Factors Influencing Hospital Governance and Performance

Origin, Organization and Performance of Hospitals Giselle R. Mills Masters of Science in nursing education, Aspen University N502 – Health Care Systems Dr. Patrica McAfee June 1, 2021

A health care system takes proper management and support in order to be successful for the people it serves. It is absolutely crucial for all parties involved in the health system to tackle the challenges to make the organization a success. We will identify four factors that contribute to the tension between medical staff, board of trustees and the administration. Discuss the public’s readiness to view survey findings of hospital care and explore the advantages and disadvantages of free-standing diagnostic, treatment centers and speciality hospitals. For a hospital to operate efficiently and effectively, the three important influences in its governance: medical staff, board of trustees, and administration, must work together in reasonable harmony. What factors contribute to the tension that usually exists among them? For the management of hospitals to operate efficiently and effectively a well-founded administration is required. In order for the health care organization to function to the best of its ability, we can treat each influencer like Lego blocks. For example, to create a model using Lego blocks, each individual block must fit into the next block appropriately for it to stand on its own and become the model we desire. Therefore, we should be able to ensure that each influencer within the hospital system is on the same page, working towards the same goals and objectives to achieve smooth operation of the hospital. Unfortunately, the health care system has a diverse population and comprises of different background and cultures, hence, tension may develop and disrupt the well-being of employees. Factors that contribute to the existing tension among the medical staff, board of trustees and administration includes: Behaviour, communication, poor management and resistance to change.

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Behaviour According to Arnwine (2002), board behaviour is operating in accordance with the set roles and responsibilities stipulated by the board. Behaviours also include pivotal characteristics which include respect, sincerity and honesty in board discussions and maintaining confidentiality. The medical staff, board of trustees and administration must be open to all ideas and all respect each other’s views. Tension between these members develops when there is lack of respect and unwillingness to be open to other ideas. In a study conducted by Stecker et al., (2013) typical disruptive behaviours include lack of team work, belittling statements, inappropriate use in tone of voice, not listening or being inattentive to information distributed. Others include sabotage (telling lies, exaggerating, gossips and spread rumours) and social media bullying. Communication Effective communication plays a key role in the success in any business. For communication to be functional it requires the source, message and destination (Schramm, 1954). Any barrier between these three elements results in failure and tension among those involved. Communication should be clear and concise. Poor communication skills may lead to retaliation in staff withholding vital information because of fear of outbursts (Ramsay, 2001). The U.S healthcare system is multi-faceted with diverse healthcare professionals from different background. Tension develops if staff is withholding information, staff are less willing to assist, and it may even lead to injury of patient, and even worse, lawsuits. In another study conducted by Panahi et al., (2019) unclear information, improper interpretation and disruption in communication channel also contribute to the probability of tension which may lead to poor staff performance or losing excellent staff.

Poor management Panahi et al., (2019) suggests that poor management influences the development of tension. The authors study reveals that a difference in salaries and benefits was one of the main contributors of tension amongst the organization. Staff also compared their work contribution and if they feel its unequal it resulted in poor team work and tension development. Management often neglects the staff’s participation and opinions in decision making, therefore leading to unsolved issues. Inappropriate distribution of funds and unrealistic budgeting can lead to lower job satisfaction, inadequate staffing leading to high staff turnover rate and potentially becomes unattractive to future new hires (Moeta et al., 2019). Resistance to change The healthcare systems are constantly evolving and seeking ways to enhance healthcare to ensure the best services are offered to their customers. Regrettably, not all parties are willing and ready to embrace change to achieve a successful organization (Narine et al., 2003). Most times individuals are stuck in old habits that they are familiar with and fear the unknown of the change. To prevent tension, all parties involved must be informed and understand reason for the change and how they will be affected individually.

Organizations such as the LeapFrog Group represent a growing trend to survey and report on the quality of hospital care and to make the findings available to the public. What are your opinions about the public's readiness to deal with having this information available and using it to make choices about medical care? The Leapfrog group is a national non-profit organization in the American healthcare, which provides transparent reports on the healthcare quality and safety, giving consumers information to make reasonable decisions (The Leapfrog group, n.d.). Making this information readily available to the public can be both positive and negative. For the positive outcomes: Customers are able to view hospitals grading according to the quality care and bring awareness as to how care is provided. Customers are made aware beforehand of new technologies used by the facility. It pushes hospitals to provide and function at its highest level so as to satisfy its customers and aim for them to return. Customers are able to view previous reviews of the hospital and the care provided so as to determine their choice in seeking care. For the negative outcomes: The survey may not be a true reflection of the institution as they may have improved on their standards. Bias, not all participants are truthful and some may be biased with answers. Sometimes a lot of persons with positive feedback do not participate in therefore causing the negative to outweigh the positives.

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Results may not be interpreted correctly, for example, a low grade or bad reviews may influence a person with life threatening condition to go out of proximity to another facility with better reviews therefore putting the person’s life at risk. Increase in patient flow to a facility with high reviews may cause increase in wait times, staff burnout and limited resources. Is the public ready for this information? I think so. In recent times customer satisfaction is the top priority of businesses. From restaurants to stores shopping malls to government facilities ask for reviews. This is not only to separate good eggs from bad eggs but for the business to improve the way service is provided.

Hospitals are facing unprecedented financial challenges from entrepreneurial physician initiatives that are establishing competitive, free-standing diagnostic and treatment centers and specialty hospitals. What are the advantages and disadvantages to these developments from a patient perspective? According to Gilmour (2003) free-standing diagnostic and treatment centers are health facilities that stand independently and provide diagnostic and surgical services that were once only available at hospitals. They have increased in numbers since the 1980’s and some even have expanded their features, provide access to wide variety of technologies and perform short stay surgical procedures. These integrated systems provides attractive ‘one- stop shopping’ benefits (Young et al., (2018). Advantages According to a study conducted by Alexander et al., (2019) the development of these free- standing facilities help to provide people with hospital based care and reduce stress on the emergency system at hospitals. Development of more facilities gives more choices to get care Less wait time/ faster appointment schedules Most often has more modern technology leading to faster and more accurate results Patient care turnover rate is faster. Disadvantages The same study conducted by Alexander et al., (2019) also revealed that costs of free standing facilities cater to those of affluent population instead of expanding care to the underserved population .

Care is more expensive than going to a primary doctor. If an individual does not have insurance, cash payment upfront required. They do not accept government insurance such as Medicaid/Medicare. Prior to the covid-19 pandemic, federal regulations did not reimburse free standing ED’s for care provided. The Trump administration temporarily allowed free standing ED to accept patients with medicad/medicare in some states were there was serge in cases (Colorado, Delaware, Rhode Island and Texas) to care for the most vulnerable citizens (Centers for Medicare and Medicaid Services, 2020)

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References Arnwine D. L. (2002). Effective governance: the roles and responsibilities of board members. Proceedings (Baylor University. Medical Center) , 15 (1), 19–22. https://doi.org/10.1080/08998280.2002.11927809 Centers for Medicare and Medicaid Services. (2020). CMS issues guidance allowing independent freestanding emergency departments to provide care to medicare and medicaid beneficiaries during the covid-19 public health emergency. https://www.cms.gov/newsroom/press-releases/cms-issues-guidance-allowing- independent-freestanding-emergency-departments-provide-care-medicare Gilmour, J. M. (2003). Regulation of free-standing health facilities: An entree for privatization and for-profit delivery in health care. Health Law Journal, 131-152. https://www.proquest.com/scholarly-journals/regulation-free-standing-health- facilities-entree/docview/212115797/se-2?accountid=34574 Moeta, M. E., & Du Rand, S. M. (2019). Use of scenarios to explore conflict management practices of nurse unit managers in public hospitals. Curationis , 42 (1), 1-7. http://dx.doi.org/10.4102/curationis.v42i1.1974 Narine, L., & Persaud, DD. (2003). Gaining and maintaining commitment to large-scale change in healthcare organizations. Health serv manage res. 16 (3), 179-187. http://doi: 10.1258/095148403322167933. PMID: 12908992 Panahi Tosanloo, M., Adham, D., Ahmadi, B., Rahimi Foroshani, A., & Pourreza, A. (2019). Causes of conflict between clinical and administrative staff in hospitals. Journal of education and health promotion , 8 , 191. https://doi.org/10.4103/jehp.jehp_54_19

Ramsay M. A. (2001). Conflict in the health care workplace. Proceedings (Baylor University. Medical Center) , 14 (2), 138–139. https://doi.org/10.1080/08998280.2001.11927749 Schramm, W. (1954). The process and effects of mass communication. University of Illinois Press. Stecker, M., Epstein, N., & Stecker, M. (2013). Analysis of inter-provider conflicts among healthcare providers. Surgical Neurology International, 4 , 375-382. http://dx.doi.org/10.4103/2152-7806.120781 The Leapfrog Group. (n.d.). Who we are and our mission. Retrieved June 4, 2021, from https://www.leapfroggroup.org/about Young, K. and Kroth, P. (2018). Sultz & Young’s Health Care USA: understanding its Organization and Delivery . Jones & Bartlett Learning.

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