving health service organizations and their managers. Quality structure, process, and outcomes impact all types of health service organizations. Exploring the following organizations will help to more fully grasp some of the external forces that impact managerial decisions and behaviors.

 

As previously noted, regulatory, accreditation, advocacy, professional organizations, and other external agencies greatly impact the functioning of health services. The steps of the QI process as outlined in Figure 8.1 in Longest and Darr is a mechanism by which organizations can address continuous quality. Consider what you are learning about improvement methodologies; CQI, Lean and Six Sigma, Lean, re-engineering (Longest and Darr, p. 370-375), and tools for CQI such as control charts, fishbone diagram, pareto analysis, scatter diagram (Longest and Darrr, p. 378-383, and other controls.

 

Explore some of the information that is available:

 

AHIPopens in a new window a national trade association representing the health insurance agencies.

Accreditation websites such as but not limited to:

JACHOopens in a new window Joint Commission on Accreditation of Healthcare Organizations (Longest and Darr, pp. 112,147, 155)

NCQAopens in a new window regarding accreditation expectations which also includes information about the Healthcare Effectiveness Data and Information Set (HEDIS) – a national report card for many health plans (Longest and Darr, pp. 112-113)

Websites that house report cards such as but not limited to:

NYSopens in a new window

Vermontopens in a new window

Governmental website such as

The National Institute for Mental Healthopens in a new window

AHRQopens in a new window (Longest and Darr, p. 149) whose mission is “to improve the quality, safety, efficiency and effectiveness of health care for all Americans.”

Affordable Care Act (ACA)opens in a new window

Centers for Medicare and Medicaid (CMS) incentive programs such as

Electronic health recordsopens in a new window

Medicare Star programopens in a new window

Discussion Topics and Instructions

As you explore the content of these links, share additional sources of external influences with the class as you discuss the following questions.

 

Infer what managers can do to reduce the likelihood of clinical and administrative ethical problems when allocating resources and working towards achieving goals given the competitiveness within the industry. Also, consider the roles played by the stakeholders that directly affect the service delivery networks.

How could meeting industry expectations, propel managers into challenging and possible conflict of interest situations? How is technology and resource allocation impacted.

Compare and contrast the technical, human relations and conceptual skills required of managers at different levels in the organization, and the competing values skills leaders (Edwards and Yankey, p. 23) need with the need to address quality and outcomes.

This is an upper level college course, so the expectation is that contributions to these web discussions will reflect quality and substance. Your contributions should demonstrate objective, scholarly thinking and reflections and be supported by the readings. Please refrain from sharing unsubstantiated personal opinions not based upon fact and/or experience. For assistance on finding Library Resources and Academic Integrity review the resources available to you.