Coursera: Healthcare Organizations and the Health System Healthcare Organizations and the Health System About this Course Have you ever been in a healthcare waiting room and thought about how the organization could be more efficient? For example, have you found yourself thinking about how to reduce the amount of time spent waiting? Or do you work in a healthcare organization and find yourself thinking about how to improve the organization? If you have, this course is for you. Course content includes an overview of healthcare organizations, their administration and management, and their governance. The course provides links to external sites to connect you to the larger "real world" of healthcare organizations. The links also serve as resources you can take with you after you complete the course experience. And because everyone loves a road trip/field trip, there are also "virtual field trips" to the often hidden places of interest on the web. The course format is readings, videos, quizzes, and an electronic poster project. The poster project requires you to synthesize course material to design a healthcare organization and governance structure the way you would have things run in the best of all worlds. The electronic poster file is an artifact of the course which you can circulate to colleagues or use for a talk or presentation event. Note: The photographer for the course logo shown above is Dmitri Popov and the photo was downloaded from Unsplash (https://unsplash.com/). ©Margaret Kilduff 2018 1 Coursera: Healthcare Organizations and the Health System Table of Contents/Syllabus LESSON ONE: HEALTHCARE ORGANIZATIONS AND THE HEALTH SYSTEM ................................................... 6 Learning Objectives ................................................................................................................................... 6 [INFO] [FUN] Welcome to the Course! ..................................................................................................... 6 Reading: [FUN] Welcome and Find Your Seat ...................................................................................... 6 Reading: [INFO] Welcome and Course Overview ............................................................................... 10 Discussion Prompt: [FUN] Feedback - Course as a Whole .................................................................. 15 [FUN] Video: History of Massachusetts General Hospital (MGH) ...................................................... 15 Discussion Prompt: [FUN] What would you like to learn in this course? ........................................... 16 [INFO] [FUN] Lesson One Content and Discussion ................................................................................. 16 Reading: [INFO] Welcome and Lesson One Overview ........................................................................ 16 Discussion Prompt: [FUN] Feedback - Lesson One ............................................................................. 16 Reading: [INFO] Topic 1. "Health Care" versus "Healthcare" ............................................................. 16 Reading: [INFO] Topic 2. Healthcare Organization and Health System .............................................. 18 [FUN] Video - Topic 2: U.S. Public Health Service (USPHS) Overview................................................. 21 Reading: [INFO] Topic 3. Healthcare Organization Definitions........................................................... 21 [FUN] Video - Topic 3: LBJ 1965 Medicare Bill-Signing Ceremony ..................................................... 28 Reading: [INFO] Topic 4. Healthcare Organization Accreditation ...................................................... 28 [FUN] Video - Topic 4: E.A. Codman, An MGH Legend ....................................................................... 32 Reading: [INFO] Topic 5: Healthcare Organization Characteristics .................................................... 33 [FUN] Video - Topic 5: Value-Based Purchasing ................................................................................. 40 Discussion Prompt: [FUN] Healthcare Organization Quality Measures ............................................. 40 [CERT] [PREP] Lesson One Quiz and "Create Your Own Healthcare Organization" ................................ 40 Quiz: [CERT] Lesson One Quiz ............................................................................................................. 40 Practice Peer-graded Assignment: [PREP] Lesson One Create Your Own Healthcare Organization .. 44 [FUN] Lesson One Trivia Question and Virtual Field Trip........................................................................ 44 Reading: [FUN] Lesson One Trivia Question ....................................................................................... 44 Reading: [FUN] Lesson One Trivia Question Answer .......................................................................... 44 Reading: [FUN] Lesson One Virtual Field Trip ..................................................................................... 45 [FUN] Video - Lesson One Virtual Field Trip ....................................................................................... 45 LESSON TWO: HEALTHCARE ADMINISTRATION AND MANAGEMENT ....................................................... 46 Learning Objectives ................................................................................................................................. 46 [INFO] [FUN] Lesson Two Content and Discussion ................................................................................. 46 Reading: [INFO] Welcome and Lesson Two Overview........................................................................ 46 ©Margaret Kilduff 2018 2 Coursera: Healthcare Organizations and the Health System Discussion Prompt: [FUN] Feedback - Lesson Two ............................................................................. 46 Reading: [INFO] Topic 1. Healthcare Administration versus Healthcare Management ..................... 47 [FUN] Video - Topic 1: Massachusetts General Hospital (MGH) Administrative Fellowship Overview ............................................................................................................................................................ 50 Reading: [INFO] Topic 2. Healthcare Administrator Skills and Knowledge......................................... 50 [FUN] Video - Topic 2: American College of Healthcare Executives (ACHE) Overview....................... 55 Reading: [INFO] Topic 3. Evidence-Based Healthcare Administration Practice ................................. 56 [FUN] Video - Topic 3. What Are Systematic Reviews? ...................................................................... 59 Reading: [INFO] Topic 4. Healthcare Administration Frameworks ..................................................... 59 [FUN] Video - Topic 4. An Introduction to Lean Thinking ................................................................... 63 Reading: [INFO] Topic 5. Healthcare Administration Professional Associations ................................ 63 [FUN] Video - Topic 5. The Perelman School of Medicine: First ......................................................... 66 Discussion Prompt: [FUN] Healthcare Organization Silos................................................................... 66 [CERT] [PREP] Lesson Two Quiz and "Create Your Own Healthcare Organization"................................ 66 Quiz: [CERT] Lesson Two Quiz ............................................................................................................. 66 Practice Peer-graded Assignment: [PREP] Lesson Two Create Your Own Healthcare Organization.. 71 Practice Peer-graded Assignment: [PREP] Copy of Lesson One Create Your Own Healthcare Organization........................................................................................................................................ 71 [FUN] Lesson Two Trivia Question and Virtual Field Trip ....................................................................... 71 Reading: [FUN] Lesson Two Trivia Question ....................................................................................... 71 Reading: [FUN] Lesson Two Trivia Question Answer (Optional) ........................................................ 72 Reading: [FUN] Lesson Two Virtual Field Trip..................................................................................... 73 [FUN] Video - Lesson Two Virtual Field Trip ....................................................................................... 74 LESSON THREE: GOVERNANCE.................................................................................................................... 75 Learning Objectives ................................................................................................................................. 75 [INFO] [FUN] Lesson Three Content and Discussion ............................................................................... 75 Reading: [INFO] Welcome and Lesson Three Overview ..................................................................... 75 Discussion Prompt: [FUN] Feedback - Lesson Three .......................................................................... 75 Reading: [INFO] Topic 1. Governance and Theory.............................................................................. 76 [FUN] Video - Topic 1. Cool Things at the National Archives .............................................................. 81 Reading: [INFO] Topic 2. Governance and Business Structure ........................................................... 81 [FUN] Video - Topic 2. Treasury Building Restoration ........................................................................ 90 Reading: [INFO] Topic 3. Governance and Tax Status ........................................................................ 90 [FUN] Video - Topic 3. Therapy Dogs at Walter Reed ......................................................................... 96 Reading: [INFO] Topic 4. Governance and Mission, Vision, and Bylaws............................................. 96 [FUN] Video - Topic 4. Olmsted's Plan for the U.S. Capitol............................................................... 102 Reading: [INFO] Topic 5. Governance and a Board of Directors....................................................... 102 ©Margaret Kilduff 2018 3 Coursera: Healthcare Organizations and the Health System [FUN] Video - Topic 5. The Board’s Role in Value Creation .............................................................. 106 Discussion Prompt: [FUN] For-Profit or Non-Profit Healthcare Organizations ................................ 106 [CERT] [PREP] Lesson Three Quiz and "Create Your Own Healthcare Organization" ........................... 107 Quiz: [CERT] Lesson Three Quiz ........................................................................................................ 107 Practice Peer-graded Assignment: [PREP] Lesson Three Create Your Own Healthcare Organization .......................................................................................................................................................... 111 Practice Peer-graded Assignment: [PREP] Copy of Lesson Two Create Your Own Healthcare Organization...................................................................................................................................... 111 Practice Peer-graded Assignment: [PREP] Copy of Lesson One Create Your Own Healthcare Organization...................................................................................................................................... 111 [FUN] Lesson Three Trivia Question and Virtual Field Trip ................................................................... 112 Reading: [FUN] Lesson Three Trivia Question .................................................................................. 112 Reading: [FUN] Lesson Three Trivia Question Answer ..................................................................... 112 Reading: [FUN] Lesson Three Virtual Field Trip ................................................................................ 113 [FUN] Video - Lesson Three Virtual Field Trip ................................................................................... 113 LESSON FOUR: DESIGN A GOVERNANCE STRUCTURE FOR A HEALTHCARE ORGANIZATION ................... 114 Learning Objectives ............................................................................................................................... 114 [INFO] [FUN] Lesson Four Content and Discussion ............................................................................... 114 Reading: [INFO] Welcome and Lesson Four Overview ..................................................................... 114 Discussion Prompt: [FUN] Feedback - Lesson Four .......................................................................... 115 Reading: [INFO] Topic 1. Synthesize Course Content ....................................................................... 115 [FUN] Video - Topic 1. This is LibreOffice.......................................................................................... 121 Reading: [INFO] Topic 2. Generate An Effective Electronic Poster................................................... 122 [FUN] Video - Topic 2. TechTime: Designing Conference Posters in PowerPoint ............................ 125 Reading: [INFO] Topic 3. Judge the Quality of a Poster .................................................................... 125 [FUN] Video - Topic 3. The Perfect Elevator Pitch ............................................................................ 130 [CERT] [FUN] Lesson Four Self-Evaluations and Peer Review ............................................................... 131 Quiz: [CERT] Synthesize Course Content Self-Evaluation ................................................................. 131 Quiz: [CERT] Generate an Effective Electronic File Poster Self-Evaluation....................................... 136 Peer-graded Assignment: [CERT] Poster Submission and Evaluation .............................................. 138 Review Your Peers: [CERT] Poster Submission and Evaluation ........................................................ 148 Discussion Prompt: [FUN] Poster Generation and Judging .............................................................. 148 [FUN] Lesson Four Trivia Question and Virtual Field Trip ..................................................................... 148 Reading: [FUN] Lesson Four Trivia Question .................................................................................... 148 ©Margaret Kilduff 2018 4 Coursera: Healthcare Organizations and the Health System Reading: [FUN] Lesson Four Trivia Question Answer ....................................................................... 149 Reading: [FUN] Lesson Four Virtual Field Trip 5 min ....................................................................... 149 [FUN] Video - Lesson Four Virtual Field Trip ..................................................................................... 150 [INFO] [FUN] Wrapping Up the Course ................................................................................................. 150 Reading: [INFO] Thank You For Participating in This Course ............................................................ 150 [FUN] Video - Highline Trail, Glacier National Park, Montana .......................................................... 151 Discussion Prompt: [FUN] Did you learn what you wanted to learn? .............................................. 151 Discussion Prompt: [FUN] Another Opportunity for Feedback - Course as a Whole ....................... 151 Appendix A: Lesson One Create Your Own Healthcare Organization....................................................... 153 Appendix B: Lesson Two Create Your Own Healthcare Organization....................................................... 156 Appendix C: Lesson Three Create Your Own Healthcare Organization .................................................... 159 Appendix D: Coursera_PD_HealthcareOrganization.pdf .......................................................................... 162 ©Margaret Kilduff 2018 5 Coursera: Healthcare Organizations and the Health System LESSON ONE: HEALTHCARE ORGANIZATIONS AND THE HEALTH SYSTEM This lesson provides an overview of the course as well as an overview of healthcare organizations and the health system. Learning Objectives Define a healthcare organization, a health system, and their relationship. [INFO] [FUN] Welcome to the Course! Reading: [FUN] Welcome and Find Your Seat 10 min Every course - every learning event - begins by "finding your seat". It begins by finding the location best suited for you to study and learn the course/event material. In today's world, especially in an online course, that "seat" can be in your kitchen, a coffee shop, on public transportation ... anywhere there is an internet connection. There is something nice, however, about finding a seat - even if only in your mind's eye - in a library, especially one of the iconic libraries. Such iconic libraries are architecturally stunning and provide a wonderful environment in which to ponder, consider, and learn. A few are shown below. Feel free to "take a seat" - any seat - in your mind's eye in one of them before moving on to the next section Welcome and Course Overview (Required). _____________________________________________________________________________________ Library of Congress (founded in 1800) especially the Main Reading Room Image from Wikipedia, File:LOC Main Reading Room Highsmith.jpg _____________________________________________________________________________________ ©Margaret Kilduff 2018 6 Coursera: Healthcare Organizations and the Health System State Library of Iowa Law Library (founded in 1840) Image from Wikipedia, File:IowaStateCapLawLibrary.jpg _____________________________________________________________________________________ Boston Public Library (founded in 1852) especially Bates Hall, Central Library Image from Wikipedia, File:Bates Hall Boston.jpg _____________________________________________________________________________________ George Peabody Library, Johns Hopkins University (founded in 1857) Image from Wikipedia, File:George-peabody-library.jpg ©Margaret Kilduff 2018 7 Coursera: Healthcare Organizations and the Health System _____________________________________________________________________________________ Chicago Public Library (founded in 1873) especially the Winter Garden, Harold Washington Library Image from Wikipedia, File:9th Level Harold Washington Library.jpg _____________________________________________________________________________________ Seattle Public Library (founded in 1890) especially the new Central Library Image from Wikipedia, File:Seattle library main branch overhead.jpg _____________________________________________________________________________________ New York Public Library (founded in 1895) especially the Rose Main Reading Room, Stephen A. Schwarzman Building Image from the New York Public Library (NYPL), Rose Reading Room ©Margaret Kilduff 2018 8 Coursera: Healthcare Organizations and the Health System _____________________________________________________________________________________ Fisher Fine Arts Library, University of Pennsylvania (founded in 1888) Image from Wikipedia, File:Furness Lib interior looking N UPenn.JPG _____________________________________________________________________________________ Suzzallo Library, University of Washington (founded in 1926) Image from Wikipedia, File:MK03235 University of Washington Suzzallo Library.jpg _____________________________________________________________________________________ William W. Cook Legal Research Library, University of Michigan (founded in 1931) ©Margaret Kilduff 2018 9 Coursera: Healthcare Organizations and the Health System Image from Wikipedia, File:UniversityofMichiganLawLibrary.jpg _____________________________________________________________________________________ Bodleian Library and Radcliffe Camera, Oxford University (founded in 1602) Image from Wikipedia, File:Radcliffe Camera, Oxford - Oct 2006.jpg (Photo by DAVID ILIFF. License: CCBY-SA 3.0) _____________________________________________________________________________________ Reading: [INFO] Welcome and Course Overview 10 min Whether you are auditing this course or enrolled for the certificate in this course, you should find the information in this section helpful. If you are auditing, thank you for visiting. I hope you enjoy your visit and decide to enroll for the certificate at some point. If you are a certificate learner, I look forward to working with you! Thank you for enrolling for the certificate. This section contains a general introduction to the course. It asks and answers the following questions: 1. 2. 3. 4. 5. 6. What is a brief summary of the course? What are the course objectives? What is needed to successfully complete the work for the certificate? What is the educational philosophy of the course? Is this course part of a specialization? What are the course rules for certificate learners? Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. ©Margaret Kilduff 2018 10 Coursera: Healthcare Organizations and the Health System 1. What is a brief summary of the course? Have you ever been in a healthcare waiting room and thought about how the organization could be more efficient? For example, have you found yourself thinking about how to reduce the amount of time spent waiting? Or do you work in a healthcare organization and find yourself thinking about how to improve the organization? If you have, this course is for you. This course is for you if you are interested in the world of healthcare organizations in the United States. Course content includes an overview of healthcare organizations, their administration and management, and their governance. The course is suitable for those with a developing interest in healthcare organization operations, administration, and management. It is also suitable for those who have some expertise, but who wish an overview or refresher of these topics. Each section of the course is marked to indicate its relevance to the work required to obtain the certificate. The markings are: [CERT] which means the section contains work which must be successfully completed to obtain the certificate. [INFO] which means the section provides information relevant to the work required for the certificate. [PREP] which means the section provides practice for the certificate work. [FUN] which means the section provides either: 1) interesting additional information which is supplemental, but not needed for the certificate; 2) an opportunity to post your comments on a specified topic for discussion with course colleagues, if you choose to do so; or 3) an opportunity to provide feedback on the course, if you choose to do so. The course format is readings, videos, quizzes, and a project. The readings sections are [INFO] sections which present content using the Socratic Method questions and answers. The videos are [FUN] sections used to present interesting supplemental content not needed to successfully complete the work for the certificate. The project [CERT] requires you to synthesize course material to design a healthcare organization and governance structure the way you would have things run in the best of all worlds. The plan (submitted as an electronic poster file) is an artifact of the course which you can circulate to colleagues or use as the basis for a talk or presentation event. Links within course sections lead to external [FUN] readings not needed for the certificate work. These [FUN] links to external sites are intended to connect you to the larger "real world" of healthcare organization business processes, business process management, and entrepreneurship. You do not have to visit these external links. Do so only if you have the interest and the time. The links also serve as resources you can take with you after you complete the course experience. ©Margaret Kilduff 2018 11 Coursera: Healthcare Organizations and the Health System And because everyone loves a road trip/field trip, there are also [FUN] "virtual field trips" to the often hidden places of interest on the web. There are also [FUN] trivia questions - just for fun - because everyone also loves little known, but interesting, fun facts. The course is 4 weeks, 4 lessons, and 4-6 hours of learner work per lesson; total time commitment for the course = 16 - 24 hours. The four lessons of the course are: 1. 2. 3. 4. Healthcare Organizations and the Health System (Assessment: Quiz) Healthcare Administration and Management (Assessment: Quiz) Governance (Assessment: Quiz) Design a Governance Structure for a Healthcare Organization(Assessment: Project Poster) For the poster project, you will need PowerPoint software or its equivalent. There are many software options other than PowerPoint. Some are available at no cost such as Impress which is part of LibreOffice. Note [FUN]: There are many wonderful videos in the public domain which are relevant to this course. One such video provides a historical overview of one healthcare organization. Healthcare organizations in the United States seem to be in a constant state of change. The video for this Welcome and Course Overview section - History of Massachusetts General Hospital (MGH) - is a YouTube video produced by MGH. This video discusses the changes in MGH over its first 200 years (1811-2011). 2. What are the course objectives? Course content includes an overview of healthcare organizations, their governance, and their administration and management. Upon successful completion of this course, a learner will have a better understanding of healthcare organizations. Learners working within a healthcare organization will be better able to contribute to the efficient and effective operations of their organization. They will be able to undertake and improve healthcare administration and management responsibilities within their organization. Specifically, upon successful completion a learner will be able to: 1. 2. 3. 4. 5. 6. Define a healthcare organization, a health system, and their relationship. Define effective evidence-based healthcare administration and management models. Define the forms of organizational governance and functions. Synthesize course content to create a healthcare organization and governance structure. Generate an effective electronic file poster suitable for presentation and printing. Judge the quality (content presentation and format) of a poster. It is hoped that upon achieving these objectives, the learner will not just know more at the end of the course than at the beginning, but that the learner will think about healthcare organization structure and ©Margaret Kilduff 2018 12 Coursera: Healthcare Organizations and the Health System governance in new ways. The goal of the course is to enable the learner to think critically about healthcare organization structure and governance in new and interesting ways. 3. What is needed to successfully complete the work for the certificate? At the beginning of this course is a section entitled [INFO] INSTRUCTOR RECOMMENDED FAST-TRACK PATHWAY TO CERTIFICATE - Reading: [INFO] STEP-BY-STEP PATHWAY TO THE CERTIFICATE which is a step-by-step instructor recommended (what I would do) 12-step pathway to successfully complete work required to obtain the certificate as quickly and efficiently as possible. The short answer is that the successful completion of work for the certificate requires that you pass each of the six course sections marked [CERT]. These are: 1. 2. 3. 4. 5. 6. Quiz: [CERT] Lesson One Quiz Quiz: [CERT] Lesson Two Quiz Quiz: [CERT] Lesson Three Quiz Quiz: [CERT] Synthesize Course Content Self-Evaluation Quiz: [CERT] Generate an Effective Electronic File Poster Self-Evaluation Peer Review: [CERT] Poster Submission and Evaluation Successful completion of the first three quizzes (Lesson One, Two, and Three) is a score of at least 80 percent (the Pass score). Each quiz is open book, open note. You can take each quiz as many times as you want. If you do not get a score of at least 80 percent on the first try, take it again. And keep taking it, if need be, until you get the Pass score of at least 80 percent. Successful completion of the two self-evaluation "quizzes" is a score of 100 percent (the Pass score). This is a self-evaluation of the work you have developed for the Peer Review: [CERT] Poster Submission and Evaluation done prior to submitting the work (the electronic file poster using PowerPoint or similar software of your design of a healthcare organization and governance structure) for peer-review. If you cannot give yourself a score of 100 percent on the first try, keep iterating on your poster and completing the self-evaluation until you can do so. Successful completion of the peer review requires that you submit your electronic poster file for peer review, review two or your learner colleagues poster submission, and receive a score of at least 50 percent (the Pass score) on your poster submission. The content for this poster addresses your design of a healthcare organization and governance structure. As such, there are no right or wrong content items. There are only sensible and reasonable items within the content criteria specified in the course. There is also no one right way to organize the poster format. There are only sensible and reasonable format aspects within the criteria specified in the course. ©Margaret Kilduff 2018 13 Coursera: Healthcare Organizations and the Health System If you do not achieve 50 percent (if you do not receive a passing score on the poster assignment) and believe it to be the result of having been evaluated by two unusually hard graders, please contact us to resolve the situation. It should be noted that the main point of this peer-review assignment is for you to have the experience of critically judging (evaluating) the quality (content presentation and format) of a poster other than your own within a forum where your judgment has meaning. Your judgment has meaning because your judgment determines your learner colleague's grade on the poster assignment. Your judgment carries with it the responsibility to be critical, honest, fair, and consistent across all the posters you judge; that is, the same responsibility found for any subjective judgment where the judgment outcome affects a person's life. 4. What is the educational philosophy of the course? The course format and philosophy are a little different from most of the other Coursera courses. Most of the Coursera courses present course content primarily through video lectures. This course presents course content through [INFO] readings (text). Links to optional [FUN] material external to the course are included in the text. The philosophy behind the use of reading content is that a reading provides a more direct relationship between the learner and the content than does a video lecture of someone telling the learner about the content. The readings also allow the use of links to resources and additional content external to the course. These links allow learners to create their own learning pathway and customize their learning experience in a way that the video lecture does not. The links make full use of the fact that the course is delivered online. Readings [INFO] content is also presented as a series of questions and answers - the Socratic Method. The philosophy behind the use of this method is that this is a better - and much more interesting - way for a learner to master content. There are videos in the course. These are professionally produced videos (e.g., from the Smithsonian, National Archives) which are included in the course to provide interesting supplemental - optional [FUN] - content. No video-presented content is needed to complete the work for the certificate. As with the [FUN] links to external material, the use of these optional [FUN] videos allows learners to create their own learning pathway and customize their learning experience. The poster project requires learners to synthesize course material to design a healthcare organization and governance structure the way you would have things run in the best of all worlds. The design (submitted as an electronic poster file) is an artifact of the course which learners can circulate to colleagues or use as the basis for a talk or presentation event. The philosophy behind this project is that more learning occurs - and learning is more fun - if a learner can actually build/create something from ©Margaret Kilduff 2018 14 Coursera: Healthcare Organizations and the Health System the course content (rather than just being tested on the content) and show this built/created artifact to others. 5. Is this course part of a specialization? Yes, this course is one course in the four-course Healthcare Organization Operations specialization. The four courses are: Healthcare Organizations and the Health System Health Care Delivery in Healthcare Organizations Business Process Management in Healthcare Organizations Quality Improvement in Healthcare Organizations Each course is a stand-alone course; the courses do not build on each other - they complement each other. No one course in the specialization is a prerequisite for another course. If you choose to enroll in all four courses to receive the specialization certificate, the courses can be completed in any order 6. What are the course rules for certificate learners? The course rules are simple. Work hard! Have fun! Never hesitate to ask a question! Discussion Prompt: [FUN] Feedback - Course as a Whole 5 min Please post any feedback you have about the course as a whole in this discussion forum at any time during the course. All feedback (e.g., suggestions, questions, concerns, criticisms) is welcome. This is your course experience. Let us know how you feel the course experience can be improved. Let us know what you feel works particularly well in the course. [FUN] Video: History of Massachusetts General Hospital (MGH) 8 min History of Massachusetts General Hospital (MGH) The video is a YouTube video (https://www.youtube.com/watch?v=CE48gVSWygk) produced by MGH. This video discusses the changes in MGH over its first 200 years (1811-2011). ©Margaret Kilduff 2018 15 Coursera: Healthcare Organizations and the Health System Discussion Prompt: [FUN] What would you like to learn in this course? 5 min Almost everyone has a personal learning goal for a course. What is your goal for this course? [INFO] [FUN] Lesson One Content and Discussion Reading: [INFO] Welcome and Lesson One Overview 10 min Welcome to Lesson One! This lesson provides an overview of healthcare organizations and the health system. Upon successful completion of this lesson, you will be able to: define a healthcare organization, a health system, and their relationship. There is a quiz, a trivia question, and a field trip. There are also optional videos which provide [FUN] supplemental content. There are many wonderful videos in the public domain which are relevant to this course. The lesson should take 4-6 hours of work to successfully complete. This lesson asks and answers the following questions: 1. 2. 3. 4. 5. Is there a difference between the term "health care" and "healthcare"? What is the relationship between a healthcare organization and a health system? Which organizations are considered healthcare organizations in the United States? What are the healthcare organization accreditation associations in the United States? What are the major characteristics of healthcare organizations? Discussion Prompt: [FUN] Feedback - Lesson One 5 min Please post any feedback you have specifically about Lesson One in this discussion forum at any time during the course. All feedback (e.g., suggestions, questions, concerns, criticisms) is welcome. This is your Lesson One course experience. Let us know how you feel the Lesson One experience can be improved. Let us know what you feel works particularly well in the Lesson One. Reading: [INFO] Topic 1. "Health Care" versus "Healthcare" 10 min Topic 1. Is there a difference between the term “health care” and “healthcare”? ©Margaret Kilduff 2018 16 Coursera: Healthcare Organizations and the Health System Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson One Quiz. It depends on whom you ask. Some people say the terms have the same meaning and can be used interchangeably. Some people say the terms have different meanings. Either usage is technically correct. However, generally speaking, in the United States, among medical professionals, the movement is to consider the terms to have different meanings. In this situation: The term “health care” is a noun which refers to the delivery of care. The term “healthcare” is an adjective which describes the organization or professional delivering that care. For example: A hospital is a healthcare organization. A doctor is a healthcare provider. An annual dental checkup is just part of good health care. I went to a healthcare provider in a healthcare organization to receive health care for my broken foot. health care operation ©Margaret Kilduff 2018 17 Coursera: Healthcare Organizations and the Health System Thoracotomy to remove a cancerous portion of a lung - Image from the United States Navy healthcare organization Pennsylvania Hospital, Philadelphia, Pennsylvania - Image from the Library of Congress Reading: [INFO] Topic 2. Healthcare Organization and Health System 10 min Topic 2. What is the relationship between a healthcare organization and a health system? Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson One Quiz. A healthcare organization is part of a health system. However, the term “health system” can have many meanings. There is no one universal definition or common usage for the term “health system”. When reading about health systems, it is important to understand the author’s definition of the term. Generally speaking, however, the meanings fall into two broad categories: 1. A health system focuses on the delivery of health care. It contains more than one healthcare organization, healthcare activity, and/or healthcare resource with a focus on the delivery of health care. For this definition of a “health system”, the term “health system” is often used interchangeably with the term “health care system” or “healthcare system”. 2. A health system focuses on health. It contains more than one health-related organization, health-related activity, and/or health-related resource with a health focus. ©Margaret Kilduff 2018 18 Coursera: Healthcare Organizations and the Health System Category 1. A health system focuses on the delivery of health care An example of the first broad category (a health system focuses on the delivery of health care) is the definition used by the Agency for Healthcare Research and Quality (AHRQ) for its Comparative Health System Performance (CHSP) Initiative. A health system is: “an organization that includes at least one hospital and at least one group of physicians that provides comprehensive care (including primary and specialty care) who are connected with each other and with the hospital through common ownership or joint management.” (Website Source of Quote) Examples of such a health system are the: Mayo Clinic Health System New York-Presbyterian Kaiser Permanente The CHSP Initiative publishes many articles and reports. You may find three of them interesting and relevant to this question. Each is optional; you do not have to read it. They are: Snapshot of U.S. Health Systems, 2016 U.S. Health System Characteristics, 2016 Variation in Health System Characteristics Across States, 2016 Category 2. A health system focuses on health (First Example - CDC) An example of the second broad category (a health system focuses on health) is the definition used by the Centers for Disease Control and Prevention (CDC) for its discussion of the CDC and the US Public Health System. “Public health systems are commonly defined as “all public, private, and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction.” This concept ensures that all entities’ contributions to the health and well-being of the community or state are recognized in assessing the provision of public health services.” (Website Source of Quote) An interesting and important part of this public health system is the Commissioned Corps of the U.S. Public Health Service which: “is an essential component of the largest public health program in the world. Corps officers may apply to a variety of positions throughout the U.S. Department of Health and Human Services (HHS) and certain non-HHS Federal agencies and programs that offer exciting ©Margaret Kilduff 2018 19 Coursera: Healthcare Organizations and the Health System professional opportunities in the areas of disease control and prevention; biomedical research; regulation of food, drugs, and medical devices; mental health and drug abuse; and health care delivery.” (Website Source of Quote) Note [FUN]: The video for Topic 2 - U.S. Public Health Service (USPHS) Overview - is a YouTube video produced by the USPHS. Many consider the USPHS to be an essential health system component in the United States. The video provides an overview of the USPHS history, structure, and function. The CDC publishes many articles and reports. You may find two of them interesting and relevant to this question. Each is optional; you do not have to read it. They are: Public Health 101 The Ten Essential Public Health Services: An Overview Category 2. A health system focuses on health (Second Example - WHO) Another example of the second broad category (a health system focuses on health) is the definition used by the World Health Organization (WHO) for discussion of its framework for action to strengthen health systems: “A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services. It includes, for example, a mother caring for a sick child at home; private providers; behaviour change programmes; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well known determinant of better health.” (Website Source of Quote) WHO publishes many articles and reports. You may find two of them interesting and relevant to this question. Each is optional; you do not have to read it. They are: Health Services Development, The WHO Health Systems Framework (just the webpage, not the links from the webpage) Chapter One: Why Do Health Systems Matter in the WHO publication entitled The World Health Report 2000 – Health Systems: Improving Performance ©Margaret Kilduff 2018 20 Coursera: Healthcare Organizations and the Health System [FUN] Video - Topic 2: U.S. Public Health Service (USPHS) Overview 5 min U.S. Public Health Service (USPHS) Overview The video is a YouTube video (https://www.youtube.com/watch?v=jHqdHp1I8Ek) produced by the USPHS. Many consider the USPHS to be an essential health system component in the United States. The video provides an overview of the USPHS history, structure, and function. Reading: [INFO] Topic 3. Healthcare Organization Definitions 10 min Topic 3. Which organizations are considered healthcare organizations in the United States? At first glance, one might think there is an easy and obvious answer to this question. Defining a healthcare organization should be straightforward. However, there may be differences of opinion between reasonable people regarding an organization's category/definition. Some may be of the opinion, for example, that fitness centers are healthcare organizations. Some would say they are not, unless, perhaps, that fitness center was located in a hospital and could be used only upon a doctor’s order. There are, however, laws and regulations which categorize/define organizations for different purposes. Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson One Quiz. Below is a summary of which organizations are defined as a healthcare organization by some of the most commonly used laws/regulations. Each of these laws/regulations is discussed in more detail in additional content sections associated with this question. A healthcare organization, therefore, can be defined as any organization: 1. Requiring regulation and licensing by a state as a health facility. 2. Meeting the definition of a health care provider as defined in the Code of Federal Regulations (CFR) used by Health and Human Services (HHS). 3. Having a National Provider Identifier (NPI) number assigned by HHS Centers for Medicare and Medicaid Services (CMS). 4. Certified by CMS (Medicare-certified, CMS-certified). 5. Classified in the North American Industry Classification System (NAICS) in subsector 621, 622, or 623. ©Margaret Kilduff 2018 21 Coursera: Healthcare Organizations and the Health System 6. Classified in NAICS in subsector 621, 622, or 623 or one of the other subsectors with a classification title including the word “health” (e.g., 44611, 532283). Definition 1. A healthcare organization can be defined as any organization requiring regulation and licensing by a state as a health facility. Most states regulate healthcare facilities (organizations). For example, The State of New Jersey Department of Health (NJDOH) regulates and licenses more than 2000 hospitals, outpatient facilities, and long term care facilities in New Jersey. A healthcare organization in any given state is an organization requiring regulation and licensing in that state as a health facility. It should be noted that some states license a healthcare provider as an individual, but not the organization within which that provider works. For example, New Jersey does not license dental offices (organizations), but does regulate and license dentists through the New Jersey Division of Consumer Affairs, Boards and Committees - State Board of Dentistry. Physicians are regulated and licensed by the New Jersey Division of Consumer Affairs, State Board of Medical Examiners. Nurses are regulated and licensed by the New Jersey Division of Consumer Affairs, State Board of Nursing. The requirements for regulation and licensing for any healthcare provider profession may vary by state. Two good examples are the fields of nutrition and dietetics. The Center for Nutrition Advocacy provides information on licensing requirements for nutrition counselors in every state. In some states it is legal to do individual nutrition counseling (e.g., New Jersey) and in some states it is illegal (e.g., Maine). The Commission on Dietetic Registration (CDR) also provides information on the licensure and certification requirements for nutrition/dietitian healthcare professionals by state. Definition 2. A healthcare organization can be defined as any organization meeting the definition of a health care provider as defined in the Code of Federal Regulations (CFR) used by Health and Human Services (HHS). The United States Department of Health and Human Services (HHS) uses the definition of a health care provider stated for individuals and organizations in the Code of Federal Regulations (CFR), specifically 45 CFR 160.103 which states that: "Health care provider means a provider of services (as defined in section 1861(u) of the Act, 42 U.S.C. 1395x(u)), a provider of medical or health services (as defined in section 1861(s) of the Act, 42 U.S.C. 1395x(s)), and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business." Further detail about section 1861 of the Act, 42 U.S.C. 1395x(u) and (s), can be found at Social Security, Compilation of the Social Security Laws, Part E – Miscellaneous, Definitions of Service. A healthcare ©Margaret Kilduff 2018 22 Coursera: Healthcare Organizations and the Health System organization is any organization meeting the definition of a health care provider as defined in the Code of Federal Regulations (CFR) used by the United States Department of Health and Human Services (HHS). Definition 3. A healthcare organization can be defined as any organization having a National Provider Identifier (NPI) number assigned by HHS Centers for Medicare and Medicaid Services (CMS). Those who meet the above HHS definition of a health care provider are eligible to obtain a National Provider Identifier (NPI) number from the HHS Centers for Medicare and Medicaid Services (CMS). NPI records can be searched at the National Plan and Provider Enumeration System (NPPES) NPI Registry site. A healthcare organization is any organization having a National Provider Identifier (NPI) number assigned by HHS Centers for Medicare and Medicaid Services (CMS). Note [FUN]: The video for Topic 3 - LBJ 1965 Medicare Bill-Signing Ceremony - is a YouTube video produced by C-SPAN. The video shows part of President Lyndon Baines Johnson's (LBJ's) June 30, 1965 bill-signing ceremony creating Medicare. President Truman was present to receive the first Medicare card. Definition 4. A healthcare organization can be defined as any organization certified by CMS (Medicarecertified, CMS-certified). CMS also certifies healthcare organizational providers regarding whether such organizations meet the Conditions of Participation (CoP) - the health, safety, and operational standards established in the Code of Federal Regulations (CFR) , specifically 42 CFR.. The organizations on this list are often referred to as Medicare-certified and sometimes CMS-certified. A healthcare organization is any organization certified by CMS (Medicare-certified, CMS-certified). Definition 5. A healthcare organization can be defined as any organization classified in the North American Industry Classification System (NAICS) in subsector 621, 622, or 623. The North American Industry Classification System (NAICS) “is the standard used by Federal statistical agencies in classifying business establishments for the purpose of collecting, analyzing, and publishing statistical data related to the U.S. business economy.“ It was developed by the United States Office of Management and Budget (OMB). Information about NAICS is found at the Bureau of Labor Statistics (BLS) NAICS Homepage. The 2017 NAICS Manual specifies Sector 62 as Health Care and Social Assistance and describes it as follows: ©Margaret Kilduff 2018 23 Coursera: Healthcare Organizations and the Health System “The Health Care and Social Assistance sector comprises establishments providing health care and social assistance for individuals. The sector includes both health care and social assistance because it is sometimes difficult to distinguish between the boundaries of these two activities. The industries in this sector are arranged on a continuum starting with establishments providing medical care exclusively, continuing with those providing health care and social assistance, and finally finishing with those providing only social assistance. Establishments in this sector deliver services by trained professionals. All industries in the sector share this commonality of process, namely, labor inputs of health practitioners or social workers with the requisite expertise. Many of the industries in the sector are defined based on the educational degree held by the practitioners included in the industry. Excluded from this sector are aerobic classes in Subsector 713, Amusement, Gambling, and Recreation Industries, and non-medical diet and weight reducing centers in Subsector 812, Personal and Laundry Services. Although these can be viewed as health services, these services are not typically delivered by health practitioners.” BLS provides information about this sector in Industries at a Glance (IG), specifically IG - Health Care and Social Assistance: NAICS 62. NAICS divides this sector into subsectors. The first three subsectors list healthcare organizations: Subsector 621 = Ambulatory Health Care Services (approximately 600,000 organizations) Subsector 622 = Hospitals (approximately 13,000 organizations) Subsector 623. Nursing and Residential Care Facilities (approximately 82,000 organization) An expanded list of organizational categories (industries) for these three subsectors is listed below: Sector 62 -- Health Care and Social Assistance Subsector 621 -- Ambulatory Health Care Services 6211 Offices of Physicians o 62111 Offices of Physicians 621111 Offices of Physicians (except Mental Health Specialists) 621112 Offices of Physicians, Mental Health Specialists 6212 Offices of Dentists o 62121 Offices of Dentists 621210 Offices of Dentists 6213 Offices of Other Health Practitioners o 62131 Offices of Chiropractors 621310 Offices of Chiropractors ©Margaret Kilduff 2018 24 Coursera: Healthcare Organizations and the Health System o o o o 62132 Offices of Optometrists 621320 Offices of Optometrists 62133 Offices of Mental Health Practitioners (except Physicians) 621330 Offices of Mental Health Practitioners (except Physicians) 62134 Offices of Physical, Occupational and Speech Therapists, and Audiologists 621340 Offices of Physical, Occupational and Speech Therapists, and Audiologists 62139 Offices of All Other Health Practitioners 621391 Offices of Podiatrists 621399 Offices of All Other Miscellaneous Health Practitioners 6214 Outpatient Care Centers o 62141 Family Planning Centers 621410 Family Planning Centers o 62142 Outpatient Mental Health and Substance Abuse Centers 621420 Outpatient Mental Health and Substance Abuse Centers o 62149 Other Outpatient Care Centers 621491 HMO Medical Centers 621492 Kidney Dialysis Centers 621493 Freestanding Ambulatory Surgical and Emergency Centers 621498 All Other Outpatient Care Centers 6215 Medical and Diagnostic Laboratories o 62151 Medical and Diagnostic Laboratories 621511 Medical Laboratories 621512 Diagnostic Imaging Centers 6216 Home Health Care Services o 62161 Home Health Care Services 621610 Home Health Care Services 6219 Other Ambulatory Health Care Services o 62191 Ambulance Services 621910 Ambulance Services o 62199 All Other Ambulatory Health Care Services 621991 Blood and Organ Banks 621999 All Other Miscellaneous Ambulatory Health Care Services Subsector 622 -- Hospitals 6221 General Medical and Surgical Hospitals ©Margaret Kilduff 2018 25 Coursera: Healthcare Organizations and the Health System o 62211 General Medical and Surgical Hospitals 622110 General Medical and Surgical Hospitals 6222 Psychiatric and Substance Abuse Hospitals o 62221 Psychiatric and Substance Abuse Hospitals 622210 Psychiatric and Substance Abuse Hospitals 6223 Specialty (except Psychiatric and Substance Abuse) Hospitals o 62231 Specialty (except Psychiatric and Substance Abuse) Hospitals 622310 Specialty (except Psychiatric and Substance Abuse) Hospitals Subsector -- 623 Nursing and Residential Care Facilities 6231 Nursing Care Facilities (Skilled Nursing Facilities) o 62311 Nursing Care Facilities (Skilled Nursing Facilities) 623110 Nursing Care Facilities (Skilled Nursing Facilities) 6232 Residential Intellectual and Developmental Disability, Mental Health, and Substance Abuse Facilities o 62321 Residential Intellectual and Developmental Disability Facilities 623210 Residential Intellectual and Developmental Disability Facilities o 62322 Residential Mental Health and Substance Abuse Facilities 623220 Residential Mental Health and Substance Abuse Facilities 6233 Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly o 62331 Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly 623311 Continuing Care Retirement Communities 623312 Assisted Living Facilities for the Elderly 6239 Other Residential Care Facilities o 62399 Other Residential Care Facilities 623990 Other Residential Care Facilities See the 2017 NAICS Manual for a more detailed description of each organizational category (industry). A healthcare organization is any organization classified in the North American Industry Classification System (NAICS) in subsector 621, 622, or 623. ©Margaret Kilduff 2018 26 Coursera: Healthcare Organizations and the Health System Definition 6. A healthcare organization can be defined as any organization classified in NAICS in subsector 621, 622, or 623 or one of the other subsectors with a classification title including the word “health” (e.g., 44611, 532283). There are also other NAICS sectors and subsectors which contain organizations related to health which some may also consider healthcare organizations. They are listed below: Other NAICS Sectors and Subsectors Which Contain Organizations Related To Health Which Some May Consider Healthcare Organizations Sector 44 -- Retail Trade Subsector 446 – Health and Personal Care Stores 4461 Health and Personal Care Stores o 44611 Pharmacies and Drug Stores 446110 Pharmacies and Drug Stores o 44613 Optical Goods Stores 446130 Optical Goods Stores o 44619 Other Health and Personal Care Stores 446191 Food (Health) Supplement Stores 446199 All Other Health and Personal Care Stores Sector 52 -- Finance and Insurance Subsector 524 -- Insurance Carriers and Related Activities 5241 Insurance Carriers o 52411 Direct Life, Health, and Medical Insurance Carriers 524114 Direct Health and Medical Insurance Carriers Subsector 525 – Funds, Trusts, and Other Financial Vehicles 5251 Insurance and Employee Benefit Funds o 52512 Health and Welfare Funds 525120 Health and Welfare Funds Sector 53 -- Real Estate and Rental and Leasing Subsector 532 – Rental and Leasing Services 5322 Consumer Goods Rental o 53228 Other Consumer Goods Rental 532283 Home Health Equipment Rental ©Margaret Kilduff 2018 27 Coursera: Healthcare Organizations and the Health System Sector 81 -- Other Services (Except Public Administration) Subsector 813 – Religious, Grantmaking, Civic, Professional, and Similar Organizations 8132 Grantmaking and Giving Services o 81321 Grantmaking and Giving Services 813212 Voluntary Health Organizations 8132 Grantmaking and Giving Services o 81321 Grantmaking and Giving Services 813212 Voluntary Health Organizations Sector 92 -- Public Administration Subsector 923 – Administration of Human Resource Programs 9231 Administration of Human Resource Programs o 92312 Administration of Public Health Programs 923120 Administration of Public Health Programs See the 2017 NAICS Manual for a more detailed description of each organizational category (industry). A healthcare organization is any organization classified in NAICS in subsector 621, 622, or 623 or one of the other subsectors with a classification title including the word “health” (e.g., 44611, 532283) Thus a healthcare organization can be defined using NAICS to be an organization with an organizational code in subsector 621, 622, or 623. Some may choose to expand the definition to also include organizations in one of the other subsectors with a classification title including the word “health” (e.g., 44611, 532283). [FUN] Video - Topic 3: LBJ 1965 Medicare Bill-Signing Ceremony 2 min LBJ 1965 Medicare Bill-Signing Ceremony The video is a YouTube video (https://www.youtube.com/watch?v=-Et5bm81SYs) produced by C-SPAN. The video shows part of President Johnson's (LBJ's) June 30, 1965 bill-signing ceremony creating Medicare. President Truman was present to receive the first Medicare card. Reading: [INFO] Topic 4. Healthcare Organization Accreditation 10 min Topic 4. What are the healthcare organization accreditation associations in the United States? ©Margaret Kilduff 2018 28 Coursera: Healthcare Organizations and the Health System There are many healthcare organization accreditation associations in the United States. As a general rule, accreditation is voluntary. However, accreditation may be necessary or may substitute for some of the healthcare organization’s operating requirements. Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson One Quiz. For example, Medicare-certified (CMS-certified) healthcare organizations must allow initial and periodic surveys (inspections) from State Survey Agencies working on behalf of CMS to ensure organizational compliance with the Conditions of Participation (CoP) as specified in 42 CFR. However, CMS allows accreditation from CMS-approved accreditation associations to substitute for the surveys of the State Survey Agencies. Healthcare organizations accredited by such an approved accreditation organization, therefore, do not have to participate in the State Survey Agencies surveys. The CMS-approved accreditation associations are said to have “deeming authority” from CMS. Accreditation associations apply for deeming authority and CMS provides information on the process at the CMS Accreditation of Medicare Certified Providers and Suppliers website. The origins of healthcare organization accreditation in the United States lie with Ernest Codman, MD and the American College of Surgeons (ACS) (founded in 1912). Dr. Codman was a founding member of ACS and proposed an “end result system of hospital standardization” which became the ACS Hospital Standardization Program in 1917. This program published a Minimum Standard for Hospitals which ACS used to begin on-site inspections of hospitals. In 1951, the Hospital Standardization Program became the Joint Commission on Accreditation of Hospitals (JCAH). JCAH continued to grow and is now known as The Joint Commission. An excellent timeline and history can be found at The Joint Commission: Over a Century of Quality and Safety . There is an interesting historical note about Dr. Codman' work as a staff surgeon at Massachusetts General Hospital (MGH) and his dedication to "quality improvement and outcomes measurement". Dr. Codman "lost staff privileges in 1914 when he insisted the hospital institute his plan for evaluating the competence of surgeons." (Website Source of Quote) Note [FUN]: The video for Topic 4 - E.A. Codman, An MGH Legend - is a YouTube video produced by Massachusetts General Hospital (MGH). It is a talk by David F. Torchiana, MD, CEO, Massachusetts General Physicians Organization about Dr. Codman's life and visionary work. Some of the better known healthcare organization accreditation associations in the United States are: ©Margaret Kilduff 2018 29 Coursera: Healthcare Organizations and the Health System 1. 2. 3. 4. 5. 6. 7. 8. The Joint Commission (The JointCommission) Accreditation Commission for Health Care (ACHC) Center for Pharmacy Practice Accreditation (CPPA) Community Health Accreditation Partner (CHAP) Det Norske Veritas – Germanischer Lloyd (DNV GL) Healthcare Healthcare Facilities Accreditation Program (HFAP) National Committee for Quality Assurance (NCQA) URAC (URAC) More information about each of these eight accreditation associations is found below. 1. The Joint Commission (The JointCommission) “ Joint Commission accreditation can be earned by many types of health care organizations, including hospitals, doctor’s offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services.“ (Website Source of Quote) The Joint Commission has deeming authority from CMS for many types of healthcare organizations. Voluntary deemed status is available for: Ambulatory Surgical Centers Clinical Laboratories Critical Access Hospitals Home Health Agencies Hospice Agencies Hospitals Psychiatric Hospitals 2. Accreditation Commission for Health Care (ACHC) “ACHC offers a full range of nationally recognized accreditation and compliance programs tailored specifically to the home care and alternate site healthcare industry.” (Website Source of Quote) ACHC has deeming authority from CMS for: DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) Home Health Agencies Hospice Agencies ACHC also offers accreditation for Specialty and Infusion Pharmacies and Compounding Pharmacies in cooperation with the Pharmacy Compounding Accreditation Board (PCAB) based on the U.S. Pharmacopeial Convention (USP) guidelines. ©Margaret Kilduff 2018 30 Coursera: Healthcare Organizations and the Health System 3. Center for Pharmacy Practice Accreditation (CPPA) CPPA “is a partnership established by the American Pharmacists Association (APhA), the National Association of Boards of Pharmacy (NABP), and the American Society of Health-System Pharmacists (ASHP) to oversee accreditation of pharmacy practice sites. CPPA develops and implements comprehensive programs of pharmacy practice site accreditation and manages the process leading to the use of consensus-based standards for pharmacy practice accreditation." (Website Source of Quote) 4. Community Health Accreditation Partner (CHAP) CHAP provides “home and community-based health care accreditation - and only home and communitybased health care accreditation.” CHAP has deeming authority from CMS for: Home Health Agencies Home Medical Equipment (HME) Hospice Agencies 5. Det Norske Veritas – Germanischer Lloyd (DNV GL) Healthcare DNV GL Healthcare describes itself as "your partner for safer healthcare, providing quality driven accreditation and clinical excellence certifications to America’s hospitals." (Website Source of Quote) DNV GL Healthcare has deeming authority from CMS for: Critical Access Hospitals Hospitals 6. Healthcare Facilities Accreditation Program (HFAP) "Originally created in 1945 to conduct an objective review of services provided by osteopathic hospitals, HFAP has maintained its deeming authority continuously since the inception of CMS in 1965 and meets or exceeds the standards required by CMS/Medicare to provide accreditation to all hospitals, ambulatory care/surgical facilities, mental health facilities, physical rehabilitation facilities, clinical laboratories and critical access hospitals." (Website Source of Quote) HFAP accredits and crosswalks to CMS standards (as applicable) for the following programs: Hospitals and their Clinical Laboratories Ambulatory Care/Surgical Facilities ©Margaret Kilduff 2018 31 Coursera: Healthcare Organizations and the Health System Mental Health Facilities Substance Abuse Facilities Physical Rehabilitation Facilities Clinical Laboratories Critical Access Hospitals 7. National Committee for Quality Assurance (NCQA) NCQA focuses on improving health care quality and states that its "programs and services reflect a straightforward formula for improvement: Measure. Analyze. Improve. Repeat." NCQA has a special focus on health care plans and states that "NCQA’s contribution to the health care system is regularly measured in the form of statistics that track the quality of care delivered by the nation’s health plans." (Website Source of Quote) NCQA accreditation is available for: Health Plans Provider Organizations (e.g., Wellness and Health Promotion) Health Plan Contracting Organizations (e.g., Case Management) Other Organizations (e.g., Utilization Management) 8. URAC (URAC) URAC "is an ... accreditation entity ... whose mission is to advance healthcare quality through leadership, accreditation, measurement and innovation ... as an independent, third party healthcare quality validator." (Website Source of Quote) URAC accredits: Health Plans with deeming authority from CMS for Medicare Advantage Plans Healthcare Management Programs Healthcare Operations Programs Pharmacy Quality Management Programs Provider Integration and Coordination Programs [FUN] Video - Topic 4: E.A. Codman, An MGH Legend 35 min E.A. Codman, An MGH Legend The video is a YouTube video (https://www.youtube.com/watch?v=y1g3VCNcK1o) produced by Massachusetts General Hospital (MGH). It is a talk by David F. Torchiana, MD, CEO, Massachusetts General Physicians Organization about Dr. Codman's life and visionary work. ©Margaret Kilduff 2018 32 Coursera: Healthcare Organizations and the Health System Reading: [INFO] Topic 5: Healthcare Organization Characteristics 10 min Topic 5. What are the major characteristics of healthcare organizations? Healthcare organizations, like all organizations, can be described by their characteristics, but there is no one official list of characteristics to describe an organization. There is no one official list of the importance of each characteristic. You can decide on the characteristics to describe a healthcare organization and the relative importance of each characteristic. For example, you could decide that in your evaluation of healthcare organizations, the most important characteristic is whether the employee cars in the parking lot are clean and neat. A host of one of the home renovation shows once said that the most important characteristic in choosing a good tenant is whether the tenant applicant’s car is clean and neat. The host’s experience was that those people who keep a car – regardless of the car’s age and value – clean and neat will keep the rental unit clean and neat. People who respect their car will respect their rental unit. In the host’s opinion, a tenant should be selected based on the cleanliness and neatness of the applicant’s car. You may decide, therefore, that healthcare organization employees who respect their cars by keeping them clean and neat will respect their workplace and its customers/patients. You may decide that you will choose a healthcare organization based on the cleanliness and neatness of the employees’ cars. Despite differences of opinion on the characteristics and their importance in describing organizations in general and healthcare organizations specifically, there is general agreement that those characteristics can be organized into three broad categories: Healthcare Organization Structure Characteristics Healthcare Organization Process Characteristics Healthcare Organization Performance Characteristics More information about each of these three broad categories is found below. Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson One Quiz. Healthcare Organization Structure Characteristics Structure characteristics are those which describe the basic static form of the healthcare organization (internal characteristics) and where it "lives" (external characteristics). It is not unlike describing the ©Margaret Kilduff 2018 33 Coursera: Healthcare Organizations and the Health System physical characteristics of an animal which lives in the wild and its habitat. For example, The Smithsonian’s National Zoo and Conservation Biology Institute has a Giant Panda Fact Sheet which describes the Giant Panda’s basic static form (Internal Characteristics: Physical Description, Size) and where it “lives” (External Characteristics: Native Habitat). As a side note, there is also a Giant Panda Cam where you can watch the National Zoo pandas which are a symbol of “cross cultural collaboration between the United States and China” . The following are examples of healthcare organization characteristics which most people would consider structure. It is not a complete list. You may have others which you would add to this list. Governance Structure (Internal Characteristic) Facilities Structure (Internal Characteristic) Workforce Structure (Internal Characteristic) Legal/Regulatory Structure (External Characteristic) Local Health Geography Structure (External Characteristic) Marketplace Structure (External Characteristic) Governance Structure This topic is discussed in Week 3, Lesson 3 of this course. Facilities Structure Facilities structure refers to the physical characteristics of the healthcare organization (e.g., how many buildings, how many beds). The architectural design of healthcare organization facilities is a specialized field. The Healthcare Design website, magazine and events focus only on this specialty. Workforce Structure Workforce structure refers to the number of people working in the healthcare organization, their distribution across space and time (e.g., emergency room, night shift), and their work focus/responsibility (occupation). The Bureau of Labor Statistics (BLS), Occupational Outlook Handbook (OOH) provides information about Healthcare Occupations, the training required for each, and the median annual wage. Legal/Regulatory Structure The legal/regulatory structure for healthcare organizations is extensive. Generally speaking, the legal structure is divided into three categories: health law (government law regarding organizations), medical law (rights of patients), and public health law (government law regarding populations). Becker's Hospital Review devotes an entire section to Legal and Regulatory Issues for the healthcare industry especially hospitals. The U.S. Department of Health and Human Services (HHS) also devotes a section of its website to Laws and Regulations associated with HHS. ©Margaret Kilduff 2018 34 Coursera: Healthcare Organizations and the Health System Local Health Geography Structure The local health geography structure for healthcare organizations not only includes the organization's physical geographic location (e.g., state, city), but also the way in which that physical geographic space affects the health of the local population most likely to be customers (patients) of the healthcare organization. The interaction between health and location is the basis for the County Health Rankings and Roadmap which provides a "revealing snapshot of how health is influenced by where we live, learn, work and play". Marketplace Structure The structure of a healthcare organization's marketplace has a major impact on an organization. If there are many competitors offering the same products/services and few customers/patients, the healthcare organization may not have a high probability of staying in business. But many think that too little competition in the marketplace is bad for customers/patients. Some articles have been published on the issue of the marketplace and competition. Some of them are listed below. However, each is optional; you do not have to read it. Competition in the Healthcare Marketplace Healthcare Needs Real Competition Competitive Markets in Health Care: The Next Revolution The Cure for Health Care is Competition Healthcare Organization Process Characteristics Process characteristics are dynamic characteristics that describe what the organization does within and using the structure characteristics. In short, process characteristics are what the people within the healthcare organization (both paid and volunteers) do - how they spend their time in support of the organization's mission, vision, and goals. The following are examples of healthcare organization characteristics which most people would consider process. It is not a complete list. You may have others which you would add to this list. Administration and Management Processes Health Care Delivery Processes Human Resources Processes Business Processes Financial Processes Quality Improvement Processes Administration and Management Processes ©Margaret Kilduff 2018 35 Coursera: Healthcare Organizations and the Health System This topic is discussed in Week 2, Lesson 2 of this course. Health Care Delivery Processes Health care delivery processes are the way in which the people in the healthcare organization process customers (patients) when they arrive, are provided health care, and when they leave. For healthcare organizations, these are the "manufacturing processes"; the processes by which the organization's "products" are "manufactured". Some may consider it odd to think of health care delivery processes in terms of the manufacturing processes, but some healthcare organizations have successfully used manufacturing processes to improve health care delivery. The two most commonly used manufacturing-related processes in health care are Six Sigma developed at Motorola and Lean which has its foundation in the Toyota Production System. More information about Lean can be found at the Lean Enterprise Institute (LEI) website. There is even an organization which advocates the combination of the two approaches; the Lean Six Sigma Institute (LSSI). Some articles have been published on the application of Six Sigma and Lean to health care delivery. Some of them are listed below. However, each is optional; you do not have to read it. How a Manufacturing Process Transformed Healthcare Delivery Lean Management – The Journey from Toyota to Healthcare The Applicability of Lean and Six Sigma Techniques to Clinical and Translational Research Lean and Six Sigma in Acute Care: A Systematic Review of Reviews (Pubmed Listing Only) Two examples of health care delivery processes are: 1) health care delivery capacity utilization (e.g., how many of the available/capacity emergency room beds are utilized by a patient); and 2) delivery of specific health care treatments. Human Resources Processes Human resources processes are the way in which employees of an organization are hired, managed, and developed. Two examples of the human resources processes are: 1) development of orientation programs and training for new hires in the organization; and 2) development of employee compensation and benefits criteria. The American Society for Healthcare Human Resources Administration (ASHHRA) is a professional association only for healthcare human resources professionals. ©Margaret Kilduff 2018 36 Coursera: Healthcare Organizations and the Health System Business Processes The American College of Healthcare Executives (ACHE) defines business processes as the processes which pertain to “specific areas/concepts of the organization.” Examples of such processes are marketing, business planning, strategic planning, crisis management, and risk management. In short, businesses processes are those processes which enable the organization to work as an efficient and effective organizational system rather than as a set of independent departments. Such independent departments are often termed “silos” and, in healthcare organizations, silos are the norm. Organizational silos exist when members of departments have a primary loyalty and identification with their department and departmental co-workers rather than with the organization as a whole. Members of a silo do not like to share resources (e.g., information, supplies, ideas) with those outside the department. Business processes can be designed in one of two ways regarding silos: 1) to reduce or eliminate silos; or 2) to connect and manage silos. In the first situation (reduce or eliminate), silos are considered bad and an organizational flaw. Silos must be eliminated if the healthcare organization is to function well. This approach agrees with the Business Dictionary which states that a Silo Mentality “will reduce efficiency in the overall operation, reduce morale, and may contribute to the demise of a productive company culture” . Such business processes attempt to blur departmental boundaries and encourage people to identify with the healthcare organization as a whole rather than with their department or healthcare profession. The focus on interprofessional education and practice in healthcare organizations is also an attempt to reduce or eliminate healthcare silos. The National Center for Interprofessional Practice and Education is a great resource for more information on such interprofessional healthcare efforts. In the second situation (connect and manage), silos are considered good or at least an unavoidable functional outcome of an organization comprised of highly specialized and trained professionals. This approach believes that silos must be networked and managed – but not eliminated – if the organization is to function well. Such business processes connect and network silos to build bigger and bigger silos. Departments, for example, are networked to build a division. Divisions are networked to build an organization. Each silo is encouraged to be a high functioning unit (team) networked to other units (teams); the organization is a team-of-teams. The following articles discuss healthcare organization silos. You may find them interesting, however, each is optional; you do not have to read it. They are: Better Patient Flow Means Breaking Down Silos Breaking Down Silos to Improve Patient Flow, Hospital Efficiency Quashing the Silos and Getting to Integrated Health Care Breaking Down Silos Is a Myth, Do This Instead ©Margaret Kilduff 2018 37 Coursera: Healthcare Organizations and the Health System The Need for a Team of Teams It Takes a Team of Teams to Transform Healthcare Fixing Healthcare Safety: A Team of Teams Financial Processes Financial processes are the way in which the organization's finances are processed; from revenue to expenditures (and ensuring that expenditures do not exceed revenues). The person in charge of the organization's financial processes is usually the Chief Financial Officer (CFO). Two examples of financial processes are: 1) development of the organization's budget; and 2) development of financial reporting systems. Quality Improvement Processes Quality improvement processes are the way in which the organization gathers data on organizational characteristics, analyzes that data, and then makes changes (improvements) as necessary to better achieve organizational goals and objectives - to improve quality. Many use the National Academy of Medicine (NAM) - formerly the Institute of Medicine (IOM) - definition of healthcare organization quality which is "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge". The Centers for Medicare and Medicaid Services (CMS) states that: "Both quality measurement and quality improvement increase the likelihood of desired health outcomes, using different but mutually supporting mechanisms ... The mechanism of quality improvement is standardization ...The mechanisms of quality measurement are selection and choice. A quality measure is used as a tool for making “good decisions” defined as decisions that make it more likely to experience a good result and less likely to experience an adverse result that was not foreseen or was not understood." (Website Source of Quote) Two quality measurement tools used by healthcare organizations are the: 1) Healthcare Effectiveness Data and Information Set (HEDIS) developed by the National Committee for Quality Assurance (NCQA) under a contract from CMS; and 2) CMS Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) which is pronounced H-caps and often referred to as the Hospital Survey or just Hcaps. Healthcare Organization Performance Characteristics Performance characteristics are dynamic characteristics that describe what the organization does within and using both the structure and process characteristics. Generally speaking, these can be divided into two different categories - although you may have others which you would add to this list: ©Margaret Kilduff 2018 38 Coursera: Healthcare Organizations and the Health System Financial Performance/Outcomes Product (Health Care Delivery) Performance/Outcomes Financial Performance/Outcomes The financial performance/outcomes of a healthcare organization can be found in an organization's financial statement and an external independent financial audit. In some cases, regulation requires that all corporate organizational public financial statements be ones that have been subject to an external independent financial audit. A for-profit healthcare organization's corporate credit rating such as one from FitchRatings or stock rating such as one from the Morningstar Rating for Stocks can also be considered financial performance/outcomes characteristics. For a non-profit healthcare organization, the financial health rating from Charity Navigator can be considered a financial performance/outcomes characteristic. Product (Health Care Delivery) Performance/Outcomes The product (health care delivery) performance/outcomes can be found in any number of ways. There are popular rankings to aid customer/patient decision-making such as that done by U.S. News and World Reports - Health which ranks/rates hospitals, doctors, and senior care based. The methodology for determining the rank/rating for hospitals is found at FAQ: How and Why We Rank and Rate Hospitals. Performance/outcome ratings to aid customer/patient decision-making are also produced by the Center for Medicare and Medicaid Services (CMS) through its Hospital Compare Overall Rating from one to five stars. Access to information about individual hospitals - information on a variety of measures as well as the performance/outcome rating - for comparison purposes is available from the Hospital Compare website. The Agency for Healthcare Quality and Research (AHQR) National Healthcare Quality and Disparities Reports (NHQDR) rates state-level health care quality relative to a set of benchmarks to help policy development. Some performance/outcomes are tied to health care delivery reimbursement. One example are the CMS Value-Based Programs which "reward health care providers with incentive payments for the quality of care they give to people with Medicare". Such value-based programs are often called pay-forperformance programs. The CMS value-based programs are: Hospital Value-Based Purchasing (HVBP) Program Hospital Readmission Reduction (HRR) Program Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM) Hospital Acquired Conditions (HAC) Program End-Stage Renal Disease (ESRD) Quality Initiative Program Skilled Nursing Facility Value-Based Program (SNFVBP) Home Health Value Based Program (HHVBP) ©Margaret Kilduff 2018 39 Coursera: Healthcare Organizations and the Health System Note [FUN]: The video for Topic 5 - Value-Based Purchasing - is a YouTube video produced by the Washington State Health Care Authority as part of its Healthier Washington program. The video provides an overview of the fundamentals and philosophy of health care value-based purchasing. [FUN] Video - Topic 5: Value-Based Purchasing 4 min Value-Based Purchasing The video for is a YouTube video (https://www.youtube.com/watch?v=bkBbcWldZHs) produced by the Washington State Health Care Authority as part of its Healthier Washington program. The video provides an overview of the fundamentals and philosophy of health care value-based purchasing. Discussion Prompt: [FUN] Healthcare Organization Quality Measures 5 min What are your thoughts about healthcare organization quality measures? For example, what do you think is the most important measure of quality? Do you think the quality measures are the same for all types of healthcare organizations? [CERT] [PREP] Lesson One Quiz and "Create Your Own Healthcare Organization" Quiz: [CERT] Lesson One Quiz 15 questions, 20 minutes Question 1 Medical professionals generally consider the terms “health care” and “healthcare” to have different meanings. Which of the following is correct in this view? I went to a healthcare provider in a healthcare organization to receive health care for my broken foot. I went to a health care provider in a health care organization to receive healthcare for my broken foot. The answer to this question is found in Topic 1. Question 2 Which of the following is an example of a health system which focuses on the delivery of health care? Kaiser Permanente ©Margaret Kilduff 2018 40 Coursera: Healthcare Organizations and the Health System Centers for Disease Control and Prevention (CDC) U.S. Department of Health and Human Services (HHS) Boston Athletic Association (BAA) The answer to this question is found in Topic 2. Question 3 What are the two missing words in the following definition of a public health system? A public health system consists of "all public, private, and voluntary entities that contribute to the delivery of essential ______ ______ services within a jurisdiction". The answer to this question is found in Topic 2. Question 4 Which organization defines a health system which focuses on health as consisting "of all organizations, people and actions whose primary intent is to promote, restore or maintain health"? World Health Organization (WHO) Boston Athletic Association (BAA) Massachusetts General Hospital (MGH) New Jersey Department of Health (NJDOH) The answer to this question is found in Topic 2. Question 5 Which one of the following is not a definition of a healthcare organization? An organization requiring regulation and licensing by a state as a health facility An organization certified by CMS (Medicare-certified, CMS-certifie) An organization classified in the North American Industry Classification System (NAICS) in subsector 621, 622, or 623. An organization listed on the New York Stock Exchange (NYSE). The answer to this question is found in Topic 3. Question 6 What is the missing word in the following partial definition of the NAICS Health Care and Social Assistance Sector? "Establishments in this sector deliver services by trained professionals ... Many of the ©Margaret Kilduff 2018 41 Coursera: Healthcare Organizations and the Health System industries in the sector are defined based on the educational ______ held by the practitioners included in the industry." The answer to this question is found in Topic 3. Question 7 The requirements for regulation and licensing for any healthcare provider profession may vary by state. True False The answer to this question is found in Topic 3. Question 8 A Medicare-certified healthcare organization is one with meets the health, safety, and operational standards (Conditions of Participation) as established in the: Code of Federal Regulations (CFR) Division of Motor Vehicles (DMV) Regulations Centers for Disease Control and Prevention (CDC) Regulations American Medical Association (AMA) Regulations The answer to this question is found in Topic 3. Question 9 The Centers for Medicare and Medicaid Services (CMS) allows accreditation from CMS-approved accreditation associations to substitute for the surveys of the State Survey Agencies. True False The answer to this question is found in Topic 4. Question 10 Deeming authority from the Centers for Medicare and Medicaid Services (CMS) means that: The accreditation association has been approved by CMS as a substitute for the State Survey Agencies. The accreditation association can grant a state license to operate for a dental office. ©Margaret Kilduff 2018 42 Coursera: Healthcare Organizations and the Health System The American Medical Association (AMA) can deem CMS compliant with reimbursement strategies. A State Department of Health can submit reimbursement requests to CMS. The answer to this question is found in Topic 4. Question 11 There is only one official healthcare accreditation association in the United States. True False The answer to this question is found in Topic 4. Question 12 There is general agreement that healthcare organization characteristics can be organized into three broad categories. Which of the following is not one of those categories? Structure Process Performance Design The answer to this question is found in Topic 5. Question 13 Which of the following can be considered an organizational silo? A department whose members identify more with the department than with the organization as a whole. A department whose members once belonged to Future Farmers of America. A department whose members are all located in an annex to the main building. A department whose members all have the same professional degree. The answer to this question is found in Topic 5. Question 14 There are two basic approaches to dealing with organizational silos. Which of the following is not one of them? ©Margaret Kilduff 2018 43 Coursera: Healthcare Organizations and the Health System Reduce or eliminate silos Connect and manage silos Expand and rename silos The answer to this question is found in Topic 5. Question 15 What is the missing word in the following definition of the Centers for Medicare and Medicaid Services (CMS) value-based programs? These are programs which "reward health care providers with incentive ________ for the quality of care they give to people with Medicare". The answer to this question is found in Topic 5. Practice Peer-graded Assignment: [PREP] Lesson One Create Your Own Healthcare Organization 45 min See Appendix A: Lesson One Create Your Own Healthcare Organization [FUN] Lesson One Trivia Question and Virtual Field Trip Reading: [FUN] Lesson One Trivia Question 2 min Almost everyone loves a trivia question - a question about a little known, but interesting, fun fact. Each lesson has one trivia question. The answer is in the Lesson One Trivia Question Answer reading section. Question: Who is widely credited with "inventing" the medical record and integrated private medical group practice as we know it today? Reading: [FUN] Lesson One Trivia Question Answer 5 min The answer to the Lesson One trivia question is: Henry Stanley Plummer For more information, please see: ©Margaret Kilduff 2018 44 Coursera: Healthcare Organizations and the Health System Mayo Clinic, Diversified Genius Wikipedia, Henry Stanley Plummer On Health Care Technology, A Century of Medical Records Mayo Clinic, History and Heritage Reading: [FUN] Lesson One Virtual Field Trip 5 min Everyone loves a road trip/field trip so each lesson of the course includes a "virtual field trip" to the often hidden places of interest on the web. Lesson One's virtual field trip is to the Great Smoky Mountains National Park via a YouTube video produced by the Great Smoky Mountains National Park for its YouTube Channel. The Great Smoky Mountains National Park is the most visited National Park in the United States - more than 11 million visitors annually. The video provides advice on Day Hiking and Wildlife. Although everyone wants to be safe on a hike, sometimes medical emergencies happen and health care is needed by park visitors. When such care is needed, the healthcare provider is usually someone who has training in Wilderness Medicine which is "defined by difficult patient access, limited equipment, and environmental extremes". Some of the organizations providing such training are: Wilderness Medicine Wilderness Medical Society Appalachian Center for Wilderness Medicine [FUN] Video - Lesson One Virtual Field Trip 5 min Day Hiking and Wildlife - Great Smoky Mountains National Park The video is a YouTube video (https://www.youtube.com/watch?v=qZ9GzIMGRMw) produced by the Great Smokey Mountains National Park which provides advice on safe hiking in the park. ©Margaret Kilduff 2018 45 Coursera: Healthcare Organizations and the Health System LESSON TWO: HEALTHCARE ADMINISTRATION AND MANAGEMENT This lesson provides an overview of healthcare administration and management. Learning Objectives Define effective evidence-based healthcare administration and management models. [INFO] [FUN] Lesson Two Content and Discussion Reading: [INFO] Welcome and Lesson Two Overview 10 min Welcome to Lesson Two! This lesson provides an overview of healthcare administration and management. Upon successful completion of this lesson, you will be able to: define effective evidence-based healthcare administration and management models. There is a quiz, a trivia question, and a field trip. There are also optional videos which provide [FUN] supplemental content. There are many wonderful videos in the public domain which are relevant to this course. The lesson should take 4-6 hours of work to successfully complete. This lesson asks and answers the following questions: 1. 2. 3. 4. 5. Is there a difference between healthcare administration and healthcare management? What skills and knowledge do healthcare administrators need? What is evidence-based healthcare administration practice? What administrative/management frameworks are used in healthcare administration? What are the healthcare administration and management professional associations in the United States? Discussion Prompt: [FUN] Feedback - Lesson Two 5 min Please post any feedback you have specifically about Lesson Two in this discussion forum at any time during the course. All feedback (e.g., suggestions, questions, concerns, criticisms) is welcome. This is your Lesson Two course experience. Let us know how you feel the Lesson Two experience can be improved. Let us know what you feel works particularly well in the Lesson Two. ©Margaret Kilduff 2018 46 Coursera: Healthcare Organizations and the Health System Reading: [INFO] Topic 1. Healthcare Administration versus Healthcare Management 10 min Topic 1: Is there a difference between healthcare administration and healthcare management? Yes, and no. Yes, in the sense that one is generally considered to have more responsibility for the organization as a whole than does the other. No, in the sense that the terms are often used interchangeably and that there is no general agreement as to which one (administration, management) has the broader organizational responsibility. For the purposes of this course, healthcare administration has more responsibility for the healthcare organization than does healthcare management. This course is more concerned with healthcare administration than healthcare management. This section discusses: Healthcare Administration Healthcare Management Illustrating the Difference between Administration and Management Healthcare Administration/Management Degrees Healthcare Administration/Management Fellowships Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Two Quiz. Healthcare Administration Healthcare administration encompasses responsibility for all aspects of a healthcare organization. The focus is both internal to the organization and external to the organization to maximize the efficient and effective operation of the organization as a whole and its survival both short-term and long term. Healthcare administrators make decisions about the direction and operation of the healthcare organization. The role of the healthcare administrator is more strategic than tactical. A strategy involves the identification of broad goals – primarily long-term goals - and a plan to achieve them. A strategy is dynamic; it is changed as conditions change. The development of a good strategy needs to acknowledge the situation best described by Donald Rumsfeld (and often quoted) in a February 12, 2002 Department of Defense news briefing: "As we know, there are known knowns. There are things we know we know. We also know, there are known unknowns. That is to say, we know there are some things we do not know. But there are also unknown unknowns, the ones we don’t know we don’t know." ©Margaret Kilduff 2018 47 Coursera: Healthcare Organizations and the Health System Strategies must adapt as the conditions change as well as when the knowns and unknowns are clarified. The strategic goals of an organization are often published in an organization's strategic plan. For example, the Massachusetts General Hospital (MGH)/Massachusetts General Physicians Organization (MGPO) Strategic Plan adopted in 2014 lists twelve key strategies (strategic goals): 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Redesign the model of care Center-based care Population health management Transform chronic disease care Strategic service expansion and network development An MGH Research Institute as a welcoming front door for industry and philanthropy Facilitate translational research Optimize clinical education across the health professions Leverage the power of MGH patient data Workforce development Intensify diversity and inclusion efforts Stronger internal governance There are many published articles and reports on an organization's strategic goals and strategic planning. Some of them are listed below. You may find some or all of them interesting. Each is optional; you do not have to read it. They are: Your Strategic Plans Probably Aren’t Strategic, or Even Plans Our Strategic Imperatives, Pfizer American Hospital Association (AHA) Strategic Plan Stanford Medicine Integrated Strategy 2020 Vision: A Strategic Plan for Columbia University College of Physicians and Surgeons Healthcare Management Healthcare management encompasses responsibility for the day-to-day operations of a part of the healthcare organization – an organizational unit (e.g., department, division). Healthcare managers implement the decisions of healthcare administrators with a primary focus on the activities of personnel and distribution of resources (e.g., expenditures) in a specific unit. The role of the healthcare manager is more tactical than strategic. Tactics are well-defined concrete steps/initiatives using specific resources to achieve the specific tasked objectives required to implement the strategy (implement the plan). Although the implementation of the tactics does not necessarily require a broad view of the organization, such a broad view is helpful for keeping the tactics consistent with the strategy. ©Margaret Kilduff 2018 48 Coursera: Healthcare Organizations and the Health System Illustrating the Difference between Administration and Management The difference between the two terms (administration, management) can be illustrated by the difference between the responsibilities of marketing versus the responsibility of sales; healthcare administration is more like marketing and healthcare management is more like sales. In large organizations, the individuals responsible for administration may be clearly differentiated from those with responsibility for management. The smaller the organization, however, the more likely a few people (or one person) assumes responsibility for both administration and management. In a small start-up company for example, one person may be developing a marketing strategy while also making sales calls. In a small start-up company, one person may be developing a strategic plan or a business plan for the start-up (administration) while also directly managing and motivating software developers (management). Over the course of a career in administration/management, professionals may find their responsibilities shift between administration and management a number of times. Healthcare Administration/Management Degrees Another question for those interested in healthcare administration/management who wish a bachelor's degree or master's degree in this area is whether to get a health-related degree or a business degree. For example, should you get a bachelor's degree in health (healthcare, health services) administration or a bachelor's degree in business (perhaps with a healthcare organization focus)? Should you get a master's degree in health (healthcare, health services) administration (MHA) or a master's of business administration (MBA) perhaps with a healthcare organization focus? The answer is not an easy one. And the right answer for you may not be the right answer for someone else. The business degree provides a broad view of administration/management applicable to all organizations. The health-related degree focuses on the administration/management of healthcare organizations specifically. Even if the business program has a concentration area in health, the focus is not as comprehensive as that found in a health-related degree program. Business degree programs are usually located within a college or university's business school. Such programs can seek accreditation from the Association to Advance Collegiate Schools of Business (AACSB) International or the Accreditation Council for Collegiate Business Schools and Programs (ACBSP). These programs are classified by the National Center for Education Statistics (NCES) in the Classification of Instructional Programs (CIP) in Category 52: Business, Management, Marketing, and Related Support Services, usually with the specific code of 52.0201: Business Administration and Management, General. ©Margaret Kilduff 2018 49 Coursera: Healthcare Organizations and the Health System Health-related administration programs are usually located within a college or university's health sciences or medical school. Such graduate-level programs can seek accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). These programs are classified by NCES in the CIP in Category 51: Health Professions and Related Clinical Sciences, usually with a specific code of either 51.0701: Health/Health Care Administration/Management or 51.0702: Hospital and Health Care Facilities Administration/Management. Healthcare Administration/Management Fellowships Many health-related organizations offer healthcare administration/management fellowships primarily for those who have a master's degree. A list of these fellowships can be found at the American College of Healthcare Executives (ACHE) Directory of Postgraduate Administrative Fellowships. A few of the specific programs are listed below: Cleveland Clinic Administrative Fellowship Johns Hopkins Administrative Fellowship Kaiser Permanente Administrative Fellowship Massachusetts General Hospital Administrative Fellowship Mayo Clinic Administrative Fellowship Note [FUN]: The video for Topic 1 - Massachusetts General Hospital (MGH) Administrative Fellowship: Program Overview - is a YouTube video produced by MGH. Many consider the USPHS to be an essential health system component in the United States. The video provides an overview of the program and career advancement opportunities. [FUN] Video - Topic 1: Massachusetts General Hospital (MGH) Administrative Fellowship Overview 8 min Massachusetts General Hospital (MGH) Administrative Fellowship: Program Overview The video is a YouTube video (https://www.youtube.com/watch?v=1um3fcMK4og) produced by MGH. It provides an overview of the Administrative Fellowship program and career advancement opportunities. Reading: [INFO] Topic 2. Healthcare Administrator Skills and Knowledge 10 min Topic 2. What skills and knowledge do healthcare administrators need? ©Margaret Kilduff 2018 50 Coursera: Healthcare Organizations and the Health System The skills and knowledge needed for any task or profession are often referred to as competencies. So this question can be reworded as "What competencies do healthcare administrators need?" Implied in the question is that the defined competencies are the ones needed to do the job of healthcare administration successfully at the optimal and most rigorous levels of efficiency and effectiveness. Two organizations have invested much time and effort in defining these competencies. The organizations are: Healthcare Leadership Alliance (HLA) American College of Healthcare Executives (ACHE) Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Two Quiz. Healthcare Leadership Alliance (HLA) The Healthcare Leadership Alliance (HLA) is a consortium of healthcare administration and management professional associations. The consortium members are: American College of Healthcare Executives (ACHE) American Organization of Nurse Executives (AONE) Healthcare Financial Management Association (HFMA) Healthcare Information Management Systems Society (HIMSS) Medical Group Management Association (MGMA) HLA, using input from consortium members, develops a list of competencies needed by healthcare administration and management professionals to be effective “managing the nation’s healthcare organizations”. This list is called the HLA Competency Directory and HLA provides an Overview of the HLA Competency Directory as well as the ability to Download the HLA Competency Directory. The HLA Competency Director contains five (5) knowledge domains and knowledge clusters within each domain. The five (5) knowledge domains and the major knowledge clusters within each domain are: Domain 1. Communication and Relationship Management. The knowledge clusters within Domain 1 are: Relationship Management Communication Skills Facilitation and Negotiation ©Margaret Kilduff 2018 51 Coursera: Healthcare Organizations and the Health System Domain 2. Leadership. The knowledge clusters within Domain 2 are: Leadership Skills and Behavior Organizational Climate and Culture Communicating Vision Managing Change Domain 3. Professionalism. The knowledge clusters within Domain 3 are: Personal and Professional Accountability Professional Development and Lifelong Learning Contributions to the Community and Profession Domain 4. Knowledge of the Healthcare Environment. The knowledge clusters within Domain 4 are: Healthcare Systems and Organizations Health Care Personnel The Patient’s Perspective The Community and the Environment Domain 5. Business Knowledge and Skills. The knowledge clusters within Domain 5 are: General Management Financial Management Human Resource Management Organizational Dynamics and Governance Strategic Planning and Marketing Information Management Risk Management Quality Improvement The American College of Healthcare Executives (ACHE) ACHE strives "to be the preeminent professional society for leaders dedicated to improving health ...To advance our members and healthcare management excellence". Note [FUN]: The video for Topic 2 - 2018 American College of Healthcare Executives (ACHE) Overview - is a YouTube video produced by ACHE. The video provides an ©Margaret Kilduff 2018 52 Coursera: Healthcare Organizations and the Health System overview of the ACHE strategic plan and details ACHE's mission, values, programs, products and services. ACHE publishes a Competencies Assessment Tool based on the HLA Competency Directory to help those aspiring to be the very best healthcare administrators and managers assess their own skills as well as develop a plan to make improvements, where needed. ACHE also outlines healthcare administration competencies via its Fellow of the American College of Healthcare Executives (FACHE) credentialing which is board certification in healthcare administration and management. One FACHE requirement is passing the ACHE Board of Governors Examination. ACHE provides free resources for this examination at its Credentialing website. These resources include: Board of Governors Examination Reference Manual Board of Governors Examination Practice Exam Questions Board of Governors Examination Practice Exam Answer Key This Board of Governors Examination tests competencies in ten (10) knowledge areas identified by ACHE as the ones needed to do the job of healthcare administration and management successfully at the optimal and most rigorous levels of efficiency and effectiveness. The knowledge areas are: Knowledge Area 1. Governance and Organizational Structure Knowledge Area 2. Human Resources Knowledge Area 3. Finance Knowledge Area 4. Healthcare Technology and Information Management Knowledge Area 5. Quality and Performance Improvement Knowledge Area 6. Laws and Regulations Knowledge Area 7. Professionalism and Ethics Knowledge Area 8. Healthcare Knowledge Area 9. Management and Leadership Knowledge Area 10. Business Summary - Combining HLA and ACHE List of Competencies Below is listed a combination of the HLA and ACHE list of competencies to produce a comprehensive list of defined eleven (11) competencies needed to do the job of healthcare administration successfully at the optimal and most rigorous levels of efficiency and effectiveness. Competency 1: Organizational Structure and Governance Competent in applying business principles, including systems thinking, to the development and analysis of a healthcare organization’s structure with delineating responsibility, authority and accountability at all levels of the healthcare organization. Competent in the development and implementation of policies and procedures for the governance process. ©Margaret Kilduff 2018 53 Coursera: Healthcare Organizations and the Health System Competency 2: Administration, Management, and Leadership Competent in applying general administration and management principles (e.g., planning, organizing, directing and controlling) to address overall goals and objectives of the healthcare organization. Competent in the ability to inspire individual and organizational excellence, create a shared vision and successfully implement processes (including change processes, as needed) to attain the healthcare organization’s strategic and tactical goals and objectives. Competency 3: Health Care and the Healthcare Environment Competent in understanding the broad range of organizations and professions involved in the delivery of health care (e.g., managed care models, health care delivery trends, ancillary services). Competent in understanding the healthcare system and the environment in which healthcare administrators, managers, and providers function. Competency 4: Quality and Performance Improvement Competent in applying business principles, including systems thinking, to the development, implementation and evaluation of healthcare organizational accountability, including quality improvement theories and frameworks as well as quality assessment and assurance philosophies, policies, programs and procedures. Competency 5: Business Competent in applying business principles, including systems thinking, to the development and assessment of specific areas, concepts, and processes of the healthcare organization operation as a whole (e.g., marketing, business planning, strategic planning). Competency 6: Finance Competent in applying business principles, including systems thinking, to the planning, development, establishment, analysis and assessment of financial management processes for a healthcare organization’s capital, budget, accounting and related reporting systems. Competency 7: Human Resources Competent in applying business principles, including systems thinking, to assessing the need for and the supply of professional staff and other personnel in the healthcare organization. ©Margaret Kilduff 2018 54 Coursera: Healthcare Organizations and the Health System Functions include recruitment, selection, training, compensation and evaluation of such personnel and how to examine ways of evaluating productivity and monitoring accountability. Competency 8: Professionalism and Ethics Competent in the development, monitoring and maintenance of procedures to ensure the needs of the healthcare organization’s professional staff are met. Competent in identifying, monitoring and disseminating codes of professional conduct; understanding the implications of ethical decisions; and providing procedures to monitor standards of behavior within the healthcare organization. Competent in aligning personal and healthcare organizational conduct with ethical and professional standards that include a responsibility to the customer/patient and community, a service orientation, and a commitment to lifelong learning and improvement. Competency 9: Healthcare Technology and Information Management Competent in applying business principles, including systems thinking to healthcare management information and clinical information systems (e.g., developing and using computer-based decision support systems for administrative/management decisions and clinical decisions in the healthcare organization). Competency 10: Laws and Regulations Competent in identifying and interpreting the impact of government regulations and laws on the healthcare organization; identifying the need for and working with others to develop new regulations and laws; investigating, monitoring, documenting and enforcing existing regulations and laws. Competency 11: Communication and Relationship Management Competent in communicating clearly and concisely with internal and external healthcare constituents and stakeholders, establishing and maintaining relationships, and facilitating constructive interactions with individuals and groups, and maintaining communication and cooperation with both public and private health-related organizations. [FUN] Video - Topic 2: American College of Healthcare Executives (ACHE) Overview 5 min 2018 American College of Healthcare Executives (ACHE) Overview ©Margaret Kilduff 2018 55 Coursera: Healthcare Organizations and the Health System The video is a YouTube video (https://www.youtube.com/watch?v=H0vnkt94WrE) produced by ACHE. The video provides an overview of the ACHE strategic plan and details ACHE's mission, values, programs, products and services. Reading: [INFO] Topic 3. Evidence-Based Healthcare Administration Practice 7 min Topic 3. What is evidence-based healthcare administration practice? Evidence-based healthcare administration practice is the use of the best scientifically-based evidence in the design of healthcare administration processes and in healthcare administrative decision-making. The origin of evidence-based healthcare administration practice lies in the evidence-based medicine (EBM) movement. This section discusses: Overview of the Origins of Evidence-Based Medicine (EBM) Overview of Evidence-Based Healthcare Administration Practice Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Two Quiz. Overview of the Origins of Evidence-Based Medicine (EBM) The origin of the term “evidence-based” is generally credited to David M. Eddy who was the first to use the term “evidence-based” in speeches and workshops in 1985. He was the first to publish the term in 1990 in an article entitled Practice Policies: Where Do They Come From? He used the term and the process in reference to the evidence-based design of health-related practice and coverage guidelines, policies, and measures. The term "evidence-based" in relationship to clinical decision-making made its first published appearance in a 1992 article by David Sackett, et. al. entitled Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. The article states that "Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research." The term and concept of evidence-based medicine (EBM) rapidly became an organizing concept for a variety of health-related work and philosophies. For example, in 1993 the Cochrane Collaboration was founded (now known simply as Cochrane. It was named for Archie Cochrane who died in 1988 and had argued throughout much of his life that medical decision-making should be based in the results of ©Margaret Kilduff 2018 56 Coursera: Healthcare Organizations and the Health System randomized control trials (RCTs); that medical decision-making should be EBM (more science than art and based in the scientific method). The motto of Cochrane is: "Trusted evidence. Informed decisions. Better health." The primary Cochrane evidence methodology is the systematic review which "summarises the results of available carefully designed healthcare studies (controlled trials) and provides a high level of evidence on the effectiveness of healthcare interventions. Judgments may be made about the evidence and inform recommendations for healthcare." These systematic reviews are published as Cochrane Reviews in the Cochrane Library. The general form of the Cochrane EBM systematic review seeks to answer the question: What is the best treatment – based in the evidence – for a particular disease or condition? Note [FUN]: The video for Topic 3 - What Are Systematic Reviews? - is a YouTube video produced by Cochrane. The video explains why systematic reviews are important and how they are done. This includes an explanation of how the effects of interventions are compared in order to provide evidence. There are many articles and reports on the development of EBM. You may find the ones listed below interesting and relevant to this question. Each is optional; you do not have to read it. They are: The Origins of Evidence-Based Medicine: A Personal Perspective What is Evidence-Based Medicine? The notion of "evidence-based" spread to fields other than clinical decision-making. There are now efforts for evidence-based practice (EBP) in many disciplines. For example: Policymaking such as the Evidence-Based Policymaking Collaborative and the Campbell Collaboration Nursing such as the Indiana Center for Evidence-Based Nursing Practice Dentistry such as the American Dental Association (ADA) Center for Evidence-Based Dentistry Complementary and Alternative Medicine such as the Journal for Evidence-Based Complementary and Alternative Medicine Policing such as the Cambridge Journal for Evidence-Based Policing Design such as the Evidence-Based Design Journal Overview of Evidence-Based Healthcare Administration Practice Management and administration also joined the evidence-based movement. The terms management and administration as noted earlier are often used interchangeably to describe the same set of responsibilities. Evidence-based healthcare administration is a part of the evidence-based management (EBMgt) movement. Evidence-based healthcare administration has a specific focus on ©Margaret Kilduff 2018 57 Coursera: Healthcare Organizations and the Health System the administration/management of healthcare organizations while EBMgt focuses on administration/management of all organizations. However, EBMgt is generally considered to have begun with a focus on healthcare administration with the 1998 article by Runo Axelsson entitled Towards Evidence-Based Health Care Management. The article “introduces a new approach for health care management called Evidence Based Management. This approach promises to improve the practice of health care management, at the same time as it may stimulate research on the organization and management of health care. Evidence Based Management means that health care managers should learn to search for and critically appraise evidence from management research as a basis for their practice.” Evidence-based healthcare administration is based in evidence (e.g., research studies) that answers the question: What is the best healthcare administration practice – based on the evidence – to achieve a particular desired organizational outcome? Where can you find the evidence you need? One place is the Center for Evidence-Based Management. Another place is journals – management and administration journals, especially those with a focus on health care. Examples include: Journal of Healthcare Management Frontiers of Health Services Management Health Care Management Science Health Care Management Review Healthcare Executive Health Services Management Research There are many published articles and reports on evidence-based management in general and evidencebased healthcare administration specifically. Some of them are listed below. You may find some or all of them interesting. Each is optional; you do not have to read it. They are: Evidence-Based Management: From Theory to Practice in Health Care The Gold Standard of Management? Evidence-Based Management and Healthcare Delivery Use of Evidence-Based Management in Healthcare Administration Decision-Making (PubMed Abstract Only) Evidence-Based Management in Health Care Organizations: A Cautionary Note (PubMed Abstract Only) Evidence-Based Management, The Basic Principles Evidence-Based Management: Foundations, Development, Controversies and Future Evidence-Based Management ©Margaret Kilduff 2018 58 Coursera: Healthcare Organizations and the Health System [FUN] Video - Topic 3. What Are Systematic Reviews? 4 min What Are Systematic Reviews? The video is a YouTube video (https://www.youtube.com/watch?v=egJlW4vkb1Y) produced by Cochrane. The video explains why systematic reviews are important and how they are done. This includes an explanation of how the effects of interventions are compared in order to provide evidence. Reading: [INFO] Topic 4. Healthcare Administration Frameworks 10 min Topic 4. What administrative/management frameworks are used in healthcare administration? Evidence-based healthcare administration strives to use the best healthcare administration practices – based on the evidence – to achieve specified healthcare organizational outcomes. Such practices often relate to strategy frameworks (a.k.a., models, theories) and tactics frameworks (a.k.a., models, theories). Every organization has strategic and tactical goals and objectives. Achievement of these goals and objectives leads to achievement of the specified organizational outcomes. The combined strategy and tactics frameworks used to achieve the goals and objectives - and thus specified outcomes - are often called administrative/management frameworks. This section addresses: Overview of the Origins of Administrative/Management Frameworks Administrative/Management Frameworks Used in Healthcare Administration Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Two Quiz. Overview of the Origins of Administrative/Management Frameworks Most human groups have strategic goals and objectives both formal and informal. So at some level strategy frameworks and tactical frameworks have existed as long as there have been humans living in groups. However, specified frameworks to achieve organizational goals and objectives to achieve specified outcomes are fairly recent in human history. Such administrative/management frameworks have their foundation in the Industrial Revolution which is generally considered to be the time period between 1760 and 1830. The Industrial Revolution brought about the urbanization – the movement of people away from rural areas to cities – of many countries ©Margaret Kilduff 2018 59 Coursera: Healthcare Organizations and the Health System including the United States. People moved to cities because there was work in the cities – the Industrial Revolution brought new manufacturing processes and new jobs. The first factory in the United States is generally considered to be the textile factory established by Samuel Slater in 1793 in Pawtucket, Rhode Island. In the United States, the population became urban-majority (more people living in cities than in rural areas) sometime between 1910 and 1920. The number of family farms in the United States peaked at 6.4 million in 1910. With factories and urbanization came an interest in administrative/management frameworks. Adam Smith is credited with laying the foundation of modern administrative/management frameworks in his observation that division of labor (each person is responsible for a specific task) increases productivity. He published this observation in An Inquiry into the Nature and Causes of the Wealth of Nations in 1776. This publication, which is often referred to as the Wealth of Nations , is considered the foundational publication for modern economics. The Wharton School, established in 1881 at the University of Pennsylvania, is recognized as being the world’s first college/university-based business school. The first comprehensive management framework/theory is generally credited to Frederick Winslow Taylor with his publication in 1911 of The Principles of Scientific Management. A brief overview of the evolution in administrative/management frameworks can be found in the article entitled Management’s Three Eras: A Brief History. Administrative/Management Frameworks Used in Healthcare Administration A reasonable question to ask is whether the administrative/management frameworks developed for non-healthcare organizations apply to healthcare organizations. Do the Principles of Scientific Management, for example, improve productivity in healthcare organizations? The Institute for Healthcare Optimization believes that they do. The Institute’s “main goal is to facilitate wider adoption of scientific management practices in healthcare”. The authors of Medical Taylorism are not as convinced. There is disagreement as to whether the frameworks apply because there is disagreement as to whether the workflow processes of healthcare organizations are sufficiently similar to those found in manufacturing for manufacturing administrative/management frameworks to be successfully applied in healthcare administration. The health care delivery workflow process is the way in which the people in the healthcare organization (large or small) process customers (patients): 1) when they arrive, 2) are provided health care, and 3) when they leave. For healthcare organizations, this is the "manufacturing process"; the process by which the organization's "products" are "manufactured". Some may consider it odd to think of the health care delivery workflow process in terms of the manufacturing workflow process, but some healthcare organizations have successfully used manufacturing administrative/management frameworks (e.g., scientific management) to improve health care delivery. Two other commonly used manufacturing-related frameworks are Six Sigma developed at ©Margaret Kilduff 2018 60 Coursera: Healthcare Organizations and the Health System Motorola and Lean which was originally developed as the Toyota Production System. More information about the Lean System can be found at the Lean Enterprise Institute (LEI) website. Some people advocate a combination of the two frameworks such as those at the Lean Six Sigma Institute (LSSI). Note [FUN]: The video for Topic 4 - An Introduction to Lean Thinking - is a YouTube video produced by the Washington State Department of Revenue Lean Transformation Office and Taxpayer Services Communication. It provides an overview of the Lean strategy and compares it to traditional management. There are many articles and reports on the Six Sigma and Lean applications to healthcare organizations. You may find the ones listed below interesting and relevant to this question. Each is optional; you do not have to read it. They are: Lean Management – The Journey from Toyota to Healthcare How a Manufacturing Process Transformed Healthcare Delivery The Applicability of Lean and Six Sigma Techniques to Clinical and Translational Research Lean and Six Sigma in Acute Care: A Systematic Review of Reviews (PubMed Abstract Only) Another popular framework with relevance to healthcare administration is the Art of War written by Sun Tzu 2500 years ago. Technically, the Art of War is a book on military strategy, but it has become popular as an administrative/management framework. A free copy of the book as translated by Lionel Giles can be found at the Internet Classics Archive, The Art of War. The book and framework are popular because of the similarity between military operations and organizational functioning regarding the importance of strategic and tactical goals and objectives. Achievement of these goals and objectives leads to achievement of the specified outcomes - whether they be military outcomes or organizational outcomes. A strategy is the overall plan for achieving the outcomes. A tactic is the specific action taken to achieve the outcomes. Below are some of the Sun Tzu quotes related to strategy and tactics. "All men can see the tactics whereby I conquer, but what none can see is the strategy out of which victory is evolved." "He who can modify his tactics in relation to his opponent and thereby succeed in winning, may be called a heaven-born captain." "The general who thoroughly understands the advantages that accompany variation of tactics knows how to handle his troops." ©Margaret Kilduff 2018 61 Coursera: Healthcare Organizations and the Health System There is also a popular quote mis-attributed to Sun Tzu which sums up the relationship between strategy and tactics: “Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.” There are many articles and reports on Sun Tzu's Art of War applications to healthcare organizations. You may find the ones listed below interesting and relevant to this question. Each is optional; you do not have to read it. They are: The Art of War Adapted to U.S. Medicine 2011 Sun Tzu and The Art of War: Implications for the Healthcare Professional (PubMed Abstract Only) A common healthcare administration strategy decision is what to do about healthcare organization silos? Organizational silos exist when members of departments have a primary loyalty and identification with their department and departmental co-workers rather than with the organization as a whole. Members of a silo do not like to share resources (e.g., information, supplies, ideas) with those outside the department. Such independent departments are often termed “silos” and, in healthcare organizations (of all sizes and purposes), silos are the norm. There are two basic strategies for dealing with silos: 1) reduce or eliminate silos; or 2) connect and manage silos. In the first situation (reduce or eliminate), silos are considered bad and an organizational flaw. It is thought that silos must be eliminated if the healthcare organization is to function well. This approach agrees with the Business Dictionary which states that a Silo Mentality “will reduce efficiency in the overall operation, reduce morale, and may contribute to the demise of a productive company culture.” The overall goal in this situation is to blur departmental boundaries and encourage people to identify with the healthcare organization as a whole rather than with their department or healthcare profession. The focus on interprofessional education and practice in healthcare organizations is an attempt to reduce or eliminate healthcare silos. The National Center for Interprofessional Practice and Education is a resource for more information on such interprofessional healthcare efforts. In the second situation (connect and manage), silos are considered good or at least a functional outcome of an organization comprised of highly specialized and trained professionals. It is thought that silos must be networked and managed – but not eliminated – if the organization is to function well. The overall goal in this situation is to connect and network silos to build bigger and bigger silos. Departments, for example, are networked to build a division. Divisions are networked to build an organization. Each silo is encouraged to be a high functioning unit (team) networked to other units (teams); the organization is a team-of-teams. This approach is based in the application of a military strategy as published by General Stanley McChrystal in his book Team-of-Teams: New Rules of Engagement for a Complex World. It is the framework used by McChrystal Group when consulting with many organizations including healthcare organizations. ©Margaret Kilduff 2018 62 Coursera: Healthcare Organizations and the Health System There are many articles and reports on strategic and tactical approaches to silos in healthcare organizations. You may find the ones listed below interesting and relevant to this question. Each is optional; you do not have to read it. They are: Better Patient Flow Means Breaking Down the Silos Breaking Down Silos to Improve Patient Flow, Hospital Efficiency Breaking Down Silos: Enhancing Care Coordination Quashing the Silos and Getting to Integrated Health Care Breaking Down Silos Is a Myth, Do This Instead The Need for a Team of Teams It Takes a Team of Teams to Transform Healthcare Fixing Healthcare Safety: Team of Teams [FUN] Video - Topic 4. An Introduction to Lean Thinking 17 min An Introduction to Lean Thinking The video is a YouTube video (https://www.youtube.com/watch?v=RxDw0Q_gVt0) produced by the Washington State Department of Revenue. It provides an overview of the Lean strategy and compares it to traditional management. Reading: [INFO] Topic 5. Healthcare Administration Professional Associations 10 min Topic 5. What are the healthcare administration and management professional associations in the United States? Wikipedia states that a "professional association (also called a professional body, professional organization, or professional society) is usually a nonprofit organization seeking to further a particular profession, the interests of individuals engaged in that profession and the public interest." This section addresses: Some Interesting Information on Professional Associations List of Healthcare Administration and Management Professional Associations Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Two Quiz. ©Margaret Kilduff 2018 63 Coursera: Healthcare Organizations and the Health System Some Interesting Information on Professional Associations There are many good reasons to join a professional association. Such reasons include, but are not limited to: building a network of professionals with the same interests, being informed of events relevant to your profession, and access to information and education relevant to your profession. The oldest professional society in the United States is the Medical Society of New Jersey which was founded in 1766 by seventeen "practitioners of physic and surgery in New Jersey ... for the advancement of their profession and promotion of the public good". (Website Source of Quote) It should be noted that these "practitioners of physic and surgery in New Jersey" probably learned their profession as apprentices - as was the custom at the time - rather than through formal academic training. Formal training existed, but it was not the usual path to the profession of medicine during this time period. The first recorded medical school is generally recognized to be the Schola Medica Salernitana founded in in Salerno, Italy in the 9th century. The school closed in 1811. The oldest continuously operating medical school is considered to be the one at the University of Oxford in Oxford, England. The founding of the University of Oxford is recognized as 1096 with instruction in the medical sciences beginning sometime in the early 1300s. The first Doctor of Medicine (MD) degree was awarded in 1703 at the University of Glasgow in Glasgow, Scotland. The first medical school in the United States was the one now known as the Perelman School of Medicine at the University of Pennsylvania. It was established in 1765 by John Morgan and William Shippen, Jr. Note [FUN]: The video for Topic 5 - The Perelman School of Medicine: First - is a YouTube video produced by the Perelman School of Medicine. It provides an overview of the school's history of innovative firsts for its first 250 years. List of Healthcare Administration and Management Professional Associations Below are listed some, but not all, of the professional associations relevant to healthcare administration and management. You may already be familiar with or be a member of some. Others may be new to you. This list is fairly comprehensive, but should not be considered the complete list of all relevant professional associations. 1. American Association of Healthcare Administrative Management (AAHAM) - "dedicated solely to the revenue cycle of both management and the front-line staff ... gives you the career-boosting power to network with the best-informed revenue cycle professionals and pick their brain about the most important issues in the field." ©Margaret Kilduff 2018 64 Coursera: Healthcare Organizations and the Health System 2. American College of Healthcare Administrators (ACHCA) - "dedicated to administrative leadership and excellence in post-acute and aging services care across the spectrum of health care services." 3. American College of Healthcare Executives (ACHE) - "an international professional society of 40,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organizations. ACHE's mission is to advance its members and healthcare management excellence." 4. American Health Information Management Association (AHIMA)- "more than 103,000 health information professionals ... taking a lead in advancing informatics, data analytics, and information governance for healthcare." 5. American Organization of Nurse Executives (AONE) - "leadership, professional development, advocacy and research to advance nursing practice and patient care, promote nursing leadership excellence and shape public policy for health care nationwide." 6. Association for Healthcare Administrative Professionals (AHCAP) - "dedicated to executive assistants, administrative assistants, and other professionals who support our nation’s healthcare leaders. By supporting healthcare leaders, we support the industry - and strive to enhance the healthcare experience on every level." 7. Health Care Administrators Association (HCAA) - "supporting the education, networking, resource and advocacy needs of benefit administrators (TPAs), stop loss insurance carriers, managing general underwriters, audit firms, medical managers, technology organizations, pharmacy benefit managers, brokers/agents, human resource managers and health care consultants." 8. Healthcare Financial Management Association (HFMA) - "membership organization for healthcare finance leaders ... mission is to lead the financial management of health care." 9. Healthcare Information Management Systems Society (HIMSS) - "voice, advisor and thought leader of health transformation through health information and technology with a unique breadth and depth of expertise and capabilities to improve the quality, safety, and efficiency of health, healthcare and care outcomes." 10. Medical Group Management Association (MGMA) - "empower practices, providers, and patients to create meaningful change in healthcare ... spearheading the path to healthcare advancement." 11. Professional Association of Health Care Management (PAHCOM) - "a support network to the managers of small group and solo provider health care practices. Smaller medical practices are ©Margaret Kilduff 2018 65 Coursera: Healthcare Organizations and the Health System significantly different from other corporate entities ... established to help the office manager achieve success." [FUN] Video - Topic 5. The Perelman School of Medicine: First 4 min The Perelman School of Medicine: First The video is a YouTube video (https://www.youtube.com/watch?v=7BGH-XXh0lA) produced by the Perelman School of Medicine. It provides an overview of the school's history of innovative firsts for its first 250 years. Discussion Prompt: [FUN] Healthcare Organization Silos 5 min What are your thoughts about healthcare organization "silos"? Organizational silos exist when members of departments have a primary loyalty and identification with their department and departmental coworkers rather than with the organization as a whole. In healthcare organizations (of all sizes and purposes), silos are the norm. There are two basic strategies for dealing with silos: 1) reduce or eliminate silos; or 2) connect and manage silos. Which of these two basic strategies do you believe is the best one to use as a healthcare administrator? [CERT] [PREP] Lesson Two Quiz and "Create Your Own Healthcare Organization" Quiz: [CERT] Lesson Two Quiz 15 questions, 20 minutes Question 1 In this course, healthcare administration: Encompasses responsibility for the day-to-day operations of a part of the healthcare organization and is more tactical than strategic. Encompasses responsibility for all aspects of a healthcare organization and is more strategic than tactical. The answer to this question is found in Topic 1. Question 2 In this course, healthcare management: ©Margaret Kilduff 2018 66 Coursera: Healthcare Organizations and the Health System Encompasses responsibility for all aspects of a healthcare organization and is more strategic than tactical. Encompasses responsibility for the day-to-day operations of a part of the healthcare organization and is more tactical than strategic. The answer to this question is found in Topic 1. Question 3 Master of Health Administration (MHA) degrees are usually found in a college or university's health sciences or medical school. True False The answer to this question is found in Topic 1. Question 4 In the combined Healthcare Leadership Alliance (HLA) and American College of Healthcare Executives (ACHE) healthcare administration competencies which competency is defined as: Competent in applying general administration and management principles (e.g., planning, organizing, directing and controlling) to address overall goals and objectives of the healthcare organization. Competent in the ability to inspire individual and organizational excellence, create a shared vision and successfully implement processes (including change processes, as needed) to attain the healthcare organization’s strategic and tactical goals and objectives. Administration, Management, and Leadership Organizational Structure and Governance Quality and Performance Improvement Communication and Relationship Management The answer to this question is found in Topic 2. ©Margaret Kilduff 2018 67 Coursera: Healthcare Organizations and the Health System Question 5 In the combined Healthcare Leadership Alliance (HLA) and American College of Healthcare Executives (ACHE) healthcare administration competencies which competency is defined as: Competent in applying business principles, including systems thinking, to the development and analysis of a healthcare organization’s structure with delineating responsibility, authority and accountability at all levels of the healthcare organization. Competent in the development and implementation of policies and procedures for the governance process. Administration, Management, and Leadership Organizational Structure and Governance Health Care and the Healthcare Environment Human Resources The answer to this question is found in Topic 2. Question 6 In the combined Healthcare Leadership Alliance (HLA) and American College of Healthcare Executives (ACHE) healthcare administration competencies which competency is defined as: Competent in applying business principles, including systems thinking, to the development, implementation and evaluation of healthcare organizational accountability, including quality improvement theories and frameworks as well as quality assessment and assurance philosophies, policies, programs and procedures. Administration, Management, and Leadership Quality and Performance Improvement Business Laws and Regulations The answer to this question is found in Topic 2. Question 7 Evidence-based medicine (EBM) can be defined as the practice of medicine which de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research." True False The answer to this question is found in Topic 3. ©Margaret Kilduff 2018 68 Coursera: Healthcare Organizations and the Health System Question 8 Evidence-based healthcare administration is a part of the evidence-based management (EBMgt) movement. Evidence-based healthcare administration has a specific focus on the administration/management of healthcare organizations while EBMgt focuses on administration/management of all organizations. True False The answer to this question is found in Topic 3. Question 9 A good place to find evidence for evidence-based healthcare administration is journals. Which of the following is NOT a good journal source for such information? Journal of Healthcare Management Health Care Management Science Health Care Management Review Digital Scholarship in the Humanities The answer to this question is found in Topic 3. Question 10 Adam Smith is credited with laying the foundation of modern administrative/management frameworks in his observation that division of labor (each person is responsible for a specific task) increases productivity. He published this observation in 1776 in: An Inquiry into the Nature and Causes of the Wealth of Nations (Wealth of Nations) An Inquiry into the Nature of Economics (Nature of Economics) An Inquiry into the Causes of Boundaries of Nations (Boundaries of Nations) An Inquiry into the Nature of Democracies and Republics (Democracies and Republics) The answer to this question is found in Topic 4. Question 11 The first comprehensive management framework/theory is generally credited to Frederick Winslow Taylor with his publication in 1911 of: The Principles of Scientific Management The Principles of Science Factories ©Margaret Kilduff 2018 69 Coursera: Healthcare Organizations and the Health System The Principles of Solid Management The Principles of the Scientific Methodology The answer to this question is found in Topic 4. Question 12 The Art of War is a book on military strategy, but it has become popular as an administrative/management framework. It was written by: Sun Tzu Robert Brown Xie Chang George Washington The answer to this question is found in Topic 4. Question 13 The oldest professional society in the United States is the Medical Society of New ______ which was founded in 1766. The answer to this question is found in Topic 5. Question 14 The first medical school in the United States was the one now known as the Perelman School of Medicine at the University of ____________. The answer to this question is found in Topic 5. Question 15 There are many good reasons to join a professional association. Which of the following would NOT be a good healthcare administration professional association to join? National Recreation and Park Association (NRPA) American College of Healthcare Executives (ACHE) Association for Healthcare Administrative Professionals (AHCAP) Medical Group Management Association (MGMA) The answer to this question is found in Topic 5. ©Margaret Kilduff 2018 70 Coursera: Healthcare Organizations and the Health System Practice Peer-graded Assignment: [PREP] Lesson Two Create Your Own Healthcare Organization 45 min See Appendix B: Lesson Two Create Your Own Healthcare Organization Practice Peer-graded Assignment: [PREP] Copy of Lesson One Create Your Own Healthcare Organization 45 min This is a copy of the Lesson One Create Your Own Healthcare Organization questions. It is repeated in case you want to update your answers or just be reminded of what the questions from Lesson One were. See Appendix A: Lesson One Create Your Own Healthcare Organization [FUN] Lesson Two Trivia Question and Virtual Field Trip Reading: [FUN] Lesson Two Trivia Question 2 min Almost everyone loves a trivia question - a question about a little known, but interesting, fun fact. Each lesson has one trivia question. The answer is in the Lesson Two Trivia Question Answer reading section. Question: Symbols are used to represent many things in daily life (e.g., a specific organization, pedestrian crossing, a specific club, a specific profession). The Rod of Asclepius (one snake wound around one staff/rod) is the universally accepted symbol of medicine. ©Margaret Kilduff 2018 71 Coursera: Healthcare Organizations and the Health System Image from Wikipedia, File:Rod of Asclepius2.svg The Caduceus (two snakes wound around one - usually winged - staff/rod) is the universally accepted symbol for commerce. Image from Wikipedia, File:Caduceus.svg However, in the United States the Caduceus is also a symbol for medicine. How did the Caduceus become a symbol for medicine in the United States? Reading: [FUN] Lesson Two Trivia Question Answer (Optional) 5 min The answer to the Lesson Two trivia question is: The use of the Caduceus as a symbol of medicine in the United States is generally considered to have resulted from the formal adoption of the symbol for officer uniforms by the The US Army Medical Corps in 1902. There is disagreement as to who in the Army Medical Corps made the decision to do this. Some say it was Captain Frederick P. Reynolds and others say it was Colonel John R. van Hoff. ©Margaret Kilduff 2018 72 Coursera: Healthcare Organizations and the Health System Image from Wikipedia, File:US Army Medical Corps Branch Plaque.gif For more information, please see: Wikipedia, Caduceus as a Symbol of Medicine Wikipedia, Caduceus Wikipedia, Rod of Asclepius Wikipedia, Medical Corps (United States Army) U.S. Army, Army Medicine, What is the Medical Corps? Reading: [FUN] Lesson Two Virtual Field Trip 5 min Everyone loves a road trip/field trip so each lesson of the course includes a "virtual field trip" to the often hidden places of interest on the web. Lesson Two's virtual field trip is to the Blackstone River Valley National Historical Park. Contained within this park is the location of the textile factory established by Samuel Slater in 1793 in Pawtucket, Rhode Island - mentioned earlier in this lesson. This river valley is considered to be the Birthplace of the American Industrial Revolution. The video provides a brief trip down the Blackstone Canal. The Blackstone Canal and other canals were essential components of the American Industrial Revolution. They provided the transportation infrastructure needed to move materials and manufactured goods to where they were needed. More information about the canals and their importance can be found at: Wikipedia, List of Canals in the United States The Erie Canal Erie Canal National Heritage Corridor Wikipedia, Patowmack Canal ©Margaret Kilduff 2018 73 Coursera: Healthcare Organizations and the Health System [FUN] Video - Lesson Two Virtual Field Trip 2 min Blackstone Canal The video is a YouTube video (https://www.youtube.com/watch?v=9r8GrjhgvKM) produced by the Blackstone River Valley National Historical Park which provides a brief overview of the Blackstone Canal. ©Margaret Kilduff 2018 74 Coursera: Healthcare Organizations and the Health System LESSON THREE: GOVERNANCE This lesson provides an overview of organizational governance and functions. Learning Objectives Define the forms of organizational governance and functions. [INFO] [FUN] Lesson Three Content and Discussion Reading: [INFO] Welcome and Lesson Three Overview 10 min Welcome to Lesson Three! This lesson provides an overview of organizational governance. Upon successful completion of this lesson, you will be able to: define the forms of organizational governance and functions. There is a quiz, a trivia question, and a field trip. There are also optional videos which provide [FUN] supplemental content. There are many wonderful videos in the public domain which are relevant to this course. The lesson should take 4-6 hours of work to successfully complete. This lesson asks and answers the following questions: 1. What is governance and governance theory? 2. What is the relationship between governance and a healthcare organization’s business structure? 3. What is the relationship between governance and a healthcare organization’s tax status? 4. What is the relationship between governance and a healthcare organization’s mission, vision, and bylaws? 5. What is the relationship between governance and an effective Board of Directors? Discussion Prompt: [FUN] Feedback - Lesson Three 5 min Please post any feedback you have specifically about Lesson Three in this discussion forum at any time during the course. All feedback (e.g., suggestions, questions, concerns, criticisms) is welcome. This is your Lesson Three course experience. Let us know how you feel the Lesson Three experience can be improved. Let us know what you feel works particularly well in the Lesson Three. ©Margaret Kilduff 2018 75 Coursera: Healthcare Organizations and the Health System Reading: [INFO] Topic 1. Governance and Theory 10 min Topic 1: What is governance and governance theory? Until recently, the term governance was used primarily in relationship to the formal governmental processes and structures of nations. The first published use of the term is generally credited to William Tyndale in his 1530 publication entitled the Practice of Prelates where he used the term in reference to the individual rule of Henry VIII: “ When the king’s grace came first to the right of the crown, and unto the governance of the realm young and unexpert …”. The first use of the term governance to reference national governmental structures - as opposed to the individual rule of a monarch - is generally credited to Charles Plummer in 1885 when he added the phrase The Governance of England to the title of his edited and annotated version of the The Difference Between an Absolute and a Limited Monarchy: As it More Particularly Regards the English Constitution written by John Fortescue in 1471. The term's use remained primarily in relationship to the formal governmental processes and structures of nations until the 1990’s when the term governance began to be widely and commonly applied to many different areas such as organizations, projects, the environment, and the internet. This section discusses: Definitions of Governance Challenges to Governance Governance Theory Shared Governance Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Three Quiz. Definitions of Governance There is no agreement on the precise definition of governance - especially in the current era where the term is used in so many areas. There is agreement on the general scope of governance as a concept, but not its precise definition. There is no one universally accepted definition of governance. Below are some of the many definitions which can be found: The Merriam-Webster online dictionary defines governance as “the way that a city, company, etc., is controlled by the people who run it”. ©Margaret Kilduff 2018 76 Coursera: Healthcare Organizations and the Health System The online Business Dictionary defines governance as the “Establishment of policies, and continuous monitoring of their proper implementation, by the members of the governing body of an organization. It includes the mechanisms required to balance the powers of the members (with the associated accountability), and their primary duty of enhancing the prosperity and viability of the organization.” The American College of Healthcare Executives (ACHE) defines governance as “delineating responsibility, authority and accountability at all levels of the organization. Functions include the development and implementation of policies and procedures for the governance process.” Wikipedia, Governance defines governance as “the way the rules, norms and actions are structured, sustained, regulated and held accountable.” The Worldwide Governance Indicators (WGI) project of the World Bank defines governance as the “traditions and institutions by which authority in a country is exercised. This includes the process by which governments are selected, monitored and replaced; the capacity of the government to effectively formulate and implement sound policies; and the respect of citizens and the state for the institutions that govern economic and social interactions among them.” AAPC defines healthcare governance as the “general term for the overall framework through which organizations are accountable for continuously improving clinical, corporate, staff, and financial performance.” AAPC also states that there are two categories of healthcare governance: 1) clinical governance ("the systematic approach to maintaining and improving the quality and safety of patient care") and 2) corporate governance ("business performance and compliance with laws, regulations, and ethical responsibilities, so that the organization contributes positively to its stakeholders and within the community it serves. Revenue cycle/reimbursement activities fall under corporate governance, but can extend into and directly influence clinical governance through ongoing reimbursement monitoring and risk assessment activities.") Challenges to Governance Existing governance processes and structures are sometimes challenged by the "governed". The outcome of challenges to governance by the "governed" or other internal or external situations is varied. The governance structure might, for example, eliminate the challenge and continue as before or the governed entity (i.e., country, organization) may change (e.g., divide into different entities). The entity may even cease to exist. Some of the more well known instances of such situations are: ©Margaret Kilduff 2018 77 Coursera: Healthcare Organizations and the Health System Henry VIII challenged the legitimacy of the governance of the Catholic Church and the Catholic Pope over his life and marriage. The outcome was a split of the entity (Catholic Church) - Henry VIII established the Church of England with the 1534 Act of Supremacy. American Revolutionaries challenged the legitimacy of the governance of the British Empire and the British monarchy. The outcome was a split of the entity (British Empire) - the United States was formed. The Declaration of Independence (signed in 1776) states that the reason for the Revolution (the challenge to the governance of the British Empire) was because when the governed have experienced “absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.--Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government.” Many of the original foundational documents for United States governance are stored in the National Archives. Note [FUN]: The video for Topic 1 - A Room for Treasures: Cool Things at the National Archives- is a YouTube video produced by the National Archives as part of its Inside the Vaults series. The video highlights some of the interesting, little-known items in the National Archives. Issac Le Maire challenged the legitimacy of the corporate governance of the Vereenigde Oostindische Compagnie (aka: VOC, Dutch East India Company) in 1609. Le Maire was a large shareholder in the VOC and demanded that the VOC governance structure and the VOC itself be liquidated because of VOC business practices. The outcome was that the VOC overcame this challenge and continued much as before. The VOC (founded in 1602) continued operations until 1799. However, Le Maire's challenge is considered to be the first recorded event of shareholder activism challenging an organization's governance processes and structure. Vote of No Confidence which the Merriam-Webster online dictionary defines as "a formal vote by which the members of a legislature or similar deliberative body indicate that they no longer support a leader, government, etc." Wikipedia defines the term as "a statement or vote which states that a person(s) in a position of responsibility (government, managerial, etc.) is no longer deemed fit to hold that position, perhaps because they are inadequate in some respect, are failing to carry out obligations, or are making decisions that other members feel are detrimental." Governance Theory Governance theory can be defined as an evidence-based proposed explanation - with broad application for observations of the way in which formal and/or informal policies, rules, norms, and regulations organize and guide the direction and functions of a group of human beings. For example, governance theory addresses the outcomes expected from the implementation of various governance structures. Often the phrase governance framework is used instead of the phrase governance structure. In ©Margaret Kilduff 2018 78 Coursera: Healthcare Organizations and the Health System discussions of governance, governance theory and governance structure/framework are equally important - because people generally have very strong opinions about a preferred form of governance structure. For example, political governance structures/frameworks are often referred to as forms of government and people have very strong opinions regarding the form under which they wish to live - conditions under which they wish to be governed. Some of the different forms of government are: Democracy Military Dictatorship Monarchy Oligarchy Republic The same is true of organizational governance structures/frameworks. Some of these structures/frameworks will be discussed later in this module. Briefly discussed in this topic area is the governance structure/framework known as shared governance. Shared Governance Just as there is no agreement on the precise definition of governance, there is no agreement on the precise definition of shared governance. There is, however, general agreement on the general scope of shared governance as a concept. The concept of shared governance within an organizational governance structure/framework means that "employees" of the organization participate in the governance decision-making. This is an issue in those organizations where the "employees" - those who directly produce the organization's "products" - are highly trained professionals such as colleges/universities and healthcare organizations. Although shared governance is not used in all healthcare organizations, when it is used, it generally takes one of two forms: 1) professional employees (e.g., physicians, nurses, other health professionals with direct patient contact) participate in a clinical governance structure co-equal to the corporate governance structure; or 2) professional employees are integrated into the corporate governance structure (e.g., member of the corporate Board of Directors). The first situation is the one defined above where AAPC defines healthcare governance as being comprised of two categories: 1) clinical governance ("the systematic approach to maintaining and improving the quality and safety of patient care") and ©Margaret Kilduff 2018 79 Coursera: Healthcare Organizations and the Health System 2) corporate governance ("business performance and compliance with laws, regulations, and ethical responsibilities, so that the organization contributes positively to its stakeholders and within the community it serves. Revenue cycle/reimbursement activities fall under corporate governance, but can extend into and directly influence clinical governance through ongoing reimbursement monitoring and risk assessment activities.") This shared governance structure (sometimes called integrated governance) is the primary governance structure of the National Health Service (NHS) in England. In the NHS, corporate governance and clinical governance go hand-in-hand where clinical governance is defined as "a systematic approach to maintaining and improving the quality of patient care within the National Health Service, (NHS)." Shared governance is also found in healthcare organizations in the United States. Examples include: Lahey Hospital and Medical Center Vanderbilt University Medical Center University of Virginia Health System Stanford Health Care, ValleyCare There are many articles and reports on governance. You may find the ones listed below interesting and relevant to this question. Each is optional; you do not have to read it. They are: Shared Governance: Hartford Hospital's Experience Evolving Hospital-Physician Relationship Demands Shared Governance, Aligned Goals Engaging Physicians in Operational Governance Power and Integrated Health Care: Shifting from Governance to Governmentality The Involvement of Medical Doctors in Hospital Governance and Implications for Quality Management: A Quick Scan in 19 and an In Depth Study in 7 OECD Countries A Primer on the Dangers of 'Shared Governance' The Evolution of Nursing Shared Governance at a Community Hospital Empowering Frontline Nurses for Shared Governance Traditional and Non-Traditional Collective Bargaining: Strategies to Improve the Patient Care Environment For First Time, Physician Practice Owners are Not the Majority 4 Best Practices for Supporting Employed Physicians' Independence Physician Engagement – A Primer for Healthcare Leaders Governance in Healthcare: Leadership for Successful Improvement Healthcare Governance Amidst Systemic Industry Change: What the Law Expects The Importance of Good Governance Governance Arrangements for Health Systems in Low-Income Countries: An Overview of Systematic Reviews Decentralised Versus Centralised Governance of Health Services ©Margaret Kilduff 2018 80 Coursera: Healthcare Organizations and the Health System Exploring the Relationship between Governance Mechanisms in Healthcare and Health Workforce Outcomes: A Systematic Review Frameworks to Assess Health Systems Governance: A Systematic Review [FUN] Video - Topic 1. Cool Things at the National Archives 5 min A Room for Treasures: Cool Things at the National Archives The video is a YouTube video (https://www.youtube.com/watch?v=yuWfpnYyX1k) produced by the National Archives as part of its Inside the Vaults series. The video highlights some of the interesting, little-known items in the National Archives. Reading: [INFO] Topic 2. Governance and Business Structure 10 min Topic 2. What is the relationship between governance and a healthcare organization’s business structure? Organizational governance structures/frameworks are related to the organization's business structure. The organization's business structure is its legal structure (sometimes called the business ownership structure or business form). Different types of business structures usually have different governance structures. Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Three Quiz. As a general rule each business structure (each organization) needs to file documents in the state in which it is formed to be considered a legal entity. The documents and process may vary by state and by business structure. For example, information on creating a business and the documents required in: California can be found at the California Secretary of State, Starting a Business website Massachusetts can be found at the Mass.gov, Types of Businesses website New Jersey can be found at the New Jersey Department of the Treasury, File Certificates of Business Formation website ©Margaret Kilduff 2018 81 Coursera: Healthcare Organizations and the Health System Regardless of the business structure used, all organizations need/want to generate income/revenue. All organizations need money. The first paper money in the "United States" was issued by Massachusetts in 1690. When the Revolutionary War began, the Continental Congress began issuing paper money called Continentals. The United States Department of the Treasury was established by an Act of Congress in 1789 and the United States dollar was adopted as the unit of currency in the United States in 1792. Construction on the current Treasury Building began in 1836. Note [FUN]: The video for Topic 2 - American Artifacts: Treasury Building Restoration - is a YouTube video produced by CSPAN which provides a brief overview of the Treasury Building and its restoration. This section discusses some of the more commonly found business structures in the private sector (military and public sector structures are discussed in the next section - Topic 3). Also discussed in this section are business structures commonly used by healthcare organizations. Therefore, this section discusses (in a brief and highly simplified way): Sole Proprietorship Partnership Limited Liability Company Corporation Business Structures Commonly Used by Healthcare Organizations Sole Proprietorship The United States Small Business Administration (SBA) defines a sole proprietorship as one which: "gives you complete control of your business. You're automatically considered to be a sole proprietorship if you do business activities but don't register as any other kind of business. Sole proprietorships do not produce a separate business entity. This means your business assets and liabilities are not separate from your personal assets and liabilities. You can be held personally liable for the debts and obligations of the business." The United States Internal Revenue Service defines a sole proprietor as “someone who owns an unincorporated business by himself or herself.” The sole proprietor establishes the governance structure for the sole proprietorship in accordance with local, state, and federal laws and is usually the governing body. The sole proprietor is responsible for the organization, its policies, and its accountability. Note: The SBA provides information and resources for small businesses. SBA defines a business as a “small business” based on a number of factors including the organization's North American Industry Classification System (NAICS) code. More information about the SBA definition of a small business can be found at: ©Margaret Kilduff 2018 82 Coursera: Healthcare Organizations and the Health System SBA Table of Size Standards Small Business Size Standards Size Standards Tool Partnership The SBA defines a partnership as the "simplest structure for two or more people to own a business together." There are different types of legal partnerships. Some of them are: General Partnership (GP) - each partner shares equally in profits, losses (personally responsible), and management of the organization Limited Partnership (LP) - one or more general partners who manage the organization along with one or more limited partners who have invested in the organization; all share in the profits, but the limited partners are only responsible for losses up to the amount of their investment Limited Liability Partnership (LLP) - similar to a general partnership in that each partner shares in the profits, losses, and management of the organization, but no partner is responsible for the negligent actions of any other partner Limited Liability Limited Partnership (LLLP) - combined characteristics of the LP and the LLP; one or more general partners who manage the organization along with one or more limited partners who have invested in the organization; limited partners are only responsible for losses up to the amount of their investment; no partner is responsible for the negligent actions of any other partner The IRS defines a partnership as the "relationship existing between two or more persons who join to carry on a trade or business. Each person contributes money, property, labor or skill, and expects to share in the profits and losses of the business." The partners (especially the general partners) establish the governance structure in accordance with local, state, and federal laws and usually form the governing body. The general partners are responsible for the organization, its policies, and its accountability. Limited Liability Company The SBA defines a Limited Liability Company (LLC) as one which takes "advantage of the benefits of both the corporation and partnership business structures. LLCs protect you from personal liability in most instances, your personal assets — like your vehicle, house, and savings accounts — won't be at risk in case your LLC faces bankruptcy or lawsuits." ©Margaret Kilduff 2018 83 Coursera: Healthcare Organizations and the Health System The IRS defines a Limited Liability Company (LLC) as a "business structure allowed by state statute. Each state may use different regulations ... Owners of an LLC are called members ... members may include individuals, corporations, other LLCs and foreign entities. There is no maximum number of members. Most states also permit “single-member” LLCs, those having only one owner." The owners/members establish the governance structure in accordance with local, state, and federal laws and usually form the governing body. The owners/members are responsible for the organization, its policies, and its accountability. Corporation The SBA defines different types of corporations. The two most common types and their SBA definitions are: C-Corporation - "a legal entity that's separate from its owners. Corporations can make a profit, be taxed, and can be held legally liable ... Corporations also require more extensive recordkeeping, operational processes, and reporting ... Corporations have an advantage when it comes to raising capital because they can raise funds through the sale of stock." S-Corporation - "a special type of corporation that's designed to avoid the double taxation drawback of regular C corps. S corps allow profits, and some losses, to be passed through directly to owners' personal income without ever being subject to corporate tax rates." The IRS defines a corporation is an organization where "prospective shareholders exchange money, property, or both, for the corporation's capital stock." In addition, a: C-Corporation - "is recognized as a separate taxpaying entity. A corporation conducts business, realizes net income or loss, pays taxes and distributes profits to shareholders. The profit of a corporation is taxed to the corporation when earned, and then is taxed to the shareholders when distributed as dividends. This creates a double tax." S-Corporation - "are corporations that elect to pass corporate income, losses, deductions, and credits through to their shareholders for federal tax purposes. Shareholders of S corporations report the flow-through of income and losses on their personal tax returns and are assessed tax at their individual income tax rates. This allows S corporations to avoid double taxation on the corporate income." Corporate governance must recognize the many corporate stakeholders including shareholders. The governance structure of a corporation is defined by its articles of incorporation in accordance with local, state, and federal law. The articles of incorporation is the document which establishes the formation of a corporation in a specific state and is filed with that state government. ©Margaret Kilduff 2018 84 Coursera: Healthcare Organizations and the Health System The specific requirements for the articles of incorporation vary by state. The California Secretary of State provides an informative website on filing the articles of incorporation in the State of California. As a general rule, the documents required by a state to establish a corporation in that state are more extensive than those required to establish a different business structure. When an organization forms a corporation, it is said to be an incorporated organization. Business Structures Commonly Used by Healthcare Organizations The United States Census Bureau publishes a number of valuable tables. Among these are the Statistics of U.S. Businesses (SUSB) tables where the businesses are organized/categorized by their North American Industry Classification System (NAICS) code. The SUSB Glossary provides a definition of all terms used in the SUSB tables. One of the provided tables is: Number of Firms, Number of Establishments, Employment, and Annual Payroll by Enterprise Employment Size for the United States, All Industries: 2015 Earlier in this course (Lesson One, Topic 3) the most relevant NAICS sector code for healthcare organizations was identified as Sector 62: Health Care and Social Assistance. Within Sector 62, the most relevant subsector codes were identified as: 621 (Ambulatory Health Care Services), 622 (Hospitals) and 623 (Nursing and Residential Care Facilities. Some of the Sector 62 data from the above Census Bureau table are displayed in the table shown below (Number of Healthcare Organizations by North American Industry Classification System (NAICS) Code, 2015). The table shows that in 2015 there were 5,921,348 firms (businesses). Of these, 11.1 percent (659,175) are in Sector 62 (Health Care and Social Assistance). The number of firms in Health Care (Subsectors 621, 622, and 623) is 530,783. The largest Health Care subsector is 621 (Ambulatory Health Care Services) with 487,277 firms (91.81 percent of Health Care). Each firm included in the table had at least one paid employee sometime during the year. Number of Healthcare Organizations by North American Industry Classification System (NAICS) Code, 2015 Data from Number of Firms, Number of Establishments, Employment, and Annual Payroll by Enterprise Employment Size for the United States, All Industries: 2015 NAICS Code NAICS Name All Sectors Total – All 62 (All) Total - Health Care and Social Assistance 659,175 62 (Part) Total – Health Care Only 530,783 ©Margaret Kilduff 2018 Number Percent of Health Care 5,921,348 100.00 85 Coursera: Healthcare Organizations and the Health System 621 (All) Ambulatory Health Care Services 487,277 91.81 621111 Offices of Physicians (except Mental Health Specialists) 167,642 31.60 6212 Offices of Dentists 125,904 23.72 62131 Offices of Chiropractors 38,732 7.30 62134 Offices of Physical, Occupational and Speech Therapists, and Audiologists 25,540 4.81 6216 Home Health Care Services 21,829 4.11 62133 Offices of Mental Health Practitioners (except Physicians) 20,782 3.92 62132 Offices of Optometrists 19,964 3.76 621399 Offices of All Other Miscellaneous Health Practitioners 16,670 3.14 Number of Healthcare Organizations by North American Industry Classification System (NAICS) Code, 2015 (continued) Data from Number of Firms, Number of Establishments, Employment, and Annual Payroll by Enterprise Employment Size for the United States, All Industries: 2015 Number Percent of Health Care 10,614 2.00 Offices of Podiatrists 7,701 1.45 621498 All Other Outpatient Care Centers 5,623 1.06 62142 Outpatient Mental Health and Substance Abuse Centers 5,472 1.03 621512 Diagnostic Imaging Centers 4,651 0.88 621493 Freestanding Ambulatory Surgical and Emergency Centers 4,214 0.79 621511 Medical Laboratories 3,302 0.62 62191 Ambulance Services 3,167 0.60 621999 All Other Miscellaneous Ambulatory Health Care Services 3,132 0.59 62141 Family Planning Centers 1,448 0.27 621492 Kidney Dialysis Centers 442 0.08 621991 Blood and Organ Banks 335 0.06 621491 HMO Medical Centers 113 0.02 622 (All) Hospitals 3,495 0.66 6221 General Medical and Surgical Hospitals 2,694 0.51 6222 Psychiatric and Substance Abuse Hospitals 417 0.08 NAICS Code Name 621112 Offices of Physicians, Mental Health Specialists 621391 ©Margaret Kilduff 2018 86 Coursera: Healthcare Organizations and the Health System 6223 Specialty (except Psychiatric and Substance Abuse) Hospitals 623 (All) 384 0.07 Nursing and Residential Care Facilities 40,011 7.53 623312 Assisted Living Facilities for the Elderly 13,757 2.59 6231 Nursing Care Facilities (Skilled Nursing Facilities) 9,153 1.72 62321 Residential Intellectual and Developmental Disability Facilities 6,246 1.18 62322 Residential Mental Health and Substance Abuse Facilities 3,824 0.72 623311 Continuing Care Retirement Communities 3,775 0.71 3,256 0.61 6239 Other Residential Care Facilities Another of the provided SUSB tables is: Number of Firms, Number of Establishments, Employment, and Annual Payroll by Legal Form of Organization and Enterprise Employment Size for the United States, NAICS Sectors: 2015 The SUSB tables identify seven (7) different business structures. The Census Bureau calls a firm's (business') business structure in a given state a Legal Form of Organization (LFO). For this section, only four of the seven Census Bureau LFOs are relevant; the relevant types are: "Corporation - An incorporated business that is granted a charter recognizing it as a separate legal entity having its own privileges, and liabilities distinct from those of its members. S-Corporation - A form of Corporation where the entity does not pay any federal income taxes. The corporation's income or losses are divided among and passed to its shareholders. The shareholders must then report the income or loss on their own individual income tax returns. Partnership - An unicorporated business where two or more persons join to carry on a trade or business with each having a shared financial interest in the business. Sole Proprietorships - An unincorporated business with a sole owner." It should be noted that the Census Bureau definition of a: LFO-Partnership includes both the SBA/IRS partnership business structure and the SBA/IRS Limited Liability Company (LLC) with more than one owner/member LFO-Sole Proprietorship includes both the SBA/IRS sole proprietorship business structure and the SBA/IRS Limited Liability Company (LLC) with only one owner/member ©Margaret Kilduff 2018 87 Coursera: Healthcare Organizations and the Health System Some of the Sector 62 data from the above Census Bureau table are displayed in the table below (North American Industry Classification System (NAICS) Sector 62 (Health Care and Social Assistance) Organizations by Legal Form of Organization (LFO), 2015). This Census Bureau table does not display Subsector-Level data, only Sector-Level data. The table below shows that in 2015 there were 5,921,348 firms (businesses). Of these, 11.1 percent (659,175) are in Sector 62 (Health Care and Social Assistance). Each firm included in the table had at least one paid employee sometime during the year. The most common LFO for Sector 62 is the Corporation (61.5 percent). In the two following attached tables, the definition of the LFO heading is as follows: Corporation includes both the C-Corporation business structure and the S-Corporation business structure Partnership includes both the Partnership business structure and the Limited Liability Company (LLC) business structure with more than one owner/member Individual includes both the Sole Proprietorship business structure and the Limited Liability Company (LLC) with only one owner/member North American Industry Classification System (NAICS) Sector 62 (Health Care and Social Assistance) Organizations by Legal Form of Organization (LFO), 2015 Data from Number of Firms, Number of Establishments, Employment, and Annual Payroll by Legal Form of Organization and Enterprise Employment Size for the United States, NAICS Sectors: 2015 LFO Type All NAICS Sectors (Number) All NAICS Sectors (Percent) NAICS Sector 62 (Number) NAICS Sector 62 (Percent) All 5,921,348 100.0 659,175 100.0 Corporation 3,891,386 65.7 405,426 61.5 Individual 894,172 15.1 130,947 19.9 Partnership 694,770 11.7 54,884 8.3 Other 441,020 7.5 67,918 10.3 A firm (LFO) with no paid employees in the past year is called a nonemployer. The specific Census Bureau definition of a nonemployer firm “is one that has no paid employees, has annual business receipts of $1,000 or more ($1 or more in the Construction industry), and is subject to federal income taxes.” The Census Bureau also provides Nonemployer Statistics (NES). One NES table is: ©Margaret Kilduff 2018 88 Coursera: Healthcare Organizations and the Health System Geographic Area Series: Nonemployer Statistics by Legal Form of Organization for the U.S. and States: 2015 Data from this NES table are displayed in the table below (Nonemployer Healthcare Organizations by North American Industry Classification System (NAICS) Code and Legal Form of Organization (LFO), 2015). As is shown in the table below, there were 24,331,403 nonemployer firms in 2015. Of these, 4.8 percent (1,156,494) were in NAICS Sector 62 (Health Care only). Of these, the largest group (331,138 or 28.8 percent) was Individual (LFO), Home Health Care Services (NAICS: 6216). Nonemployer Healthcare Organizations by North American Industry Classification System (NAICS) Code and Legal Form of Organization (LFO), 2015 Data from Geographic Area Series: Nonemployer Statistics by Legal Form of Organization for the U.S. and States: 2015 NAICS Code NAICS Name All LFO Individual Partnership Corporation All Sectors Total – All 24,331,403 21,023,170 1,803,587 1,504,646 62 (Part) Total – Health Care Only 1,156,494 1,081,905 16,733 57,856 621391 Offices of podiatrists 3,538 3,038 76 424 62132 Offices of optometrists 12,758 11,478 238 1,042 6214 Outpatient care centers 18,692 15,577 1,205 1,910 6215 Medical and diagnostic laboratories 18,839 15,838 1,089 1,912 62131 Offices of chiropractors 27,906 23,260 727 3,919 62112 Offices of physicians, mental health specialists 41,833 39,226 462 2,145 6219 Other ambulatory health care services 45,601 43,633 719 1,249 6212 Offices of dentists 45,800 40,367 707 4,726 623 Nursing and residential care facilities 67,541 64,302 956 2,283 62134 Offices of physical, occupational and speech therapists, and audiologists 75,349 69,711 1,228 4,410 62133 Offices of mental health practitioners (except physicians) 118,783 113,830 1,286 3,667 62111 Offices of physicians (except mental health specialists) 154,014 134,559 3,453 16,002 ©Margaret Kilduff 2018 89 Coursera: Healthcare Organizations and the Health System 621399 Offices of all other miscellaneous health practitioners 186,965 173,948 3,316 9,701 6216 Home health care services 338,875 333,138 1,271 4,466 [FUN] Video - Topic 2. Treasury Building Restoration 6 min American Artifacts: Treasury Building Restoration The video is a YouTube video (https://www.youtube.com/watch?v=prcZzMCRafE) produced by CSPAN which provides a brief overview of the Treasury Building and its restoration. Reading: [INFO] Topic 3. Governance and Tax Status 10 min Topic 3. What is the relationship between governance and a healthcare organization’s tax status? Organizational governance structures/frameworks are related to the organization's tax status. The tax status of an organization affects its governance because a specific tax status may have specific governance requirements. As with the organization’s business structure, the organization’s tax status is a legal status. There are many business/organizational tax status designations at both the state and federal level. For the purposes of this course, only three categories of business/organizational tax status designations will be discussed: 1) for-profit; 2) non-profit; and 3) government. Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Three Quiz. As stated in the last section (Topic 2), the United States Census Bureau publishes a number of valuable tables. Among these are the Statistics of U.S. Businesses (SUSB) tables where the businesses are organized/categorized by their North American Industry Classification System (NAICS) code. The SUSB Glossary provides a definition of all terms used in the SUSB tables. One of the provided tables is: Number of Firms, Number of Establishments, Employment, and Annual Payroll by Legal Form of Organization and Enterprise Employment Size for the United States, NAICS Sectors: 2015 ©Margaret Kilduff 2018 90 Coursera: Healthcare Organizations and the Health System The SUSB tables identify seven (7) different business structures. The Census Bureau calls a firm's (business') business structure in a given state a Legal Form of Organization (LFO). For the last section (Topic 2), only four of the seven Census Bureau LFOs were relevant (Corporation, S-Corporation, Partnership, Sole Proprietorships). The remaining three LFO structures are: "Non-profits - An organization that does not distribute surplus funds to its owners or shareholders, but instead uses surplus funds to help pursue its goals. Most non-profit organizations are exempt from taxes. Government - A business that taxpayers primarily fund. Most government businesses are out of scope to the Statistics of U.S. Businesses (SUSB) program. Other (trusts, estates, cooperatives with undetermined tax status, etc.)" Some of the Sector 62 (Health Care and Social Assistance) data from the above Census Bureau table are displayed in the table shown below (North American Industry Classification System (NAICS) Sector 62 (Health Care and Social Assistance) Organizations by Tax Status, 2015). This Census Bureau table does not display Subsector-Level data, only Sector-Level data. Each firm included in the table had at least one paid employee sometime during the year. The table below shows that in 2015 there were 5,921,348 firms (businesses). Of these, 11.1 percent (659,175) are in Sector 62 (Health Care and Social Assistance). The most common tax status for Sector 62 is the For-Profit (89.69 percent). In the following attached table, the definition of the tax status heading is as follows: For-Profit includes the Corporation, S-Corporation, Partnership, and Sole Proprietorships LFO Non-Profit is the Non-profits LFO Government is the Government LFO Other is the Other LFO North American Industry Classification System (NAICS) Sector 62 (Health Care and Social Assistance) Organizations by Tax Status, 2015 Data from Number of Firms, Number of Establishments, Employment, and Annual Payroll by Legal Form of Organization and Enterprise Employment Size for the United States, NAICS Sectors: 2015 Tax Status All NAICS Sectors (Number) All NAICS Sectors (Percent) NAICS Sector 62 (Number) NAICS Sector 62 (Percent) All 5,921,348 100.0 659,175 100.0 ©Margaret Kilduff 2018 91 Coursera: Healthcare Organizations and the Health System For-Profit 5,480,328 92.55 591,257 89.69 Non-Profit 430,197 7.27 66,293 10.06 Government 1,896 0.03 1,168 0.18 Other 8927 0.15 457 0.07 Therefore, this section discusses (in a brief and very simplified way): For-Profit Non-Profit Government For-Profit The Business Dictionary defines a for-profit organization as: "A business or other organization whose primary goal is making money (a profit), as opposed to a non profit organization which focuses a goal such as helping the community and is concerned with money only as much as necessary to keep the organization operating." A For-Profit organization pays a variety of taxes at the state level. Generally, these taxes - called business taxes - include those on business income, sales, and property. These taxes may vary by state and by business structure. For example, information on for-profit business taxes required in: California can be found at the California Franchise Tax Board, Businesses website Massachusetts can be found at the Mass.gov, Business Taxes website New Jersey can be found at the New Jersey Division of Taxation, Businesses Formation website A For-Profit organization pays a variety of taxes at the federal level. Generally, these taxes include those on business income. These taxes vary by business structure. Information on federal business taxes can be found at the Internal Revenue Service (IRS), Tax Information for Businesses website. The governance structure for businesses/organizations which are for-profit was discussed in the last section (Topic 2). Part of the governance process of a for-profit is ensuring that the organization is in compliance with all state and federal for-profit tax requirements. Non-Profit ©Margaret Kilduff 2018 92 Coursera: Healthcare Organizations and the Health System The Business Dictionary defines a non-profit organization as: "Associations, charities, cooperatives, and other voluntary organizations formed to further cultural, educational, religious, professional, or public service objectives. Their startup funding is provided by their members, trustees, or others who do not expect repayment, and who do not share in the organization's profits or losses which are retained or absorbed. Approved, incorporated, or registered NPOs are usually granted tax exemptions, and contributions to them are often tax deductible." A Non-Profit organization does not pay business taxes at the state level. However, the state must first officially recognize that organization as a non-profit before it is exempt from state business taxes. Such recognition can occur only after the organization has been formed as a legal entity in the state. After it is recognized as a legal entity (legal business), then the organization/business can file for non-profit status. The requirements for the non-profit status may vary by state. For example, information on non-profit requirements in: California can be found at the California Attorney General, Charities website. A record of all California non-profits can be found at the California Registry of Charitable Trusts website. Massachusetts can be found at the Mass.gov, Attorney General, Registering a Public Charity website. A record of all Massachusetts non-profits can be found at the Massachusetts NonProfits and Charities Document Search website. New Jersey can be found at the New Jersey Division of Taxation, Non-Profit Organizations website. A record of all New Jersey non-profits can be found at the New Jersey Division of Consumer Affairs, Search for a Charity website. A Non-Profit organization does not pay business taxes at the federal level. However, the federal government must first officially recognize that organization as a non-profit before it is exempt from federal business taxes. Such recognition can occur only after the organization has been formed as a legal entity in a state. After it is recognized as a legal entity (legal business), then the organization/business can file for non-profit status at the federal level. The requirements for the non-profit status may vary by business structure. It should be noted that technically the term "non-profit" applies only to the organization's state-level exemption from business taxes. At the federal level, the organization is designated a "tax-exempt" organization. In common use, however, the term "non-profit" is used to describe an organization exempt from business taxes at both the state and federal level. Being a state-level non-profit does not, however, guarantee that an organization will be approved as a federal-level tax-exempt organization. Information on tax-exempt requirements can be found at the Internal Revenue Service (IRS), Tax Information for Charities and Other Non-Profits website. A record of all federal tax-exempt organizations can be found at the Internal Revenue Service (IRS), Tax Exempt Organization Search ©Margaret Kilduff 2018 93 Coursera: Healthcare Organizations and the Health System website. Tax-exempt organizations file a 990 form with the IRS; more information about this filing can be found at the Internal Revenue Service (IRS), About Form 990, Return of Organization Exempt from Income Tax website. Non-profits typically accept donations from the general public. There are many good resources which the general public can use (in addition to information provided by the non-profit itself) to determine if a donation will be used as the donor intends. These include: Charity Navigator GuideStar Charity Watch GiveWell Foundation Center, 990 Finder A non-profit usually has one of the business structures discussed in the last section (Topic 2). The most common business structure for a non-profit is a corporation. Part of the governance process of a nonprofit is ensuring that the organization is in compliance with all state and federal non-profit requirements. Government The Internal Revenue Service (IRS) defines a government entity in the following way: "Federal and state governments are established and recognized by the U.S. Constitution and state constitutions. Federally recognized Indian tribal governments are recognized by the U.S. Constitution, treaties, statutes and court decisions. Other entities may be recognized as governments by state law, court decision, or an examination of facts and circumstances that indicate it has the characteristics of a government, such as powers of taxation, law enforcement and civil authority." However, when most people think of government as a tax status, they use the term "public sector". The Business Dictionary defines the public sector as: "The part of national economy providing basic goods or services that are either not, or cannot be, provided by the private sector. It consists of national and local governments, their agencies, and their chartered bodies. The public sector is one of the largest sectors of any economy; in the US, for example, it accounts for about 20 percent of the entire economy." The organizations in the public sector are owned and operated by the local, state, or federal government. Employees of these organizations are government (public) employees. Included in this category are military personnel, firefighters, police officers, town clerks, and public school teachers. ©Margaret Kilduff 2018 94 Coursera: Healthcare Organizations and the Health System There are, however, other organizations in the for-profit or non-profit tax sectors which receive a large amount of their revenue from the local, state, and/or federal government. The employees of these organizations are not considered government (public) employees, but their jobs are very dependent on money provided by the government. Employees of public universities are in this category. Many would include employees of Federally Qualified Health Centers (FQHCs) in this category. More information about these centers which are often referred to as Community Health Centers (CHCs) can be found at the Health Resources and Services Administration (HRSA) Health Center Program website. Also included in this category are the employees of organizations to which the government has sub-contracted specific work. The United States General Services Administration (GSA) maintains the Federal Procurement Data System (FPDS) and from that produces the Top 100 Contractors Report. The report for 2017 shows that the contractor receiving the most money from the federal government in 2017 was the Lockheed Martin Corporation ($50,696,022,242). The three contractors receiving the most money in 2017 from the Department of Health and Human Services were: Merck & Co. Inc. ($1,767,482,997) Leidos Holdings Inc. ($1,149,697,817) Pfizer Inc. ($1,131,228,762) Public sector healthcare organizations are often those related to public health such as local health departments and the Commissioned Corps of the U.S. Public Health Service. The National Association of County and City Health Officials (NACCHO) provides a Directory of Local Health Departments. Also included are public hospitals, medical facilities in the Veterans Health Administration (VHA), and military hospitals. The American Hospital Association (AHA) reports that in 2018 there were 956 registered state and local government community hospitals and 209 registered federal government hospitals. New York City Health and Hospitals is the largest public sector healthcare organization/system in the United States. The location of VHA medical facilities can be found on the VHA, Locations website. The United States Military Health System (MHS): "is one of America’s largest and most complex health care institutions, and the world’s preeminent military health care delivery operation. Our MHS saves lives on the battlefield, combats infectious disease around the world, and cares for 9.4 million beneficiaries in one of the nation’s largest health benefit plans" The location of military hospitals and clinics can be found at the MHS Tricare Find a Military Hospital or Clinic website. One of the most famous military hospital facilities is the Walter Reed National Military Medical Center (WRNMMC). ©Margaret Kilduff 2018 95 Coursera: Healthcare Organizations and the Health System Note [FUN]: The video for Topic 3 - Therapy Dogs at Walter Reed - is a YouTube video produced by the U.S. Navy which provides a brief overview of the daily routine the hospital's therapy dogs. The governance of government organizations is generally defined by state and federal Constitutions, laws, statutes, and court decisions. Part of the governance process of a government organization is ensuring that the organization is in compliance with the relevant state and/or federal requirements. The Centers for Disease Control and Prevention (CDC) describes the governance structure of state health departments at its Health Department Governance website. The governance structure of the Commissioned Corps of the U.S. Public Health Service is outlined at its About Us, Leadership/Organizational Structure website. The governance structure of the Veterans Health Administration (VHA) is described in the VA Functional Organizational Manual. The governance structure of the Military Health System (MHS) can be found at the About the MHS website. [FUN] Video - Topic 3. Therapy Dogs at Walter Reed 2 min Therapy Dogs at Walter Reed The video is a YouTube video (https://www.youtube.com/watch?v=qzxxE1G4RFo) produced by the U.S. Navy which provides a brief overview of the daily routine the hospital's therapy dogs. Reading: [INFO] Topic 4. Governance and Mission, Vision, and Bylaws 10 min Topic 4. What is the relationship between governance and a healthcare organization’s mission, vision, and bylaws? Organizational governance structures/frameworks are related to the organization's mission, vision, and bylaws. The mission and vision provide a broad direction for the governance structure/framework. Forprofit, non-profit, and government organizations usually state a mission and vision. The bylaws define the broad daily operational rules for governance. Only for-profit and non-profit organizations develop bylaws. The broad operations rules for government organizations can often be found in state or federal laws, statutes, and regulations. At the federal level, such rules can be found in the United States Code. An example of state-level rules can be found at the Massachusetts General Laws website, particularly Part I. The Administration of the Government. This section discusses: Mission Statement Vision Statement Bylaws ©Margaret Kilduff 2018 96 Coursera: Healthcare Organizations and the Health System Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Three Quiz. Mission Statement There are many views of the content and utility of an organizational mission statement. Most views state that the mission statement should be a statement of the organization's purpose. For example, the Business Dictionary defines a mission statement as: "A written declaration of an organization's core purpose and focus that normally remains unchanged over time. Properly crafted mission statements (1) serve as filters to separate what is important from what is not, (2) clearly state which markets will be served and how, and (3) communicate a sense of intended direction to the entire organization. A mission is different from a vision in that the former is the cause and the latter is the effect; a mission is something to be accomplished whereas a vision is something to be pursued for that accomplishment. Also called company mission, corporate mission, or corporate purpose." The article entitled Strategic Planning Framework: The Importance of Mission states that: "Mission statements answer the question, "Why do we exist?" It gives the organization purpose and meaning and speaks to why people want to work for your company. If you're a for-profit organization, the fundamental mission of the business is to create shareholder wealth, but that won't attract anyone to come work for you, and it does not give rise to a bigger corporate purpose. Every organization needs to define its fundamental purpose, philosophy and values, as well as develop a strong foundation for its strategic planning framework. The mission statement answers the basic questions of why your company exists and describes the needs your company was created to fulfill. This is not about the products and services you provide; rather, it is about why you provide them." However, the article entitled Your Company’s Purpose Is Not Its Vision, Mission, or Values states the organization's purpose is different from the organization's mission. The mission statement: "... describes what business the organization is in (and what it isn’t) both now and projecting into the future. Its aim is to provide focus for management and staff. A consulting firm might define its mission by the type of work it does, the clients it caters to, and the level of service it provides. For example: “We’re in the business of providing high-standard assistance on ©Margaret Kilduff 2018 97 Coursera: Healthcare Organizations and the Health System performance assessment to middle to senior managers in medium-to-large firms in the finance industry.” There are many available resources for those tasked with writing an organizational mission statement. Two of them are: Minnesota Department of Health Developing a Mission Statement website Cornell University Small Farms Program Create Your Mission Statement website (This website is geared toward those starting a small farm, but the process of writing a mission statement is the same regardless of business structure or industry.) The mission statement of some healthcare organizations is listed below: United States Department of Health and Human Services (HHS): "The mission of the U.S. Department of Health and Human Services (HHS) is to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services." Commissioned Corps of the U.S. Public Health Service: "The mission of the U.S. Public Health Service Commissioned Corps is to protect, promote, and advance the health and safety of our Nation." New York City (NYC) Health and Hospitals: "NYC Health + Hospitals is committed to excellence in health care. Our providers work together to provide comprehensive, personalized care to all New Yorkers. Our mission is: To extend equally to all New Yorkers, regardless of their ability to pay, comprehensive health services of the highest quality in an atmosphere of humane care, dignity, and respect. To promote and protect, as both innovator and advocate, the health, welfare, and safety of the people of the City of New York. To join with other health workers and with communities in a partnership which will enable each of our institutions to promote and protect health in its fullest sense – the total physical, mental and social well-being of the people." ©Margaret Kilduff 2018 98 Coursera: Healthcare Organizations and the Health System California Department of Public Health (CDPH): "To Optimize the Health and Wellbeing of the people in California" Mayo Clinic: "To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research." Massachusetts General Hospital (MGH): "Guided by the needs of our patients and their families, Massachusetts General Hospital aims to deliver the very best health care in a safe, compassionate environment; to advance that care through innovative research and education; and to improve the health and well-being of the diverse communities we serve." Vision Statement There are many views of the content and utility of an organizational vision statement. Most views state that the vision statement should be a statement of the organization's short and long term goals for the future. For example, the Business Dictionary defines a vision statement as: "An aspirational description of what an organization would like to achieve or accomplish in the mid-term or long-term future. It is intended to serves as a clear guide for choosing current and future courses of action." Although most organizations develop and publish mission statement, not all develop and publish a vision statement. In fact, of the six healthcare organizations whose mission statement is listed above, only one publishes a vision statement: California Department of Public Health (CDPH): "CDPH public health professionals, researchers, scientists, doctors, nurses, and other staff members have a shared vision to protect and improve the health of all Californians. We are dedicated to public service and passionate about our work and the people and communities we serve and protect." Some of the organizations which publish both a mission statement and a vision statement are listed below with both their mission and vision statements. National Multiple Sclerosis Society: ©Margaret Kilduff 2018 99 Coursera: Healthcare Organizations and the Health System Mission - "People affected by MS can live their best lives as we stop MS in its tracks, restore what has been lost and end MS forever." Vision - "A World Free of MS." Massachusetts General Hospital (MGH) Center for Community Health Improvement (CCHI) (affiliated with MGH): Mission - "To improve the health and well-being of the diverse communities we serve." Vision - "At CCHI, we envision healthy, safe and thriving communities where all people have equitable access to employment, food, education, housing and a high-quality health care system that addresses these and other social determinants of health." Merck: Mission - "To discover, develop and provide innovative products and services that save and improve lives around the world." Vision - "To make a difference in the lives of people globally through our innovative medicines, vaccines, and animal health products. We are committed to being the premier, research-intensive biopharmaceutical company and are dedicated to providing leading innovations and solutions for today and the future." Toyota: Mission - "To attract and attain customers with high-valued products and services and the most satisfying ownership experience in America." Vision - "To be the most successful and respected car company in America." Creative Commons: Mission - "Creative Commons develops, supports, and stewards legal and technical infrastructure that maximizes digital creativity, sharing, and innovation." Vision - "Our vision is nothing less than realizing the full potential of the Internet — universal access to research and education, full participation in culture — to drive a new era of development, growth, and productivity." Smithsonian: ©Margaret Kilduff 2018 100 Coursera: Healthcare Organizations and the Health System Mission - "The Institution was founded in 1846 with funds from the Englishman James Smithson (1765-1829) according to his wishes under the name of the Smithsonian Institution, an establishment for the increase and diffusion of knowledge among men.” Vision - "Shaping the future by preserving our heritage, discovering new knowledge, and sharing our resources with the world." Bylaws Not every for-profit and non-profit business structure creates bylaws, although all corporations do. Government organizations do not have bylaws. The bylaws outline the basic operations of the organization - the basic "rules" by which the organization operates. Wikipedia defines a bylaw as: "A by-law (bylaw) is a rule or law established by an organization or community to regulate itself, as allowed or provided for by some higher authority. The higher authority, generally a legislature or some other government body, establishes the degree of control that the by-laws may exercise. By-laws may be established by entities such as a business corporation, a neighborhood association, or depending on the jurisdiction, a municipality." The bylaws must comply with the organization's articles of incorporation/association filed with the state in which the organization became a legal business entity. Bylaws do not usually have to be filed with the state government. The bylaws must also comply with all state and federal laws. Federal laws in the United States are made by the legislative branch of the federal government. The two legislative components are the United States Senate and the United States House of Representatives which are together called the United States Congress. Congress meets in the United States Capitol. The Architect of the Capitol (AOC) is responsible for preserving and maintaining "the historic buildings, monuments, art and inspirational gardens on the Capitol campus ... 18.4 million square feet of facilities, 570 acres of grounds and thousands of works of art." Note [FUN]: The video for Topic 4 - Olmsted's Plan for the U.S. Capitol - is a YouTube video produced by the Architect of the Capitol (AOC), U.S. Capitol. The video provides an overview of Frederick Law Olmsted's original design for the United States Capitol Grounds. The format and general content area of bylaws are relatively consistent across all organizations (forprofit and non-profit) although the specifics vary greatly by organization. In general, the sections of the bylaws are called Articles and the bylaws address issues such as location of organizational offices, meetings, formation of committees, as well as the composition and selection of a Board of Directors. ©Margaret Kilduff 2018 101 Coursera: Healthcare Organizations and the Health System The Free Management Library provides links to a number of helpful resources for those writing bylaws at its Bylaws website. The New Hampshire Center for Non-Profits provides Sample Bylaws for use and reference by non-profit organizations in New Hampshire. Sometimes an organization publicly publishes the bylaws. Sometimes it does not. Only four of the forprofit and non-profit organizations listed in this section have publicly published bylaws: New York City (NYC) Health and Hospitals Bylaws Mayo Clinic Bylaws Merck Bylaws Creative Commons Bylaws [FUN] Video - Topic 4. Olmsted's Plan for the U.S. Capitol 4 min Olmsted's Plan for the U.S. Capitol The video is a YouTube video (https://www.youtube.com/watch?v=BAQfmvMN5jk) produced by the Architect of the Capitol (AOC), U.S. Capitol. The video provides an overview of Frederick Law Olmsted's original design for the U.S. Capitol Grounds. Reading: [INFO] Topic 5. Governance and a Board of Directors 10 min Topic 5. What is the relationship between governance and an effective Board of Directors? Organizational governance structures/frameworks are related to the organization's Board of Directors. Not all business structures, however, have a Board of Directors. The Board of Directors is a required governance structure for public for-profit corporations and non-profit corporations. In a non-profit organization, however, the Board of Directors is often called the Board of Trustees. Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Three Quiz. Government organizations do not have either a Board of Directors or a Board of Trustees. Privately held corporations do not usually have a Board of Directors per se although many management experts recommend their use. Some examples of such recommendations are found in the resources listed ©Margaret Kilduff 2018 102 Coursera: Healthcare Organizations and the Health System below. You may find them interesting and relevant to this question. Each is optional; you do not have to read it. Why Have an Independent Board of Directors in a Privately Held Corporation? What Is a Board’s Role in a Family Business? The Role Of Boards Of Directors In Small Companies A privately held corporation is one which does not publicly trade stock on public stock exchanges for purchase by the public-at-large. All stock is privately held. Three of the largest privately held corporations in the United States are: Cargill Koch Industries Mars Six of the largest health-related privately held corporations in the United States are: Medline HCR ManorCare Steward Health Care Life Care Centers of America Golden Living JM Smith Corporation One of the most famous cases of the failure of corporate governance in a privately held corporation is Theranos which is chronicled in the book entitled Bad Blood: Secrets and Lies in a Silicon Valley Startup by John Carreyrou. For those organizations with a Board of Directors/Trustees, an effective Board is essential for effective governance. The National Association of Corporate Directors (NACD) is a membership association for Board Members aimed at increasing Board of Directors/Trustees effectiveness. It has 19,000 members from almost 1,000 organizations. Note [FUN]: The video for Topic 5 - The Board’s Role in Value Creation - is a YouTube video produced by the National Association of Corporate Directors (NACD). The video addresses the ways a Board can assess performance using financial and nonfinancial metrics. This section discusses: Public, For-Profit Board of Directors Non-Profit Board of Directors/Trustees ©Margaret Kilduff 2018 103 Coursera: Healthcare Organizations and the Health System Public, For-Profit Board of Directors The Business Dictionary defines a public, for-profit Board of Directors as follows: "Governing body (called the board) of an incorporated firm. Its members (directors) are elected normally by the subscribers (stockholders) of the firm (generally at an annual general meeting or AGM) to govern the firm and look after the subscribers' interests. The board has the ultimate decision-making authority and, in general, is empowered to (1) set the company's policy, objectives, and overall direction, (2) adopt bylaws, (3) name members of the advisory, executive, finance, and other committees, (4) hire, monitor, evaluate, and fire the managing director and senior executives, (5) determine and pay the dividend, and (6) issue additional shares. Though all its members might not be engaged in the company's day-to-day operations, the entire board is held liable (under the doctrine of collective responsibility) for the consequences of the firm's policies, actions, and failures to act. Members of the board usually include seniormost executives (called 'inside directors' or 'executive directors') as well as experts or respected persons chosen from the wider community (called 'outside directors' or 'non-executive directors')." An effective public, for-profit Board of Directors is essential for effective corporate governance. There are many resources available describing the characteristics of an effective Board of Directors. Overall, the common elements in these resources are that an effective Board of Directors is one that is engaged in organizational strategic planning, holds itself and organizational leadership accountable, and is dynamic (e.g., actively recruits new members, members actively participate in meetings and organizational activities). Some resources which examine the characteristics of an effective public, for-profit Board of Directors in more detail are listed below. You may find them interesting and relevant to this question. Each is optional; you do not have to read it. What Makes Great Boards Great A More Effective Board of Directors For-Profit (Corporate) Boards The CEO Guide to Boards Three of the largest public, for-profit corporations in the United States are: Walmart (NYSE: WMT): Also of interest is the Investors website and the Corporate Governance website ©Margaret Kilduff 2018 104 Coursera: Healthcare Organizations and the Health System Exxon Mobil (NYSE: XOM): Also of interest is the Investors website and the Corporate Governance website Apple (NYSE: APPL): Also of interest is the Investor Relations website and the Leadership and Governance website Three of the largest health-related public, for-profit corporations in the United States are: United Health Group (NYSE: UNH): Also of interest is the Investor Information website and the Corporate Governance website Medtronic (NYSE: MDT): Also of interest is the Investor Information website and the Corporate Governance website Abbott Laboratories (NYSE: ABT): Also of interest is the Investors website and Governance website One of the most famous cases of the failure of corporate governance in a public, for-profit corporation is Enron which is chronicled in the book entitled The Smartest Guys in the Room: The Amazing Rise and Scandalous Fall of Enron by Bethany McLean and Peter Elkind. Non-Profit Board of Directors/Trustees The Business Dictionary defines a non-profit Board of Trustees as follows: "Board of directors of a non-profit organization (NPO) such as a charity, trust, or university. Members of the board are appointed (not elected) to set the policies of the organization, and appoint (and fire) senior management personnel. Under the doctrine of collective responsibility, the entire board is liable for the financial and other consequences of the organization's activities." An effective non-profit Board of Directors/Trustees is essential for effective corporate governance. There are many resources available describing the characteristics of an effective non-profit Board of Directors/Trustees. Overall, the common elements in these resources are the same as those for a public, for-profit Board of Directors (i.e., engaged in organizational strategic planning, holds itself and organizational leadership accountable, and is dynamic (e.g., actively recruits new members, members actively participate in meetings and organizational activities). However, there is usually one additional important characteristic for a non-profit Board of Directors/Trustees - members actively engage in revenue-generation for the non-profit organization. This characteristic is often summarized by the phrase "Get it, give it, or get off." meaning that a nonprofit Board members should get money for the organization (fundraise), give a personal donation, or ©Margaret Kilduff 2018 105 Coursera: Healthcare Organizations and the Health System get off the Board. There is much discussion and re-thinking about whether this characteristic is a good one. Some resources which examine this issue as well as other characteristics of an effective non-profit Board of Directors/Trustees in more detail are listed below. You may them interesting and relevant to this question. Each is optional; you do not have to read it. Should Board Members Be Required to Give? Myth: Good Board Members “Give, Get, or Get Off.” How to Be a Better Nonprofit Board Member Board Roles and Responsibilities How to Succeed on a Nonprofit Board Three of the largest non-profit corporations in the United States are: United Way Worldwide: Also of interest is the Leadership Team website Feeding America: Also of interest is the Leadership website Salvation Army: Also of interest is the Who We Are website Three of the largest health-related non-profit corporations in the United States are: Task Force for Global Health: Also of interest is the Leadership website St. Jude Children's Research Hospital: Also of interest is the Leadership at St. Jude website Direct Relief: Also of interest is the People website One of the most famous cases of the failure of corporate governance in a non-profit corporation is the Federal Employment & Guidance Service (FEGS) which is addressed in two reports: 1) New York Nonprofits in the Aftermath of FEGS: A Call to Action; and 2) Risk Management Report for NonProfits. [FUN] Video - Topic 5. The Board’s Role in Value Creation 5 min The Board’s Role in Value Creation The video is a YouTube video (https://www.youtube.com/watch?v=T8VUwmgHoGs) video produced by the National Association of Corporate Directors (NACD). The video addresses the ways a Board can assess performance using financial and non-financial metrics. Discussion Prompt: [FUN] For-Profit or Non-Profit Healthcare Organizations 5 min ©Margaret Kilduff 2018 106 Coursera: Healthcare Organizations and the Health System In the non-government sector of healthcare organizations, the healthcare organizations are structured as for-profit (either privately held or public) or non-profit. Do you have an opinion whether all healthcare organizations should be for-profit or non-profit? Should there be a mix of for-profit and nonprofit? If there should be a mix, which healthcare organizations should be for-profit and which should be non-profit? [CERT] [PREP] Lesson Three Quiz and "Create Your Own Healthcare Organization" Quiz: [CERT] Lesson Three Quiz 15 questions, 20 minutes Question 1 Which of the following is the AAPC definition of healthcare governance? “general term for the overall strategy used by healthcare consumers to govern their healthcare choices and improve their personal health and reduce their personal healthcare expenditures." “general term for the overall framework through which organizations are accountable for continuously improving clinical, corporate, staff, and financial performance." The answer to this question is found in Topic 1. Question 2 Some healthcare organizations conceptualize the governance framework into two categories. Which of the following best describes these two categories of governance? Financial Governance and Patient Governance Clinical Governance and Corporate Governance The answer to this question is found in Topic 1. Question 3 In general, shared governance takes one of two forms. Which of the following is not a form of shared governance? Professional employees (e.g., physicians, nurses, other health professionals with direct patient contact), patients, and administrative employees all complete evaluation surveys of each other and share in revenue. The answer to this question is found in Topic 1. ©Margaret Kilduff 2018 107 Coursera: Healthcare Organizations and the Health System Professional employees (e.g., physicians, nurses, other health professionals with direct patient contact) participate in a clinical governance structure co-equal to the corporate governance structure. Professional employees (e.g., physicians, nurses, other health professionals with direct patient contact) are integrated into the corporate governance structure (e.g., member of the corporate Board of Directors). The answer to this question is found in Topic 1. Question 4 As a general rule each business structure (each organization) needs to file documents in the state in which it is formed to be considered a legal entity. The documents and process may vary by state and by business structure. True False The answer to this question is found in Topic 2. Question 5 Which of the following is not a common business structure? Sole Proprietorship Club Divided Shareowned Limited Liability Company Corporation The answer to this question is found in Topic 2. Question 6 The North American Industry Classification System (NAICS) identifies three Health Care subsectors: 621 (Ambulatory Health Care Services), 622 (Hospitals), and 623 (Nursing and Residential Care Facilities). According to the 2015 Statistics of U.S. Businesses (SUSB), the largest subsector has 487,277 firms/organizations. Which subsector is this? 622 (Hospitals) 621 (Ambulatory Health Care Services) 623 (Nursing and Residential Care Facilities) The answer to this question is found in Topic 2. ©Margaret Kilduff 2018 108 Coursera: Healthcare Organizations and the Health System Question 7 The North American Industry Classification System (NAICS) identifies Sector 62 as Health Care and Social Assistance Service. Using the 2015 Statistics of U.S. Businesses (SUSB), there are four tax status categories: For-Profit, Non-Profit, Government, and Other. The largest category in Sector 62 has 591,257 firms/organizations. Which category is this? For-Profit Non-Profit Government Other The answer to this question is found in Topic 3. Question 8 The difference between a for-profit business entity and a non-profit business entity is that a for-profit business entity generally pays all state and federal business taxes while a non-profit business entity does not pay these taxes. True False The answer to this question is found in Topic 3. Question 9 The largest public sector healthcare organization/system in the United States is: Miami Health and Ambulatory Care New York City Health and Hospitals Dallas Hospitals and Clinics Seattle Hospitals and Health The answer to this question is found in Topic 3. Question 10 One partial definition of an organizational mission statement is that it answers "the question, "Why do we exist?" It gives the organization purpose and meaning and speaks to why people want to work for your company." One example is the statement by the National Multiple Sclerosis Society: "People affected by MS can live their best lives as we stop MS in its tracks, restore what has been lost and end MS forever." True ©Margaret Kilduff 2018 109 Coursera: Healthcare Organizations and the Health System False The answer to this question is found in Topic 4. Question 11 One partial definition of an organizational vision statement is that it is an "aspirational description of what an organization would like to achieve or accomplish in the mid-term or long-term future. It is intended to serves as a clear guide for choosing current and future courses of action." One example is the statement by the National Multiple Sclerosis Society: "A World Free of MS." True False The answer to this question is found in Topic 4. Question 12 One partial definition of an organizational bylaw is that it is "a rule or law established by an organization or community to regulate itself, as allowed or provided for by some higher authority. The higher authority, generally a legislature or some other government body, establishes the degree of control that the by-laws may exercise." True False The answer to this question is found in Topic 4. Question 13 One partial definition of a public, for-profit organization's Board of Directors is that it "has the ultimate decision-making authority and, in general, is empowered to (1) set the company's policy, objectives, and overall direction, (2) adopt bylaws, (3) name members of the advisory, executive, finance, and other committees, (4) hire, monitor, evaluate, and fire the managing director and senior executives, (5) determine and pay the dividend, and (6) issue additional shares." True False The answer to this question is found in Topic 5. Question 14 ©Margaret Kilduff 2018 110 Coursera: Healthcare Organizations and the Health System One partial definition of a non-profit organization's Board of Directors/Trustees is that "Members of the board are appointed (not elected) to set the policies of the organization, and appoint (and fire) senior management personnel. Under the doctrine of collective responsibility, the entire board is liable for the financial and other consequences of the organization's activities." True False The answer to this question is found in Topic 5. Question 15 A common responsibility of a member of a non-profit Board of Directors/Trustees is that the member actively engage in revenue-generation for the non-profit organization. This responsibility is often summarized by the phrase "Get it, ____ it, or get off." The answer to this question is found in Topic 5. Practice Peer-graded Assignment: [PREP] Lesson Three Create Your Own Healthcare Organization 45 min See Appendix C: Lesson Three Create Your Own Healthcare Organization Practice Peer-graded Assignment: [PREP] Copy of Lesson Two Create Your Own Healthcare Organization 45 min This is a copy of the Lesson Two Create Your Own Healthcare Organization questions. It is repeated in case you want to update your answers or just be reminded of what the questions from Lesson Two were. See Appendix B: Lesson Two Create Your Own Healthcare Organization Practice Peer-graded Assignment: [PREP] Copy of Lesson One Create Your Own Healthcare Organization 45 min This is a copy of the Lesson One Create Your Own Healthcare Organization questions. It is repeated in case you want to update your answers or just be reminded of what the questions from Lesson One were. ©Margaret Kilduff 2018 111 Coursera: Healthcare Organizations and the Health System See Appendix A: Lesson One Create Your Own Healthcare Organization [FUN] Lesson Three Trivia Question and Virtual Field Trip Reading: [FUN] Lesson Three Trivia Question 2 min Almost everyone loves a trivia question - a question about a little known, but interesting, fun fact. Each lesson has one trivia question. The answer is in the Lesson Three Trivia Question Answer reading section. Question: The American Revolutionary War represented many things, not the least of which was a very serious disagreement between some of the American colonists and the British monarchy on the issue of Governance. Although many people were involved in this disagreement, only one colonist was involved in all of the activities from the beginning (signing the Declaration of Independence in 1776) to the end (signing the Constitution at the closing of the Constitutional Convention in 1787). Who was this person? Reading: [FUN] Lesson Three Trivia Question Answer 5 min The answer to the Lesson Three trivia question is: Benjamin Franklin For more information, please see: Benjamin Franklin, Citizen Ben Wikipedia, Benjamin Franklin Benjamin Franklin House, London Another interesting note about Benjamin Franklin is that his son, William Franklin, was the last colonial Governor of New Jersey and loyal to the British monarchy. Governor Franklin spent much of the Revolutionary War in prison and died in England in 1813. For more information, please see: Wikipedia, William Franklin William Franklin, Ben’s Son, Spent the Revolutionary War in a Connecticut Jail ©Margaret Kilduff 2018 112 Coursera: Healthcare Organizations and the Health System Reading: [FUN] Lesson Three Virtual Field Trip 5 min Everyone loves a road trip/field trip so each lesson of the course includes a "virtual field trip" to the often hidden places of interest on the web. Lesson Three's virtual field trip is to Colonial Williamsburg in Williamsburg, Virginia. Prior to the American Revolutionary War (before the governance dispute between the American colonists and the British monarchy), Williamsburg was the center of governance (the capital) of the Virginia Colony (16991776). From 1776 to 1780, Williamsburg was the capital of the new American Commonwealth of Virginia. In 1780, Richmond became the capital of the Commonwealth of Virginia. Williamsburg's time as as center of governance is recreated in Colonial Williamsburg whose mission is: "to be a center for history and citizenship, encouraging national and international audiences to learn from the past through the preservation, restoration, and presentation of 18th-century Williamsburg and the study, interpretation, and teaching of America's founding democratic principles." The video provides a brief orientation to the activities and facilities in Colonial Williamsburg. The facilities include a number of museums and collections as well as online collections and webcams. [FUN] Video - Lesson Three Virtual Field Trip 7 min Colonial Williamsburg Orientation The video is a YouTube video (https://www.youtube.com/watch?v=rn8GiXvqSy0) produced by Colonial Williamsburg which provides a brief orientation to the activities and facilities in Colonial Williamsburg. ©Margaret Kilduff 2018 113 Coursera: Healthcare Organizations and the Health System LESSON FOUR: DESIGN A GOVERNANCE STRUCTURE FOR A HEALTHCARE ORGANIZATION This lesson is a synthesis of the course material to design and present a healthcare organization and governance structure the way you would have things run in the best of all worlds. Learning Objectives Synthesize course content to create a healthcare organization and governance structure. Generate an effective electronic file poster suitable for presentation and printing. Judge the quality (content presentation and format) of a poster. [INFO] [FUN] Lesson Four Content and Discussion Reading: [INFO] Welcome and Lesson Four Overview 10 min This lesson is a synthesis of the course material to design and present a healthcare organization and governance structure the way you would have things run in the best of all worlds. Upon successful completion of this lesson, you will be able to: Synthesize course content to create a healthcare organization and governance structure. Generate an effective electronic file poster suitable for presentation and printing. Judge the quality (content presentation and format) of a poster. There are three evaluations (two of them self-evaluations), one electronic poster submission, a trivia question, and a field trip. The electronic poster file is an artifact of the course which you can circulate to colleagues or use for a talk or presentation event. There are also optional videos which provide supplemental (optional) content. There are many wonderful videos in the public domain which are relevant to this course. The lesson should take 4-6 hours of work to successfully complete. In constructing your poster, you are going to do so from the perspective of the chief healthcare administrator for your organization. Healthcare administration encompasses responsibility for all aspects of a healthcare organization. The focus is both internal to the organization and external to the organization to maximize the efficient and effective operation of the organization as a whole and its survival both short-term and long term. Healthcare administrators make decisions about the direction and operation of the healthcare organization. The role of the healthcare administrator is more strategic than tactical. This lesson asks and answers the following questions: 1. What is the synthesized course content required to create the healthcare organization and governance structure for the Lesson Four course assignment? ©Margaret Kilduff 2018 114 Coursera: Healthcare Organizations and the Health System 2. How do you generate an effective electronic file poster suitable for presentation and printing for the Lesson Four course assignment? 3. How do you judge the quality (content presentation and format) of the electronic poster for the Lesson Four course assignment? Discussion Prompt: [FUN] Feedback - Lesson Four 5 min Please post any feedback you have specifically about Lesson Four in this discussion forum at any time during the course. All feedback (e.g., suggestions, questions, concerns, criticisms) is welcome. This is your Lesson Four course experience. Let us know how you feel the Lesson Four experience can be improved. Let us know what you feel works particularly well in the Lesson Four. Reading: [INFO] Topic 1. Synthesize Course Content 10 min The poster project requires you to synthesize course material to design a healthcare organization and governance structure the way you would have things run in the best of all worlds. The electronic poster file is an artifact of the course which you can circulate to colleagues or use for a talk or presentation event. In constructing your poster, you are going to do so from the perspective of the chief healthcare administrator for your organization. You are describing your organization to an audience. Healthcare administration encompasses responsibility for all aspects of a healthcare organization. The focus is both internal to the organization and external to the organization to maximize the efficient and effective operation of the organization as a whole and its survival both short-term and long term. Healthcare administrators make decisions about the direction and operation of the healthcare organization. The role of the healthcare administrator is more strategic than tactical. The required content was specified in: Lesson One Create Your Own Healthcare Organization Lesson One Create Your Own Healthcare Organization Lesson One Create Your Own Healthcare Organization You can add more content to your poster than the eighteen (18) required content items, but it must include the specified content items which are listed below; each one is listed below with an example and the evaluation rubric (evaluation criterion). ©Margaret Kilduff 2018 115 Coursera: Healthcare Organizations and the Health System In the Lesson Four Self-Evaluations and Peer Review section of this course is a quiz entitled Synthesize Course Content Self-Evaluation (Required). This quiz is a self-evaluation as to whether you have accomplished the synthesis of course content described here. It is an eighteen (18) question quiz asking whether you have developed the 18 required content items. The passing score for the quiz is 100 percent because you should develop each of the required 18 content items for the poster in order to meet the content requirements of the electronic poster assignment. Required Content Items for the Electronic Poster Required Content Item 1. The name of your healthcare organization. Example: Charles Harbor General Hospital Evaluation Rubric: The name should be original and appealing to both employees of the healthcare organization as well as the public at-large. Required Content Item 2. A brief description of your healthcare organization; a description of what your healthcare organization does. Example: Charles Harbor General Hospital is a general hospital with an emergency room. It offers a full range of clinical specialties (e.g., internal medicine, general surgery, oncology, cardiology, infectious disease) with a focus on adults although there is a pediatrics unit. Its purpose is to provide the very best health care and improve the health of all those in the local Charles Harbor General Hospital community. Evaluation Rubric: The description should be a few sentences which concisely and clearly summarize the work and purpose of your healthcare organization. Required Content Item 3. At least one healthcare occupation employed by your organization as that occupation is listed by the Bureau of Labor Statistics (BLS) at the Healthcare Occupations website. Example: Charles Harbor General Hospital employs Physicians and Surgeons (https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-1). Evaluation Rubric: One healthcare occupation from the BLS website consistent with the healthcare organization's description should be listed. More can be listed, but only one is needed. There is no need to list other occupations employed by the organization (e.g., accountants) or the number of people employed. ©Margaret Kilduff 2018 116 Coursera: Healthcare Organizations and the Health System Required Content Item 4. The North American Classification System (NAICS) code for your healthcare organization. Example: Charles Harbor General Hospital has a NAICS code of 622110 - General Medical and Surgical Hospitals (https://www.census.gov/cgibin/sssd/naics/naicsrch?code=622110&search=2017%20NAICS%20Search). Evaluation Rubric: The listed code should be a valid NAICS code and appropriate for the organization's description. Required Content Item 5. The U.S. state and county of that state in which your healthcare organization is located. Example: Charles Harbor General Hospital is located in Massachusetts in Suffolk County (https://en.wikipedia.org/wiki/Suffolk_County,_Massachusetts). Evaluation Rubric: The state should be a valid U.S. state (or the District of Columbia) and a valid county within that state. Required Content Item 6. The county health ranking from the County Health Rankings and Roadmap website. Example: Suffolk County ranks 11 in Health Outcomes out of the 14 ranked counties in Massachusetts (Length of Life = 7; Quality of Life = 13; Health Factors = 12; Health Behaviors = 9; Clinical Care = 6; Social and Economic Factors = 13; Physical Environment = 7) (http://www.countyhealthrankings.org/app/massachusetts/2018/rankings/suffolk/county/outc omes/overall/snapshot) Evaluation Rubric: The health ranking information should be the valid information for that county from the County Health Rankings and Roadmap website. Required Content Item 7. The name and web address (url) of the state licensing agency for healthcare organizations in your chosen state (e.g., Department of Health). Example: Massachusetts Department of Public Health (DPH) (https://www.mass.gov/orgs/department-of-public-health) and the regulations are found at https://www.mass.gov/regulations/105-CMR-13000-hospital-licensure. Note: A list of all DPH licensed healthcare facilities can be found at https://www.mass.gov/service-details/findinformation-about-licensed-or-certified-health-care-facilities, specifically https://www.mass.gov/doc/list-of-health-care-facilities-licensed-or-certified-by-the- ©Margaret Kilduff 2018 117 Coursera: Healthcare Organizations and the Health System division/download. Charles Harbor General Hospital must be licensed by DPH as an acute hospital to do business in Massachusetts. Evaluation Rubric: The state licensing agency and web address should be valid for the chosen state. Required Content Item 8. Name one accreditation association for your healthcare organization, if any exist. If one is named, state whether this accreditation association has deeming authority from the Centers for Medicare and Medicaid (CMS) for your healthcare organization. Example: The Joint Commission (https://www.jointcommission.org/) is an accreditation association which can accredit Charles Harbor General Hospital as a general hospital (https://www.jointcommission.org/accreditation/hospitals.aspx). The Joint Commission has deeming CMS-deeming authority for a general hospital such as Charles Harbor General Hospital. Evaluation Rubric: The statement regarding the existence of an accreditation association must be valid. If an accreditation association is named, it must be a valid one for the healthcare organizations and its CMS deeming authority status must be valid. Required Content Item 9. Name one strategic goal for your healthcare organization. Example: Create a patient-centered model of care which recognizes the patient as a customer/consumer who has many care choices. Evaluation Rubric: The goal should be a broad and bold one for the organization as a whole, but doable. Required Content Item 10. Eleven (11) combined Healthcare Leadership Alliance (HLA) and American College of Healthcare Executives (ACHE) are listed in the course. Rank order them in the order you think is the most important for a healthcare administrator where 1 is the most important and 11 is the least important. Example: 1. Administration, Management, and Leadership 2. Organizational Structure and Governance 3. Quality and Performance Improvement 4. Health Care and the Healthcare Environment 5. Communication and Relationship Management 6. Laws and Regulations 7. Healthcare Technology and Information Management ©Margaret Kilduff 2018 118 Coursera: Healthcare Organizations and the Health System 8. Professionalism and Ethics 9. Business 10. Finance 11. Human Resources Evaluation Rubric: The listed competencies must be the ones from the course. Required Content Item 11. There are many journals and publications from which a healthcare administrator can find evidence for the evidence-based practice of healthcare administration. Name two (and the url for the journal or publication) which you would use as a healthcare administrator. Example: 1. Journal of Healthcare Management - https://www.ache.org/pubs/journals.cfm 2. Becker's Hospital Review - https://www.beckershospitalreview.com/ Evaluation Rubric: The listed journals and/or publications do not have to be ones listed in the lesson, but they need to real journals or publications. Required Content Item 12. There are many administrative/management frameworks from which a healthcare administrator can choose to guide the evidence-based practice of healthcare administration. Name the administrative/management framework (or combination of frameworks) which you would use as a healthcare administrator. Example: Lean Management combined with the Team-of-Teams framework. Evaluation Rubric: The listed framework (or combination) does not have to be one listed in the course. It does not even have to be one previously described. You can define your own framework. If you define your own framework, please describe it in a sentence or two. Required Content Item 13. There are many healthcare administration-related professional associations which a healthcare administrator can join. Name one (and the url for the association) which you would join as a healthcare administrator for your organization. Example: American College of Healthcare Executives (ACHE) - http://www.ache.org/ Evaluation Rubric: The listed professional association does not have to be one listed in the lesson, but it needs to be a real healthcare administration-related professional association. ©Margaret Kilduff 2018 119 Coursera: Healthcare Organizations and the Health System Required Content Item 14. State whether the governance structure of your healthcare organization is shared or not-shared. Briefly describe the governance relationship between the administrative part of the organization and the professional clinical part of the organization. Example: It is a shared governance structure where the administrative part of the organization and the professional clinical part of the organization have their own organizational hierarchy. There is a Chief Operating Officer (COO) in charge of the administrative part of the organization. There is a Chief Clinical Officer (CCO) in charge of the professional clinical part of the organization. Both report to the Chief Executive Officer (CEO) who is responsible for the overall operation of the organization. Evaluation Rubric: The description should be a few sentences which concisely and clearly summarize a reasonable governance structure. Required Content Item 15. State the business structure of your healthcare organization. State the name and web address (url) of the state agency in your chosen state with which your organization must file legal business structure documents (e.g., Department of State). Example: It is a corporation located in Massachusetts. In Massachusetts, the corporation business filing agency is the Secretary of the Commonwealth of Massachusetts, Corporations Division (http://www.sec.state.ma.us/cor/coridx.htm). Evaluation Rubric: The business structure and state agency and web address should be valid for the chosen state. Required Content Item 16. State the tax status of your healthcare organization. State the name and web address (url) of the state agency in your chosen state with which your organization must file legal tax documents (e.g., Department of Treasury). Example: It is a non-profit located in Massachusetts. In Massachusetts, the non-profit tax status filing agency is the Secretary of the Commonwealth of Massachusetts, Corporations Division (http://www.sec.state.ma.us/cor/coridx.htm), specifically the section Non-Profit Corporation Forms (https://www.sec.state.ma.us/cor/corpweb/cornp/npinf.htm). Tax paying business organizations in Massachusetts file taxes with the Massachusetts Department of Revenue (https://www.mass.gov/orgs/massachusetts-department-of-revenue). Evaluation Rubric: The tax status and state agency and web address should be valid for the chosen state. ©Margaret Kilduff 2018 120 Coursera: Healthcare Organizations and the Health System Required Content Item 17. State your healthcare organization's mission statement and vision statement. Example: Mission: To provide the best patient-centered care to every patient through excellent, compassionate clinical practice combined with effective, compassionate administrative processes. Vision: A local community population with optimal health and wellness who views Charles Harbor General Hospital as integral to that achievement. Evaluation Rubric: The statements should be no more than a few sentences which concisely and clearly state a reasonable mission and vision for your organization. Required Content Item 18. State whether your healthcare organization has a Board of Directors/Trustees. If so, describe the general characteristics you want in Board members. If not, describe how the oversight and expertise generally accomplished by a Board of Directors/Trustees is achieved in your healthcare organization. Example: Charles Harbor General Hospital has a Board of Trustees. Each Board member should be dedicated the organization's mission and vision. Overall the Board membership should reflect expertise in healthcare organization clinical issues, financial issues, management issues, regulatory requirements, and operational efficiency. Evaluation Rubric: The description should be a few sentences which concisely and clearly summarize reasonable characteristics for Board members or a reasonable alternate oversight mechanism. This synthesized information will be presented to your learner colleagues as an electronic poster. The next section discusses the creation of the electronic poster. Many learners will use PowerPoint for the poster. There are many software options other than PowerPoint. Some are available at no cost such as Impress which is part of LibreOffice. Note [FUN]: The video for Topic 1 - This is LibreOffice - is a YouTube video produced by the Document Foundation. The video provides an overview of LibreOffice (a free, open source office suite). [FUN] Video - Topic 1. This is LibreOffice 2 min This is LibreOffice The video is a YouTube video (https://www.youtube.com/watch?v=3KC0ZdcA6s8) produced by the Document Foundation. The video provides an overview of LibreOffice (a free, open source office suite). ©Margaret Kilduff 2018 121 Coursera: Healthcare Organizations and the Health System Reading: [INFO] Topic 2. Generate An Effective Electronic Poster 10 min Topic 2. How do you generate an effective electronic file poster suitable for presentation and printing for the Lesson Four course assignment? The poster project requires you to synthesize course material to design a healthcare organization and governance structure the way you would have things run in the best of all worlds. The required synthesis items were described in Topic 1 of Lesson Four. The electronic poster file is an artifact of the course which you can circulate to colleagues or use for a talk or presentation event. In constructing your poster, you are going to do so from the perspective of the chief healthcare administrator for your organization. You are describing your organization to an audience. The basic process for generating an effective electronic file poster is: 1. Choose the template/design 2. Add the content to the template 3. Iterate to improve In the Lesson Four Self-Evaluations and Peer Review section of this course is a quiz entitled Generate an Effective Electronic File Poster Self-Evaluation (Required). This quiz is a self-evaluation as to whether you have generated an effective electronic file poster. It is a nine (9) question quiz asking whether you have incorporated the 9 required template/design characteristics into your poster. The passing score for the quiz is 100 percent because you should develop each of the required 9 template/design items for the poster in order to meet the template/format requirements of the electronic poster assignment. This section discusses: Required Template/Design Characteristics for the Electronic Poster Electronic Poster Design and Technical Resources Printing Your Poster Resources (If You Should Need to Print a Poster in the Future) Required Template/Design Characteristics for the Electronic Poster The basic template/design for the electronic poster for Lesson Four is a scientific research poster (as opposed to an advertising poster). For the purposes of this course, there are nine (9) required format characteristics of the template/design. Beyond these nine characteristics, you are free to choose your own template/design for your poster. The nine characteristics are: Required Template/Design Characteristic 1. The electronic poster is one slide (e.g., one PowerPoint slide) ©Margaret Kilduff 2018 122 Coursera: Healthcare Organizations and the Health System Required Template/Design Characteristic 2. The page size (page setup) of the slide is 48 inches (width) by 36 inches (height); landscape orientation . The standard page size of a PowerPoint slide is 10 inches (width) by 7.5 inches height); landscape orientation. Note: this is the printing size of the slide/poster; you do not work electronically with a slide that is 48 inches by 36 inches or 10 inches by 7.5 inches. Required Template/Design Characteristic 3. The poster design layout has sufficient space between the content (i.e., text, graphics, images); that is, there is sufficient “white space” so the poster does not appear cluttered. Required Template/Design Characteristic 4. There is a border (white space) around the edge of the poster which serves as a frame for the poster content; content does not continue to the very edge of the slide/poster. Required Template/Design Characteristic 5. One font-type is used for the entire poster. The chosen font-type is easily readable and not distracting from the content. Common choices for a poster font-type include: Arial, Book Antigua, Bookman Old Style, Calibri, Cambria, Garamond, Helvetica, and Times New Roman. Required Template/Design Characteristic 6. The font-size for the different content sections/types of the poster is different while the font-size for a specific content section/type is the same across the entire poster. The recommended range of font-size for the different content sections/types is: poster title = 55 points to 60 points poster author name = 50 points to 54 points poster headings = 32 points to 48 points poster sub-headings = 20 points to 31 points main body text/narrative = 18 points to 36 points graphic/image captions = 16 points to 18 points Required Template/Design Characteristic 7. The poster format only uses graphics/images in support of the poster content; the reason for any graphics/images and their interpretation are clear to the poster viewer/reader. Required Template/Design Characteristic 8. The poster title is less than 15 words and provides the poster viewer/reader a clear understanding of the poster’s focus. Required Template/Design Characteristic 9. The name of the poster presenter/developer is shown below the poster title. In the course two files are attached to this section content. One is a PowerPoint file/slide (Coursera_PP_HealthcareOrganization.pptx) and one is a pdf of that PowerPoint file/slide (found in this document in Appendix D: Coursera_PD_HealthcareOrganization.pdf). The PowerPoint slide is an ©Margaret Kilduff 2018 123 Coursera: Healthcare Organizations and the Health System example of a completed poster which has the required template/design characteristics and the required content items. In the example, the font-type is Arial and the font-sizes are: poster title = 60 point, author name = 54 point, headings = 44 point, and main body text/narrative = 36 point (with urls in 35 point). The poster title is: Overview of Charles Harbor General Hospital and Its Governance. The name of the poster presenter is: I.M. Incharge, CEO Electronic Poster Design and Technical Resources Feel free to download the PowerPoint file/slide in the course (Coursera_PP_HealthcareOrganization.pptx) to use as a template for your own poster. Of course, if you would rather make your own template/design, you can. The common way to produce an electronic poster suitable for presentation and printing is to use PowerPoint, but other software is sometimes used such as Impress or Draw which are both part of LibreOffice or Adobe Photoshop or Apple Keynote. There are downloads of free poster templates available for PowerPoint and other poster presentation software. You can use one of these free templates for your electronic poster if you prefer. Some of the sources of such templates are: Genegraphics Free PowerPoint Research Poster Templates PosterPresentation.com Free Research Poster PowerPoint Templates MakeSigns Scientific Poster PowerPoint Templates Poster Presentation Templates including a Poster Presentation Template for Impress 48X36 There are also free templates for a multi-slide (non-poster) presentation including those from: Free PowerPointTemplates from fppt.com LibreOffice Impress Templates LibreOffice Extensions and Templates Although using a template is a good guide for producing any poster, there are many great (and detailed) resources on both the "artistry" and technical nuts-and-bolts of electronic poster development. Some of these resources are: Creating Large Format Posters Using PowerPoint Creating Effective Poster Presentations Effective Poster Presentations Designing Effective Posters Creating Scholarly Posters in PowerPoint MakeSigns We're Here To Help You Make The Best Scientific Poster Tutorials ©Margaret Kilduff 2018 124 Coursera: Healthcare Organizations and the Health System Note [FUN]: The video for Topic 2 - TechTime: Designing Conference Posters in PowerPoint - is a YouTube video produced by the National Network of Libraries of Medicine (NNLM). The video provides an overview of design strategies for professional looking posters using PowerPoint. This is a long video (60 minutes) because it is very thorough and detailed. You may want to view all of the video or only parts of it. Printing Your Poster Resources (If You Should Need to Print a Poster in the Future) Although you do not have to print your poster for this course assignment, you may be wondering how to print a poster for a presentation. There are many poster printing services available. In general, you give your electronic poster file to the service (usually by uploading the file to their website) and they use that file to print the poster on the material of your choice. Some of the services which do this are: Genigraphics Scientific, Medical, and Research Poster Printing PosterPresentations.com which also offers printing on fabric to make traveling with the poster easier (many airlines count a paper poster in a poster tube as a carry-on item. So if you are traveling with a laptop in a small bag, a small suitcase, and the poster tube, one of those items will have to be checked to comply with the two carry-on rule. A poster printed on fabric can be folded and placed in your small bag or suitcase. MakeSigns Scientific Posters which also offers printing on fabric FedEx Posters: Custom Poster Printing & More [FUN] Video - Topic 2. TechTime: Designing Conference Posters in PowerPoint 1h TechTime: Designing Conference Posters in PowerPoint The video is a YouTube video (https://www.youtube.com/watch?v=iV6o5cuJM9A) produced by the National Network of Libraries of Medicine (NNLM). The video provides an overview of design strategies for professional looking posters. It is long - you may want to view the whole video or only parts of it. Reading: [INFO] Topic 3. Judge the Quality of a Poster 10 min Topic 2. How do you Judge the quality (content presentation and format) of a poster? The quality of a poster is usually judged on two major factors:1) whether the poster content is sufficient for its intended purpose, and 2) whether the poster appearance is such that the content can be grasped relatively easily. Most posters are produced for a specific purpose (e.g., a conference, a meeting) and the sufficiency of the content is related to its purpose. If the poster is to be formally judged, the ©Margaret Kilduff 2018 125 Coursera: Healthcare Organizations and the Health System organization hosting the "poster event" usually provides both the poster judging criteria and the judges. In short, you judge the quality (content presentation and format) of a poster according to the criteria set for the judging. This section discusses: Overview of Peer-Review Poster Assignment Criteria for Judging the Poster Quality Poster Presentation Elevator Speech Overview of Peer-Review Poster Assignment You submit your poster and peer-review the poster of two of your learner colleagues in the Lesson Four Self-Evaluations and Peer Review section of this course, specifically in the Poster Submission and Evaluation (Required). Your poster is peer-reviewed by two of your learner colleagues. You submit the poster as a PDF file; save the file you developed in the poster presentation software (e.g., PowerPoint) as a PDF and upload it in the Poster Submission and Evaluation (Required) section of the course. It should be noted that the main point of this peer-review assignment is for you to have the experience of critically judging (evaluating) the quality (content presentation and format) of a poster other than your own within a forum where your judgement has meaning. Your judgement has meaning because your judgement determines your learner colleague's grade on the poster assignment. Your judgement carries with it the responsibility to be critical, honest, fair, and consistent across all posters you judge; that is, the same responsibility found for any subjective judgement where the judgement outcome affects a person's life. In the best of all possible worlds, poster evaluators would first norm their evaluation against a standard. One method for doing this is to have each evaluator view the same sample of posters of differing qualities until the group of evaluators agrees on the same score to assign to each quality-level. This is not done in this course (although a sample poster is provided in Appendix D: Coursera_PD_HealthcareOrganization.pdf) so it is reasonable to assume that different evaluators may assign different scores to the same quality-level characteristic. It is no surprise to any learner that some evaluators are harder graders than others. You may be a very hard grader; you may be a very easy grader. Those evaluating your poster may be very hard graders; they may be very easy graders. To account for the possible difference in the grading styles of those evaluating your poster (e.g., you are evaluated by two very hard graders), the passing grade is set at 50 percent (rather than 80 or 90 percent). Your grade is the combination of the grades (scores) given you by your two learner colleague evaluators. ©Margaret Kilduff 2018 126 Coursera: Healthcare Organizations and the Health System Note: If you do not achieve 50 percent (if you do not receive a passing score on the poster assignment) and believe it to be the result of having been evaluated by two unusually hard graders, please contact us to resolve the situation. Criteria for Judging the Poster Quality In the poster project (assignment) for this course, the poster content criteria have been specified throughout the course as have the criteria for the poster appearance. Your poster will be judged by these criteria (listed below). You will judge two (2) other posters using the criteria. The score for each of the twenty-seven (27) evaluation criteria questions/items is: Yes (1 point) and No (0 points). In evaluating a poster on each evaluation question item, if the answer to the question is more Yes than No in your judgment, answer Yes to the item question. The poster display does not have to be perfect with respect to the evaluation criteria for a Yes answer/judgment. The 27 criteria evaluation questions are: 1. Does the poster display a name for the healthcare organization which is original and appealing to both employees of the healthcare organization as well as the public at-large? 2. Does the poster display a brief description of the healthcare organization (a description of what the healthcare organization does) which concisely and clearly summarizes the work and purpose of the healthcare organization in a few sentences? 3. Does the poster display at least one healthcare occupation employed by the organization as that occupation is listed by the Bureau of Labor Statistics (BLS) at the Healthcare Occupations website? Is this healthcare occupation consistent with the healthcare organization's description? More can be listed, but only one is needed. There is no need to list other occupations employed by the organization (e.g., accountants) or the number of people employed. 4. Does the poster display a North American Classification System (NAICS) code for the healthcare organization which is appropriate for the organization's description? 5. Does the poster display a valid U.S. state (or the District of Columbia) and a valid county of that state in which the healthcare organization is located? 6. Does the poster display valid county health ranking information from the County Health Rankings and Roadmap website for the county in which healthcare organization is located? ©Margaret Kilduff 2018 127 Coursera: Healthcare Organizations and the Health System 7. Does the poster display the valid name and web address (url) of the state licensing agency for healthcare organizations for the state in which the healthcare organization is located (e.g., Department of Health)? 8. Does the poster display one valid accreditation association for the healthcare organization, if any exist? If one is named, does the poster display whether this accreditation association has deeming authority from the Centers for Medicare and Medicaid (CMS) for the healthcare organization? If no accreditation association is listed, and there really are no valid accreditation associations for the healthcare organization, answer Yes for this review question. 9. Does the poster display one strategic goal for the healthcare organization which is a broad and bold one for the organization as a whole, but doable? 10. Does the poster display a rank order of the eleven (11) combined Healthcare Leadership Alliance (HLA) and American College of Healthcare Executives (ACHE) competencies listed in the course where 1 is the most important and 11 is the least important? 11. Does the poster display the name of two real journals (and the url for the journal or publication) which a healthcare administrator could use to find evidence for the evidence-based practice of healthcare administration? 12. Does the poster display the name of an administrative/management framework (or combination of frameworks) which a healthcare administrator could use? If the author/presenter describes a personally developed framework, is it described it in a sentence or two? 13. Does the poster display the name of one real healthcare administration-related professional association (and the url for the association) which a healthcare administrator for this healthcare organization might join? 14. Does the poster display whether the governance structure of the healthcare organization is shared or not-shared and display a brief description of the governance relationship between the administrative part of the organization and the professional clinical part of the organization in a few sentences which concisely and clearly summarize a reasonable governance structure? 15. Does the poster display a business structure for the healthcare organization and the valid name and web address (url) of the state agency in the chosen state with which the organization must file legal business structure documents (e.g., Department of State)? 16. Does the poster display a tax status for the healthcare organization and the valid name and web address (url) of the state agency in the chosen state with which the organization must file legal tax documents (e.g., Department of Treasury)? ©Margaret Kilduff 2018 128 Coursera: Healthcare Organizations and the Health System 17. Does the poster display the healthcare organization's mission statement and vision statement in no more than a few sentences which concisely and clearly state a reasonable mission and vision for the organization? 18. Does the poster display whether the healthcare organization has a Board of Directors/Trustees? If the organization has a Board of Directors/Trustees, does the poster display a description of the general characteristics of Board members? If the organization does not have a Board of Directors/Trustees, does the poster display a description of how the oversight and expertise generally accomplished by a Board of Directors/Trustees is achieved in the healthcare organization? Do these descriptions concisely and clearly summarize reasonable characteristics for Board members or a reasonable alternate oversight mechanism in a few sentences? 19. Is the electronic poster one slide (e.g., one PowerPoint slide)? 20. Is the page size (page setup) of the slide 48 inches (width) by 36 inches (height); landscape orientation? The standard page size of a PowerPoint slide is 10 inches (width) by 7.5 inches height); landscape orientation. Note: If you open the pdf file and view it in "Actual Size", the size of the poster will be displayed in the lower left corner of the pdf frame and should display 48.00 x 36.00 in. 21. Does the poster design layout have sufficient space between the content (i.e., text, graphics, images); that is, is there sufficient “white space” so the poster does not appear cluttered? 22. Is there a border (white space) around the edge of the poster which serves as a frame for the poster content; that is, content does not continue to the very edge of the slide/poster? 23. Is one font-type is used for the entire poster and is the font-type chosen easily readable and not distracting from the content? Common choices for a poster font-type include: Arial, Book Antigua, Bookman Old Style, Calibri, Cambria, Garamond, Helvetica, and Times New Roman. 24. Is the font-size for the different content sections/types of the poster different while the fontsize for a specific content section/type is the same across the entire poster? The recommended range of font-size for the different content sections/types is: poster title = 55 points to 60 points; poster author name = 50 points to 54 points; poster headings = 32 points to 48 points; poster sub-headings = 20 points to 31 points; main body text/narrative = 18 points to 36 points; graphic/image captions = 16 points to 18 points 25. Does the poster format only uses graphics/images in support of the poster content; the reason for any graphics/images and their interpretation are clear to the poster viewer/reader? Note: If no graphics/images are used, answer Yes. ©Margaret Kilduff 2018 129 Coursera: Healthcare Organizations and the Health System 26. Is the poster title is less than 15 words and provides the poster viewer/reader a clear understanding of the poster’s focus? 27. Is a name for the poster presenter/developer shown below the poster title? Note: The name shown does not have to be your name. It just needs to be a name. In the example poster, the name of the presenter/developer is I.M. Incharge. You can use the same name if you wish. Poster Presentation Elevator Speech Usually a poster is displayed in conjunction with an oral presentation or speech by the poster developer/author. Such an oral presentation/speech is not used in this course, but it is worthwhile to look at the characteristics of such an oral presentation/speech. At its core, the poster illustrates and reinforces the oral presentation/speech and vice versa. One common characteristic is what is known as the "elevator speech" or "elevator pitch". This speech/pitch is a short verbal/oral description of the poster content/concept (or a company, idea, research, etc.) which: " explains the concept in a way such that any listener can understand it in a short period of time ... The goal is simply to convey the overall concept or topic in an exciting way ... The name—elevator pitch—reflects the idea that it should be possible to deliver the summary in the time span of an elevator ride, or approximately thirty seconds to two minutes." (Website Source of Quote) The elevator speech/pitch begins the oral presentation/speech about the poster content. Below are some resources which are helpful in crafting the elevator speech/pitch: Win the Business with this Elevator Pitch How to Craft a Successful Elevator Pitch Tips for Developing a Nonprofit "Elevator Pitch" for Your Board Members 6 tips for putting together the perfect elevator pitch Note [FUN]: The video for Topic 3 - The Perfect Elevator Pitch - is a YouTube video produced by the Rice Business Plan Competition (RBPC) discussing what works and what does not work in an elevator speech/pitch. [FUN] Video - Topic 3. The Perfect Elevator Pitch 3 min The Perfect Elevator Pitch The video is a YouTube video (https://www.youtube.com/watch?v=1lJHOEoUP1c) produced by the Rice Business Plan Competition (RBPC) discussing what and know what works and does not work in an elevator speech/pitch. ©Margaret Kilduff 2018 130 Coursera: Healthcare Organizations and the Health System [CERT] [FUN] Lesson Four Self-Evaluations and Peer Review Quiz: [CERT] Synthesize Course Content Self-Evaluation 18 questions, 24 minutes Question 1 Have you written a name for your healthcare organization which is original and appealing to both employees of the healthcare organization as well as the public at-large? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 2 Have you written a brief description of your healthcare organization (a description of what your healthcare organization does) which concisely and clearly summarizes the work and purpose of your healthcare organization in a few sentences? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 3 Have you chosen at least one healthcare occupation to be employed by your organization as that occupation is listed by the Bureau of Labor Statistics (BLS) at the Healthcare Occupations website? Is this healthcare occupation consistent with the healthcare organization's description? More can be listed, but only one is needed. There is no need to list other occupations employed by the organization (e.g., accountants) or the number of people employed. Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 4 Have you chosen The North American Classification System (NAICS) code for your healthcare organization which is appropriate for the organization's description? ©Margaret Kilduff 2018 131 Coursera: Healthcare Organizations and the Health System Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 5 Have you chosen a valid U.S. state (or the District of Columbia) and a valid county of that state in which to locate your healthcare organization? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 6 Have you identified and collected the valid county health ranking information from the County Health Rankings and Roadmap website for the county you have chosen to locate your healthcare organization? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 7 Have you identified and collected the valid name and web address (url) of the state licensing agency for healthcare organizations for the state you have chosen to locate your healthcare organization (e.g., Department of Health)? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 8 Have you named one valid accreditation association for your healthcare organization, if any exist? If one is named, have you stated whether this accreditation association has deeming authority from the ©Margaret Kilduff 2018 132 Coursera: Healthcare Organizations and the Health System Centers for Medicare and Medicaid (CMS) for your healthcare organization? If you are saying that none exist, are you sure that there are none? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 9 Have you written one strategic goal for your healthcare organization which is a broad and bold one for the organization as a whole, but doable? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 10 Have you rank ordered the eleven (11) combined Healthcare Leadership Alliance (HLA) and American College of Healthcare Executives (ACHE) competencies listed in the course in the order you think is the most important for a healthcare administrator where 1 is the most important and 11 is the least important? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 11 Have you named two real journals (and the url for the journal or publication) which you would use as a healthcare administrator to find evidence for the evidence-based practice of healthcare administration? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. ©Margaret Kilduff 2018 133 Coursera: Healthcare Organizations and the Health System Question 12 Have you named the administrative/management framework (or combination of frameworks) which you would use as a healthcare administrator? If you are defining your own framework, have you described it in a sentence or two? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 13 Have you named one real healthcare administration-related professional association (and the url for the association) which you would join as a healthcare administrator for your organization? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 14 Have you decided whether the governance structure of your healthcare organization is shared or notshared and briefly described the governance relationship between the administrative part of the organization and the professional clinical part of the organization in a few sentences which concisely and clearly summarize a reasonable governance structure? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 15 Have you chosen the business structure of your healthcare organization and stated the valid name and web address (url) of the state agency in your chosen state with which your organization must file legal business structure documents (e.g., Department of State)? Yes No ©Margaret Kilduff 2018 134 Coursera: Healthcare Organizations and the Health System This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 16 Have you chosen the tax status of your healthcare organization and stated the valid name and web address (url) of the state agency in your chosen state with which your organization must file legal tax documents (e.g., Department of Treasury)? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 17 Have you written your healthcare organization's mission statement and vision statement in no more than a few sentences which concisely and clearly state a reasonable mission and vision for your organization? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 18 Have you stated whether your healthcare organization has a Board of Directors/Trustees? If your organization has a Board of Directors/Trustees, have you described the general characteristics you want in Board members? If your organization does not have a Board of Directors/Trustees, have you described how the oversight and expertise generally accomplished by a Board of Directors/Trustees is achieved in your healthcare organization? Do these descriptions concisely and clearly summarize reasonable characteristics for Board members or a reasonable alternate oversight mechanism in a few sentences? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. ©Margaret Kilduff 2018 135 Coursera: Healthcare Organizations and the Health System Quiz: [CERT] Generate an Effective Electronic File Poster Self-Evaluation 9 questions, 12 min Question 1 Is your electronic poster one slide (e.g., one PowerPoint slide)? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 2 Is the page size (page setup) of the slide 48 inches (width) by 36 inches (height); landscape orientation? The standard page size of a PowerPoint slide is 10 inches (width) by 7.5 inches height); landscape orientation. Note: this is the printing size of the slide/poster; you do not work electronically with a slide that is 48 inches by 36 inches or 10 inches by 7.5 inches. Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 3 Does the poster design layout have sufficient space between the content (i.e., text, graphics, images); that is, is there sufficient “white space” so the poster does not appear cluttered? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 4 Is there a border (white space) around the edge of the poster which serves as a frame for the poster content; that is, content does not continue to the very edge of the slide/poster? Yes No ©Margaret Kilduff 2018 136 Coursera: Healthcare Organizations and the Health System This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 5 Is one font-type is used for the entire poster and is the font-type chosen easily readable and not distracting from the content? Common choices for a poster font-type include: Arial, Book Antigua, Bookman Old Style, Calibri, Cambria, Garamond, Helvetica, and Times New Roman. Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 6 Is the font-size for the different content sections/types of the poster different while the font-size for a specific content section/type is the same across the entire poster? The recommended range of font-size for the different content sections/types is: poster title = 55 points to 60 points poster author name = 50 points to 54 points poster headings = 32 points to 48 points poster sub-headings = 20 points to 31 points main body text/narrative = 18 points to 36 points graphic/image captions = 16 points to 18 points Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 7 Does the poster format only uses graphics/images in support of the poster content; the reason for any graphics/images and their interpretation are clear to the poster viewer/reader? Note: If no graphics/images are used, answer Yes. Yes ©Margaret Kilduff 2018 137 Coursera: Healthcare Organizations and the Health System No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 8 Is the poster title is less than 15 words and provides the poster viewer/reader a clear understanding of the poster’s focus? Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Question 9 Is a name for the poster presenter/developer shown below the poster title? Note: The name shown does not have to be your name. It just needs to be a name. In the example poster, the name of the presenter/developer is I.M. Incharge. You can use the same name if you wish. Yes No This is your own personal self-evaluation of the synthesized course material needed for the electronic poster. Peer-graded Assignment: [CERT] Poster Submission and Evaluation 1h 10m Short summary of the learning goals of this assignment You have now Designed a Governance Structure for a Healthcare Organization. This task required that you synthesize course content to create your own healthcare organization and governance structure. It is now time to present your synthesized information to your learner colleagues as an electronic poster. The electronic poster file is an artifact of the course which you can circulate to colleagues or use for a talk or presentation event. You will also judge the quality (content presentation and format) of a poster. You submit your poster and peer-review the poster of two of your learner colleagues. Your poster is peer-reviewed by two of your learner colleagues. ©Margaret Kilduff 2018 138 Coursera: Healthcare Organizations and the Health System It should be noted that the main point of this peer-review assignment is for you to have the experience of critically judging (evaluating) the quality (content presentation and format) of a poster other than your own within a forum where your judgment has meaning. Your judgment has meaning because your judgment determines your learner colleague's grade on the poster assignment. Your judgment carries with it the responsibility to be critical, honest, fair, and consistent across all posters you judge; that is, the same responsibility found for any subjective judgment where the judgment outcome affects a person's life. In the best of all possible worlds, poster evaluators would first norm their evaluation against a standard. One method for doing this is to have each evaluator view the same sample of posters of differing qualities until the group of evaluators agrees on the same score to assign to each quality-level. This is not done in this course (although a sample poster is provided as an example) so it is reasonable to assume that different evaluators may assign different scores to the same quality-level characteristic. It is no surprise to any learner that some evaluators are harder graders than others. You may be a very hard grader; you may be a very easy grader. Those evaluating your poster may be very hard graders; they may be very easy graders. To account for the possible difference in the grading styles of those evaluating your poster (e.g., you are evaluated by two very hard graders), the passing grade is set at 50 percent (rather than 80 or 90 percent). Your grade is the combination of the grades (scores) given you by your two learner colleague evaluators. Note: If you do not achieve 50 percent (if you do not receive a passing score on the poster assignment) and believe it to be the result of having been evaluated by two unusually hard graders, please contact us to resolve the situation. Number of required reviews: 2 Brief explanation on how the peer-review assignment will be graded In the poster project (assignment) for this course, the poster content criteria have been specified throughout the course as have the criteria for the poster appearance. Your poster will be judged by these criteria. You will judge two (2) other posters using the criteria. The score for each of the twenty-seven (27) evaluation criteria questions/items is: Yes (1 point) and No (0 points). In evaluating a poster on each evaluation question item, if the answer to the question is more Yes than No in your judgment, answer Yes to the item question. The poster display does not have to be perfect with respect to the evaluation criteria for a Yes answer/judgment. ©Margaret Kilduff 2018 139 Coursera: Healthcare Organizations and the Health System There is also an opportunity for you to provide constructive feedback or general comments on the poster to those whose poster you evaluate; and to receive such feedback or comments from those who evaluate your poster. Providing feedback is optional Example Submissions An example of a poster submission can be found in Appendix D: Coursera_PD_HealthcareOrganization.pdf Prompt 1: Poster Submission Please upload your poster as a PDF file; save the file you developed in the poster presentation software (e.g., PowerPoint) as a PDF and upload it here. Grading Rubrics for Prompt 1 Prompt 1: Rubric 1 Does the poster display a name for the healthcare organization which is original and appealing to both employees of the healthcare organization as well as the public at-large? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 2 Does the poster display a brief description of the healthcare organization (a description of what the healthcare organization does) which concisely and clearly summarizes the work and purpose of the healthcare organization in a few sentences? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 3 Does the poster display at least one healthcare occupation employed by the organization as that occupation is listed by the Bureau of Labor Statistics (BLS) at the Healthcare Occupations website? Is this healthcare occupation consistent with the healthcare organization's description? ©Margaret Kilduff 2018 140 Coursera: Healthcare Organizations and the Health System More can be listed, but only one is needed. There is no need to list other occupations employed by the organization (e.g., accountants) or the number of people employed. Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 4 Does the poster display a North American Classification System (NAICS) code for the healthcare organization which is appropriate for the organization's description? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 5 Does the poster display a valid U.S. state (or the District of Columbia) and a valid county of that state in which the healthcare organization is located? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 6 Does the poster display valid county health ranking information from the County Health Rankings and Roadmap website for the county in which healthcare organization is located? Rubric Options No (0 points) Yes (1 point) ©Margaret Kilduff 2018 141 Coursera: Healthcare Organizations and the Health System Prompt 1: Rubric 7 Does the poster display the valid name and web address (url) of the state licensing agency for healthcare organizations for the state in which the healthcare organization is located (e.g., Department of Health)? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 8 Does the poster display one valid accreditation association for the healthcare organization, if any exist? If one is named, does the poster display whether this accreditation association has deeming authority from the Centers for Medicare and Medicaid (CMS) for the healthcare organization? If no accreditation association is listed, and there really are no valid accreditation associations for the healthcare organization, answer Yes for this review question. Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 9 Does the poster display one strategic goal for the healthcare organization which is a broad and bold one for the organization as a whole, but doable? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 10 Does the poster display a rank order of the eleven (11) combined Healthcare Leadership Alliance (HLA) and American College of Healthcare Executives (ACHE) competencies listed in the course where 1 is the most important and 11 is the least important? ©Margaret Kilduff 2018 142 Coursera: Healthcare Organizations and the Health System Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 11 Does the poster display the name of two real journals (and the url for the journal or publication) which a healthcare administrator could use to find evidence for the evidence-based practice of healthcare administration? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 12 Does the poster display the name of an administrative/management framework (or combination of frameworks) which a healthcare administrator could use? If the author/presenter describes a personally developed framework, is it described it in a sentence or two? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 13 Does the poster display the name of one real healthcare administration-related professional association (and the url for the association) which a healthcare administrator for this healthcare organization might join? Rubric Options No (0 points) Yes (1 point) ©Margaret Kilduff 2018 143 Coursera: Healthcare Organizations and the Health System Prompt 1: Rubric 14 Does the poster display whether the governance structure of the healthcare organization is shared or not-shared and display a brief description of the governance relationship between the administrative part of the organization and the professional clinical part of the organization in a few sentences which concisely and clearly summarize a reasonable governance structure? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 15 Does the poster display a business structure for the healthcare organization and the valid name and web address (url) of the state agency in the chosen state with which the organization must file legal business structure documents (e.g., Department of State)? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 16 Does the poster display a tax status for the healthcare organization and the valid name and web address (url) of the state agency in the chosen state with which the organization must file legal tax documents (e.g., Department of Treasury)? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 17 Does the poster display the healthcare organization's mission statement and vision statement in no more than a few sentences which concisely and clearly state a reasonable mission and vision for the organization? ©Margaret Kilduff 2018 144 Coursera: Healthcare Organizations and the Health System Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 18 Does the poster display whether the healthcare organization has a Board of Directors/Trustees? If the organization has a Board of Directors/Trustees, does the poster display a description of the general characteristics of Board members? If the organization does not have a Board of Directors/Trustees, does the poster display a description of how the oversight and expertise generally accomplished by a Board of Directors/Trustees is achieved in the healthcare organization? Do these descriptions concisely and clearly summarize reasonable characteristics for Board members or a reasonable alternate oversight mechanism in a few sentences? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 19 Is the electronic poster one slide (e.g., one PowerPoint slide)? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 20 Is the page size (page setup) of the slide 48 inches (width) by 36 inches (height); landscape orientation? The standard page size of a PowerPoint slide is 10 inches (width) by 7.5 inches height); landscape orientation. Note: If you open the pdf file and view it in "Actual Size", the size of the poster will be displayed in the lower left corner of the pdf frame and should display 48.00 x 36.00 in. ©Margaret Kilduff 2018 145 Coursera: Healthcare Organizations and the Health System Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 21 Does the poster design layout have sufficient space between the content (i.e., text, graphics, images); that is, is there sufficient “white space” so the poster does not appear cluttered? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 22 Is there a border (white space) around the edge of the poster which serves as a frame for the poster content; that is, content does not continue to the very edge of the slide/poster? Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 23 Is one font-type is used for the entire poster and is the font-type chosen easily readable and not distracting from the content? Common choices for a poster font-type include: Arial, Book Antigua, Bookman Old Style, Calibri, Cambria, Garamond, Helvetica, and Times New Roman. Rubric Options No (0 points) Yes (1 point) ©Margaret Kilduff 2018 146 Coursera: Healthcare Organizations and the Health System Prompt 1: Rubric 24 Is the font-size for the different content sections/types of the poster different while the font-size for a specific content section/type is the same across the entire poster? The recommended range of font-size for the different content sections/types is: poster title = 55 points to 60 points poster author name = 50 points to 54 points poster headings = 32 points to 48 points poster sub-headings = 20 points to 31 points main body text/narrative = 18 points to 36 points graphic/image captions = 16 points to 18 points Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 25 Does the poster format only uses graphics/images in support of the poster content; the reason for any graphics/images and their interpretation are clear to the poster viewer/reader? Note: If no graphics/images are used, answer Yes. Rubric Options No (0 points) Yes (1 point) Prompt 1: Rubric 26 Is the poster title is less than 15 words and provides the poster viewer/reader a clear understanding of the poster’s focus? Rubric Options No (0 points) Yes (1 point) ©Margaret Kilduff 2018 147 Coursera: Healthcare Organizations and the Health System Prompt 1: Rubric 27 Is a name for the poster presenter/developer shown below the poster title? Note: The name shown does not have to be your name. It just needs to be a name. In the example poster, the name of the presenter/developer is I.M. Incharge. You can use the same name if you wish. Rubric Options No (0 points) Yes (1 point) Assignment Level Rubric (Ungraded) Should you wish to provide any constructive feedback or general comments on the poster for the poster developer/presenter, please do so. It is not required. Providing feedback is optional. Review Your Peers: [CERT] Poster Submission and Evaluation You submit your poster and peer-review the poster of two of your learner colleagues. Your poster is peer-reviewed by two of your learner colleagues. Discussion Prompt: [FUN] Poster Generation and Judging 10 min What, if anything, surprised you most about the process of producing an electronic poster? What, if anything, surprised you most about the process of judging a poster? What did you find most interesting, challenging, fun, ....? [FUN] Lesson Four Trivia Question and Virtual Field Trip Reading: [FUN] Lesson Four Trivia Question 2 min Almost everyone loves a trivia question - a question about a little known, but interesting, fun fact. Each lesson has one trivia question. The answer is in the Lesson Four Trivia Question Answer reading section. Question: ©Margaret Kilduff 2018 148 Coursera: Healthcare Organizations and the Health System Edward Tufte has been recognized as an expert in data visualization since he first published The Visual Display of Quantitative Information in 1983. Data visualization techniques are very useful in a poster display. Tufte is credited with the coining of a term referencing quantitative information displays which are not useful or informative and distract the viewer/reader. What is this term? Reading: [FUN] Lesson Four Trivia Question Answer 5 min The answer to the Lesson Four trivia question is: chartjunk For more information, please see: chartjunk Wikipedia, Edward Tufte Edward Tufte Homepage Reading: [FUN] Lesson Four Virtual Field Trip 5 min Everyone loves a road trip/field trip so each lesson of the course includes a "virtual field trip" to the often hidden places of interest on the web. Lesson Four's virtual field trip is to the Isabella Stuart Gardner Museum in Boston, Massachusetts. Why? Because a poster is in many ways a storytelling device. The content of the poster assignment in this course tells a story about the healthcare organization you created. Paintings - great paintings - also tell a story. And in the case of the Isabella Stuart Gardner Museum, the lack of a painting - an empty frame with no painting - also tells a story. It tells a story of the greatest art heist of all times. On March 18, 1990, more than $500 million of art was stolen from the Museum. None of the stolen art has ever been recovered. The paintings were cut from their frames and the empty frames hang in the Museum. So the empty frames in the museum tell the story of the art heist. For more information, please see: About the Theft Isabella Stuart Gardner Museum Wikipedia, Isabella Stuart Gardner Museum Theft ©Margaret Kilduff 2018 149 Coursera: Healthcare Organizations and the Health System Isabella Stewart Gardner Heist: 25 Years of Theories The video provides behind the scenes look at art conservation at the Isabella Stuart Gardner Museum. [FUN] Video - Lesson Four Virtual Field Trip 4 min Art Conservation Behind the Scenes The video is a YouTube video (https://www.youtube.com/watch?v=3OjvBk2Ao9M) produced by the Isabella Stewart Gardner Museum showing a behind-the-scenes look inside the Art Conservation department. [INFO] [FUN] Wrapping Up the Course Reading: [INFO] Thank You For Participating in This Course 10 min Thank You for Participating in This Course! Whether you visited this course or enrolled in this course, thank you for participating! If you enrolled and successfully completed the course, you should be now be able to: 1. 2. 3. 4. 5. 6. Define a healthcare organization, a health system, and their relationship. Define effective evidence-based healthcare administration and management models. Define the forms of organizational governance and functions. Synthesize course content to create a healthcare organization and governance structure. Generate an effective electronic file poster suitable for presentation and printing. Judge the quality (content presentation and format) of a poster. It is hoped that upon achieving these objectives, the you do not just know more at the end of the course than at the beginning, but that you think about healthcare organization structure and governance in new ways. The goal of the course is to enable the learner to think critically about healthcare organization structure and governance in new and interesting ways. I hope you enjoyed the course and will consider visiting or enrolling in other Coursera courses, especially those in the Healthcare Organization Operations specialization. The four courses in the specialization are: Healthcare Organizations and the Health System Health Care Delivery in Healthcare Organizations ©Margaret Kilduff 2018 150 Coursera: Healthcare Organizations and the Health System Business Process Management in Healthcare Organizations Quality Improvement in Healthcare Organizations Each course is a stand-alone course; the courses do not build on each other - they complement each other. No one course in the specialization is a prerequisite for another course. If you choose to enroll in all four courses to receive the specialization certificate, the courses can be completed in any order But wherever your learning path and journey take you, I hope that the course rules apply: 1) work hard; 2) have fun; and 3) never hesitate to ask a question. I also hope that your path and journey are as pleasant and interesting as many of those which can be found in the National Parks of the United States. Some truly spectacular paths can be found in Glacier National Park in Montana. One of them is the Highline. Note [FUN]: The video for this Wrapping Up section - Highline Trail, Glacier National Park, Montana - is a YouTube video produced by Amazing Places on Our Planet. This video is a journey along the Highline path. [FUN] Video - Highline Trail, Glacier National Park, Montana 7 min Highline Trail, Glacier National Park, Montana The video is a YouTube video (https://www.youtube.com/watch?v=PQ5Mnqcj9ks) produced by Amazing Places on Our Planet. This video is a journey along the Highline path. Discussion Prompt: [FUN] Did you learn what you wanted to learn? 5 min At the beginning of the course, you were asked if you had a personal learning goal for the course. If you did, was your goal achieved? Did you learn what you wanted to learn in this course? If not, please tell us what could have been done differently in the course to help you achieve your learning goal. Discussion Prompt: [FUN] Another Opportunity for Feedback - Course as a Whole 5 min If you have not yet posted any feedback you have about the course as a whole in the discussion forum in Lesson One and wish to do so now in this discussion forum, please do so. ©Margaret Kilduff 2018 151 Coursera: Healthcare Organizations and the Health System All feedback (e.g., suggestions, questions, concerns, criticisms) is welcome. This is your course experience. Let us know how you feel the course experience can be improved. Let us know what you feel works particularly well in the course. ©Margaret Kilduff 2018 152 Coursera: Healthcare Organizations and the Health System Appendix A: Lesson One Create Your Own Healthcare Organization Short summary of the learning goals of this assignment In Lesson Four, you will Design a Governance Structure for a Healthcare Organization. This task requires that you synthesize course content to create your own healthcare organization and governance structure. Your synthesized information will be presented to your learner colleagues as an electronic poster. The electronic poster file is an artifact of the course which you can circulate to colleagues or use for a talk or presentation event. For the poster project, you will need PowerPoint software or its equivalent. There are many software options other than PowerPoint. Some are available at no cost such as Impress which is part of LibreOffice. However, it is best not to wait until Lesson Four to begin to synthesize course content to create your own healthcare organization and governance structure. The earlier in the course that you begin this creation process, the better your healthcare organization and governance structure will be. So in each lesson prior to Lesson Four, there will be an opportunity to synthesize material – an opportunity to create your healthcare organization - via an ungraded peer review assessment. Any aspect of your healthcare organization and governance structure can be changed up until the moment you submit the poster. An ungraded peer review assessment is used to allow you to create aspects of your healthcare organization and governance structure as an iterative process throughout the course - should you so choose. An ungraded peer review assessment is used to allow you to provide constructive feedback on this iterative creation of your learner colleague's healthcare organization and governance structure - should you so choose. An ungraded peer review assessment is used to allow your learner colleagues to provide constructive feedback on your iterative creation of your healthcare organization and governance structure - should they so choose. Number of suggested (optional) reviews: 1 Brief explanation on how to do the review This is an ungraded optional assignment. You can choose to create aspects of your healthcare organization and governance structure or you can choose not to do so. You can choose to provide constructive feedback to one of your learner colleagues or you can choose not to do so. Learner ©Margaret Kilduff 2018 153 Coursera: Healthcare Organizations and the Health System colleagues may choose to provide constructive feedback to you or they may choose not to do so. The feedback you provide should be your best and most sincere effort to help your learner colleague create the best healthcare organization possible. All feedback you receive should be evaluated in that light your learner colleagues are sincerely trying to help. Having said that, you are free to disagree with any feedback and ignore it. Example Submissions Here is an example for each prompt to help you understand what your assignment should look like. Use this example to understand the assignment guidelines more thoroughly. Prompt 1. What is the name of your healthcare organization? The name should be original and appealing to both employees of the healthcare organization as well as the public at-large. Example: Charles Harbor General Hospital Prompt 2. Provide a brief description of your healthcare organization. What does your healthcare organization do? The description should be a few sentences which concisely and clearly summarize the work and purpose of your healthcare organization. Example: Charles Harbor General Hospital is a general hospital with an emergency room. It offers a full range of clinical specialties (e.g., internal medicine, general surgery, oncology, cardiology, infectious disease) with a focus on adults although there is a pediatrics unit. Its purpose is to provide the very best health care and improve the health of all those in the local Charles Harbor General Hospital community. Prompt 3. Which of the healthcare occupations listed by the Bureau of Labor Statistics (BLS) at the Healthcare Occupations website are employed by your organization? One healthcare occupation from the BLS website consistent with the healthcare organization's description should be listed. More can be listed, but only one is needed. There is no need to list other occupations employed by the organization (e.g., accountants) or the number of people employed. Example: Charles Harbor General Hospital employs Physicians and Surgeons (https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-1). Prompt 4. What is the North American Classification System (NAICS) code for your healthcare organization? The listed code should be a valid NAICS code and appropriate for the organization's description. Example: Charles Harbor General Hospital has a NAICS code of 622110 - General Medical and Surgical Hospitals (https://www.census.gov/cgibin/sssd/naics/naicsrch?code=622110&search=2017%20NAICS%20Search). ©Margaret Kilduff 2018 154 Coursera: Healthcare Organizations and the Health System Prompt 5. In which U.S. state and in which county of that state is your healthcare organization located? The state should be a valid U.S. state (or the District of Columbia) and a valid county within that state. Example: Charles Harbor General Hospital is located in Massachusetts in Suffolk County (https://en.wikipedia.org/wiki/Suffolk_County,_Massachusetts). Prompt 6. What is the county health ranking for the county from the County Health Rankings and Roadmap website? The health ranking information should be the valid information for that county from the County Health Rankings and Roadmap website. Example: Suffolk County ranks 11 in Health Outcomes out of the 14 ranked counties in Massachusetts (Length of Life = 7; Quality of Life = 13; Health Factors = 12; Health Behaviors = 9; Clinical Care = 6; Social and Economic Factors = 13; Physical Environment = 7) (http://www.countyhealthrankings.org/app/massachusetts/2018/rankings/suffolk/county/out comes/overall/snapshot) Prompt 7. What is the name and web address (url) of the state licensing agency for healthcare organizations in your chosen state (e.g., Department of Health)? The state licensing agency and web address should be valid for the chosen state. Example: Massachusetts Department of Public Health (DPH) (https://www.mass.gov/orgs/department-of-public-health) and the regulations are found at https://www.mass.gov/regulations/105-CMR-13000-hospital-licensure. Note: A list of all DPH licensed healthcare facilities can be found at https://www.mass.gov/service-details/findinformation-about-licensed-or-certified-health-care-facilities, specifically https://www.mass.gov/doc/list-of-health-care-facilities-licensed-or-certified-by-thedivision/download. Charles Harbor General Hospital must be licensed by DPH as an acute hospital to do business in Massachusetts. Prompt 8. Is there an accreditation association for your healthcare organization? If yes, name one accreditation association. Does this accreditation association have deeming authority from the Centers for Medicare and Medicaid (CMS) for your healthcare organization? The statement regarding the existence of an accreditation association must be valid. If an accreditation association is named, it must be a valid one for the healthcare organizations and its CMS deeming authority status must be valid. Example: The Joint Commission (https://www.jointcommission.org/) is an accreditation association which can accredit Charles Harbor General Hospital as a general hospital (https://www.jointcommission.org/accreditation/hospitals.aspx). The Joint Commission has deeming CMS-deeming authority for a general hospital such as Charles Harbor General Hospital. ©Margaret Kilduff 2018 155 Coursera: Healthcare Organizations and the Health System Appendix B: Lesson Two Create Your Own Healthcare Organization Short summary of the learning goals of this assignment In Lesson Four, you will Design a Governance Structure for a Healthcare Organization. This task requires that you synthesize course content to create your own healthcare organization and governance structure. Your synthesized information will be presented to your learner colleagues as an electronic poster. The electronic poster file is an artifact of the course which you can circulate to colleagues or use for a talk or presentation event. For the poster project, you will need PowerPoint software or its equivalent. There are many software options other than PowerPoint. Some are available at no cost such as Impress which is part of LibreOffice. However, it is best not to wait until Lesson Four to begin to synthesize course content to create your own healthcare organization and governance structure. The earlier in the course that you begin this creation process, the better your healthcare organization and governance structure will be. So in each lesson prior to Lesson Four, there will be an opportunity to synthesize material – an opportunity to create your healthcare organization - via an ungraded peer review assessment. Any aspect of your healthcare organization and governance structure can be changed up until the moment you submit the poster. An ungraded peer review assessment is used to allow you to create aspects of your healthcare organization and governance structure as an iterative process throughout the course - should you so choose. An ungraded peer review assessment is used to allow you to provide constructive feedback on this iterative creation of your learner colleague's healthcare organization and governance structure - should you so choose. An ungraded peer review assessment is used to allow your learner colleagues to provide constructive feedback on your iterative creation of your healthcare organization and governance structure - should they so choose. Number of suggested (optional) reviews: 1 Brief explanation on how to do the review This is an ungraded optional assignment. You can choose to create aspects of your healthcare organization and governance structure or you can choose not to do so. You can choose to provide constructive feedback to one of your learner colleagues or you can choose not to do so. Learner ©Margaret Kilduff 2018 156 Coursera: Healthcare Organizations and the Health System colleagues may choose to provide constructive feedback to you or they may choose not to do so. The feedback you provide should be your best and most sincere effort to help your learner colleague create the best healthcare organization possible. All feedback you receive should be evaluated in that light your learner colleagues are sincerely trying to help. Having said that, you are free to disagree with any feedback and ignore it. Example Submissions Here is an example for each prompt to help you understand what your assignment should look like. Use this example to understand the assignment guidelines more thoroughly. In constructing your poster, you are going to do so from the perspective of the chief healthcare administrator for your organization. Healthcare administration encompasses responsibility for all aspects of a healthcare organization. The focus is both internal to the organization and external to the organization to maximize the efficient and effective operation of the organization as a whole and its survival both short-term and long term. Healthcare administrators make decisions about the direction and operation of the healthcare organization. The role of the healthcare administrator is more strategic than tactical. Prompt 1. Name one strategic goal for your healthcare organization. The goal should be a broad and bold one for the organization as a whole, but doable. Example: Create a patient-centered model of care which recognizes the patient as a customer/consumer who has many care choices. Prompt 2. Eleven (11) combined Healthcare Leadership Alliance (HLA) and American College of Healthcare Executives (ACHE) competencies are listed in this lesson. Rank order them in the order you think is the most important for a healthcare administrator where 1 is the most important and 11 is the least important. The listed competencies must be the ones from the lesson. Example: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Administration, Management, and Leadership Organizational Structure and Governance Quality and Performance Improvement Health Care and the Healthcare Environment Communication and Relationship Management Laws and Regulations Healthcare Technology and Information Management Professionalism and Ethics Business Finance ©Margaret Kilduff 2018 157 Coursera: Healthcare Organizations and the Health System 11. Human Resources Prompt 3. There are many journals and publications from which a healthcare administrator can find evidence for the evidence-based practice of healthcare administration. Name two (and the url for the journal or publication) which you would use as a healthcare administrator. The listed journals and/or publications do not have to be ones listed in the lesson, but they need to real journals or publications. Example: 1. Journal of Healthcare Management - https://www.ache.org/pubs/journals.cfm 2. Becker's Hospital Review - https://www.beckershospitalreview.com/ Prompt 4. There are many administrative/management frameworks from which a healthcare administrator can choose to guide the evidence-based practice of healthcare administration. Name the administrative/management framework (or combination of frameworks) which you would use as a healthcare administrator. The listed framework (or combination) does not have to be one listed in the lesson. It does not even have to be one previously described. You can define your own framework. If you define your own framework, please describe it in a sentence or two. Example: Lean Management combined with the Team-of-Teams framework. Prompt 5. There are many healthcare administration-related professional associations which a healthcare administrator can join. Name one (and the url for the association) which you would join as a healthcare administrator for your organization. The listed professional association does not have to be one listed in the lesson, but it needs to be a real healthcare administration-related professional association. Example: American College of Healthcare Executives (ACHE) - http://www.ache.org/ ©Margaret Kilduff 2018 158 Coursera: Healthcare Organizations and the Health System Appendix C: Lesson Three Create Your Own Healthcare Organization Short summary of the learning goals of this assignment In Lesson Four, you will Design a Governance Structure for a Healthcare Organization. This task requires that you synthesize course content to create your own healthcare organization and governance structure. Your synthesized information will be presented to your learner colleagues as an electronic poster. The electronic poster file is an artifact of the course which you can circulate to colleagues or use for a talk or presentation event. For the poster project, you will need PowerPoint software or its equivalent. There are many software options other than PowerPoint. Some are available at no cost such as Impress which is part of LibreOffice. However, it is best not to wait until Lesson Four to begin to synthesize course content to create your own healthcare organization and governance structure. The earlier in the course that you begin this creation process, the better your healthcare organization and governance structure will be. So in each lesson prior to Lesson Four, there will be an opportunity to synthesize material – an opportunity to create your healthcare organization - via an ungraded peer review assessment. Any aspect of your healthcare organization and governance structure can be changed up until the moment you submit the poster. An ungraded peer review assessment is used to allow you to create aspects of your healthcare organization and governance structure as an iterative process throughout the course - should you so choose. An ungraded peer review assessment is used to allow you to provide constructive feedback on this iterative creation of your learner colleague's healthcare organization and governance structure - should you so choose. An ungraded peer review assessment is used to allow your learner colleagues to provide constructive feedback on your iterative creation of your healthcare organization and governance structure - should they so choose. Number of suggested (optional) reviews: 1 Brief explanation on how to do the review This is an ungraded optional assignment. You can choose to create aspects of your healthcare organization and governance structure or you can choose not to do so. You can choose to provide constructive feedback to one of your learner colleagues or you can choose not to do so. Learner ©Margaret Kilduff 2018 159 Coursera: Healthcare Organizations and the Health System colleagues may choose to provide constructive feedback to you or they may choose not to do so. The feedback you provide should be your best and most sincere effort to help your learner colleague create the best healthcare organization possible. All feedback you receive should be evaluated in that light your learner colleagues are sincerely trying to help. Having said that, you are free to disagree with any feedback and ignore it. Example Submissions Here is an example for each prompt to help you understand what your assignment should look like. Use this example to understand the assignment guidelines more thoroughly. Prompt 1. Is the governance structure of your healthcare organization shared or not-shared? Briefly describe the governance relationship between the administrative part of the organization and the professional clinical part of the organization. The description should be a few sentences which concisely and clearly summarize a reasonable governance structure. Example: It is a shared governance structure where the administrative part of the organization and the professional clinical part of the organization have their own organizational hierarchy. There is a Chief Operating Officer (COO) in charge of the administrative part of the organization. There is a Chief Clinical Officer (CCO) in charge of the professional clinical part of the organization. Both report to the Chief Executive Officer (CEO) who is responsible for the overall operation of the organization. Prompt 2. What is the business structure of your healthcare organization? What is the name and web address (url) of the state agency in your chosen state with which your organization must file legal business structure documents (e.g., Department of State)? The business structure and state agency and web address should be valid for the chosen state. Example: It is a corporation located in Massachusetts. In Massachusetts, the corporation business filing agency is the Secretary of the Commonwealth of Massachusetts, Corporations Division (http://www.sec.state.ma.us/cor/coridx.htm). Prompt 3. What is the tax status of your healthcare organization? What is the name and web address (url) of the state agency in your chosen state with which your organization must file legal tax documents (e.g., Department of Treasury)? The tax status and state agency and web address should be valid for the chosen state. Example: It is a non-profit located in Massachusetts. In Massachusetts, the non-profit tax status filing agency is the Secretary of the Commonwealth of Massachusetts, Corporations Division (http://www.sec.state.ma.us/cor/coridx.htm), specifically the section Non-Profit Corporation Forms (https://www.sec.state.ma.us/cor/corpweb/cornp/npinf.htm). Tax paying ©Margaret Kilduff 2018 160 Coursera: Healthcare Organizations and the Health System business organizations in Massachusetts file taxes with the Massachusetts Department of Revenue (https://www.mass.gov/orgs/massachusetts-department-of-revenue). Prompt 4. What is your healthcare organization's mission statement and vision statement? The statements should be no more than a few sentences which concisely and clearly state a reasonable mission and vision for your organization. Example: Mission: To provide the best patient-centered care to every patient through excellent, compassionate clinical practice combined with effective, compassionate administrative processes. Vision: A local community population with optimal health and wellness who views Charles Harbor General Hospital as integral to that achievement. Prompt 5. Does your healthcare organization have a Board of Directors/Trustees? If so, what general characteristics do you want in Board members? If not, how is the oversight and expertise generally accomplished by a Board of Directors/Trustees achieved in your healthcare organization? The description should be a few sentences which concisely and clearly summarize reasonable characteristics for Board members or a reasonable alternate oversight mechanism. Example: Charles Harbor General Hospital has a Board of Trustees. Each Board member should be dedicated the organization's mission and vision. Overall the Board membership should reflect expertise in healthcare organization clinical issues, financial issues, management issues, regulatory requirements, and operational efficiency. ©Margaret Kilduff 2018 161 ©Margaret Kilduff 2018 Coursera: Healthcare Organizations and the Health System Appendix D: Coursera_PD_HealthcareOrganization.pdf 162
