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24 February 2016

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Chapter 5

1. Describe how we measure the clinical performance of an HCO as a whole? For example, can you aggregate good performance in cardiology and poor performance in obstetrics, and say “overall, performance is average”? It depends on how measurement is being done. If a scorecard is used, yes the performance could be aggregated. However, the book mentions moving the departments off the scorecard that do not need improvements and focusing on the departments that aren’t doing well or need improvement in certain areas. Scorecards are beneficial in showing overall performance but can also be evaluated to see which departments are not meeting or exceeding the benchmark. If measurement was on a department basis and one was not doing well, that department would need to focus on the developmental areas in order to say that performance is good. “Overall” means an average or an overview. It’s not specific to one department but an average of all. One could fail and others exceed in which “overall performance” would be “average.”

Chapter 6

1. Describe how an institution can ensure that its medical staff plan is realistic? List the specific steps you think would be important, and which would make a reassuring checklist when presented to physicians and to the governing board. An institution needs to measure input and output to effectively staff the facility. Input can be measured by patient arrivals and appointment requests (request for care). Output can be measured by patients treated, cost per case, quality and access. The physician organization also assists in providing excellent care by recruiting and retaining physicians necessary to provide this care. Physician supply should remain open to leave and come as the community demand raises and lowers. However, it is more effective to be strategic in planning the staffing needs. Too big leaves physicians underworked. Too small leaves physicians­­ overworked. A medical staff plan should be implemented to protect physicians against new competitors.

2. Medical staff leadership: Why should medical staff leadership be appointed by and accountable to the governing board, as opposed to being selected entirely by the medical staff or by the executive? To avoid tax situations, the board must remain nonphysicians (pg 205). Also the board must vote for what is in the best interest of the community. If there were several physicians on the board or the medical staff or executive appointed this, it would be considered a conflict of interest because it’d be harder for the medical staff to do what’s in the best interest of the community rather than what’s in the best interest of the physicians.

3. What is the goal of communication with physicians? How is that goal attained in large organizations? The intent of the communication network is to identify potential conflicts in advance, analyze and understand them (pg 205). PITs, surveys and organizational guidelines and processes are implemented to help resolve these issues. Bylaws are also set and used to describe rights and obligations of each party. They are also used to encourage negotiations and conflict resolution (pg 206).

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