An important note from Griffith book -

The most crucial deciding factor of joint investment venture between the physician and hospital is -

"Mission of the Healthcare Organization".

It is this mission statement that will

- Protect Tax Exemption status

-Comply with Antitrust Regulation

- Avoid Gain-Sharing

- Protect from Fraud and Abuse Regulation.

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In order to determine if a new clinical support service (CSS) proposal should be adopted, a determination must be made whether the benefits outweigh the treatments alternatives that currently exist.  According to Griffith and White (2007), the contribution that a CSS provides can be calculated by multiplying:

a.       The demand for the service, probability that the service will improve the outcome, and the cost of the service

b.      The demand for the service, value of the improvement, and the cost of the service

c.       The demand for the service, probability that the service will improve the outcome, and the value of the improvement

d.      None of the above

Answer is C (p 314)

Contribution = (demand for a service)x(probability that the service will improve the outcome)x(value of the improvement)

What are the 4 critical issues in a nursing organization?

1. An adequate supply of nurses at all levels must be recruited.-supply to nursing staff must be available from both locally to nationally.

2. The transition to service lines has created a dual accountability in nursing- to the service line team and to the organization.  The nursing organization is emerging as the source of standards for common elements of nursing care, staffing and scheduling models, training for nonprofessional nursing personnel, and training for nurse supervisors.

3. A culture of improvement must replace a culture of blame.-nurses and others must feel free to report errors and near misses and must work with others to devise processes that eliminate them.- Notice why The Joint Commission is placing so much weight on Performance Improvement Indicators...do the staff know them...do they know how it affects them...are they discussed routinely in staff meetings.

4. Retention of nursing personnel is essential.  Turnover is costly, both in direct dollars for finding and training new personnel and in hidden costs of errors and team efficiency. -so management should answer staff's questions, provide support, encourage involvement in protocol selection and performance improvement- Notice this is how many union organizations survive.  -Hiring the 'Right Person' for the job is crucial...and retaining and growing that individual is even more important.

So, we need to have active avenues of recruitment, we need to be able to focus on specific service line of nursing, we need to involve nurses in what we are measuring...and then help us manage it, and we must retain and grow our nursing staff.

Brad 

Griffith and White "The Well-Managed Healthcare Organizations" Chapter 6 sites the ACGME as identifying 6 competencies of a physician.  They include all but which?

A. Patient Care & Medical knowledge

B. Morbidity & Mortality Rates

C Professionalism & Interpersonal and communication skills

D Practice-based learning, improvement & System-based practice

Answer - B, M&M rates do not determine competency

As highlighted by the powerpoint presentation, figure 8.2 outlines the functions of CSSs.  The clinical functions are:

-quality; technical, patient-centered, integrated

-appropriateness

The managerial functions are:

-facility, equipment, and staff planning

-amenities and marketing

-patient scheduling

-continuous improvement

-budgeting

-human resource management

A. Population Demographics

B. Morbidity Rate

C. Capitation Rate

D. Mortality Rate

E. Utilization Rate

Source: Online Tutorial

1. What is NCQA and why is it important to health maintenance organizations?

The National Committee on Quality Assurance arose largely as the result of private purchasers' desire to instill a commitment to quality in the HMO industry and to do this through private sector initiatives rather than relying on public regulation. Working in collaboration with the HMO industry, NCQA has developed progressively more demanding standards for use in evaluating the performance of plans. A major impetus to its status and stature has come from a number of large employers requiring NCQA accreditation for HMOs as a condition of bidding for coverage for their employees. This, in turn, has made HMOs invest heavily in the systems necessary to meet accreditation standards and demonstrate efforts toward continuous improvement, a key philosophy of NCQA. The HMO industry has also recognized that NCQA accreditation may be preferable to publicly developed standards that might be promulgated at the state level, introducing enormous inter-state variability. Additionally, the current public relations problems of the HMO industry has caused many plans to use NCQA accreditation as a basis for arguing that they are being subjected to careful, systematic scrutiny by outside organizations that issue opinions as to the performance and trustworthiness of an HMO.

A. Satisfaction

B. Demand

C. Output /Productivity

D. Prescribing Habits

E. Quality

Answer: "D". The Well Managed HCO, 6th Edition, Griffith/White, pp242