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CMN 463 Exam 2
Terms in this set (59)
What bias do Poole and Real identify in the literature on teams in health care?
ideologies on the "right" way to provide health care; a considerable number of case studies are reports of team success from a member of the team, so its difficult to determine whether biases affected the conclusions
three or more individuals who must interact interdependently to achieve common goals
What factors are involved in variations in entivity or solidarity of work groups?
-identity: do they identify themselves as a member?
motivation to participate: varies across population and time
-aware of shared knowledge experiences, norms, and values: recognize common values with other team members
-interaction: are team members just available or also interactive with one another?
How many stages identified in the evolution of teams in health care?
-1910-1945: fitful growth- naive optimism that we would always work together
-1945-1970: high tide- new disciplines, organizations
-1970s: re-evaluation- it is really working? (re-assesment of how teams work)
-1980s: present "consolidation" - TQM- bloomed in the 80s and is here to stay, uses statistical data and teamwork to identify production process problems
nurses in one area, all trained the same way and focus on patients in the same way (high functioning team)
silos, require effective communication, leadership, fight their way out of silos to see someone else's point of view (needs leadership to organize)
ongoing cooperation, hard but has high value, difficult to have this kind of team without feeling like you're talking across cultures (you have different values and orientations)
cross training, hardest, our training now doesn't allow people to train in 2 disciplines in medicine because so much training is required for each
boundedness, centralization, and diversity are characteristics of what aspect of teams in health care
internal versus external reporting
concentration of authority
similarity of members
how is a medical group defined
-3 or more physicians (practice together in the same area for a long time)
-formally organized as a legal entity
-governed by physicians, shared facilities, record, personnel
-goals objectives, values commonly defined
-income treated as receipts of the group, distributed as a plan
medical groups single or multi-speciality?
most groups single speciality and small, but over half of physician positions are in some kind of groups, multi-specialty groups larger and more likely to include primary care physicians
the first prominent medical group in the US was the _______ brothers clinic in rochester, minnesota
What areas or specialties of practice are typically associated with primary care?
what features of communication are typically associated with primary care?
-technical: classified techniques on how to do things/talk about things
-formal: written down
-complex: variety of mixes of health conditions and patient types and from administrative point of view
-urgent: people that show up often have a pressing matter
-private: hard to keep information available to those who need it and private from those who don't
-shared: information is shared between doctors that need it
medical specialty "board"
boards: the organization of knowledge and practice by practitioners
boards: nonprofit organizations that act as gatekeepers
What is the relationship between the gender and medical profession on the one hand and gender and the wider culture on the other?
gender and medical training, more men than women, the occupation of medical practice is influenced by the wider culture; women who enter medicine face many of the same constraints faced by women in other occupations
Why is it important that hispanic and AA physicians disproportionately serve their communities of ethnic origin?
-50% of black MD's patients are black
-nonwhite physicians do not reflect their numbers in the population, but minority physicians tend to treat a high proportion of patients of their own race or ethnicity, and women and minority physicians are much more likely to serve minority, poor, and medicaid poulations
is the supply of physicians in a country direct evidence of the quality of medical care or the quality of health in that country?
the supply of physicians in a country is not direct evidence of the quality of medical care or the quality health in that country
according to lecture roughly what percentage of the health care workforce is accounted for by physicians?
less than 10%
what is the trend in median medical education debt for indebted medical students in the US?
-debt is increasing
-average medical debt in 2009- 156,456
-79% of graduates have debt of at least 100,000
-58% of graduates have debt of at least 150,000
-87% of graduating medical students carry outstanding loans
3 ways a nursing degree may be obtained
bachelor of arts (BA), associates degree (AA), diploma
what is the number of non-profit hospitals in the US
what are the benefits of nonprofit status for hospitals?
don't have to pay income taxes on their earnings (income and property tax exemptions), also have reduced mailing rates
4 rhetorical standpoints may be identified in the communication of hospital staff regarding DRG's
advocate, strategist, referee, bystanders
values efficiency over all else
values care over efficiency (care is most important)
values balance of care and efficiency
don't get involved in debate
-joint commission on accreditation of health organizations
-nonprofit organization that accredits hospitals, health care networks, home care orgs, long-term care facilities, assisted living residences, behavioral health orgs, ambulatory care providers, clinical laboratories
what percentage of american physicians are members of the AMA?
just under 300,000 members in 1999 accounting for roughly 38% of american physicains
primarily made up of individual members, therefore not as relevant because so many physicians are now employed or members of medical groups, not as unified about policy matters as they once were, less than 1/2 of US physicians among its association
aside from the traditional status difference between physicians and nurses, their associations and work situations contrast sharply, composed of 53 associations, 13 affiliated associations, and approximately 70 other, it is more integrated and federated than AMA, individual members of the ANA are automatically enrolled as members of constituent associations at the state level
simplest form for the delivery of health services in the US?
solo-practicing physician, although the percentage practicing as solo has declines, the most common practice type and the one that remains as a cultural icon is the solo practice
more common, solo or group?
how many non-physicians does the typical private solo medical practice employ?
as of 1996, how many medical groups were in the US?
why has the hospital been described as a "negotiated order?"
-feature of hospitals= dual hierarchy, physicians are organized in one hierarchial staff, and other hospital personnel
other than obvious procedures, there are few explicit rules for conduct
-many ways to "produce" a healthy patient (ex. surgery or drugs to cure something)
-when there is a policy, it may not apply equally to all situations
-conflict between prevailing (by the books) and evolving order (differs between different patient and team of doctors)
-the dual hierarchy: physicians organized in hierarchial staff, and other hospital personnel organized in a second chain of command --- contributes to the nature of the hospital as a negotiated order
why are nursing homes described as unusual as medical care settings?
-extremely high rates of mortality after industrialization
-patients and providers in nursing homes, as contrasted with hospitals and other settings, interact almost entirely within the org and in insolation from other social influences
in what 4 ways is hospice organized?
-Both proprietary and nonprofit home health agencies (providing care in homes rather than in inpatient facilities)
-Operating units or departments of hospitals
-Operating units of departments of a nursing facility
-Freestanding, independent, mostly nonprofit organizations
why is increasing disease chronicity important for health organizations?
-care for chronic disease typically involves a variety of clinicians and health care settings over extended periods
-U.S. Institute of Medicine is encouraging providers to recognize the important of improving chronic care services as a part of overall quality improvement in U.S. health care systems.
-care for the chronically ill frequently requires a collaborative, multi-disciplinary approach.
-effective methods of communication among caregivers and between caregivers and patients are critical to providing high-quality care.
-Problem: physicians, hospitals, and other health organizations typically work so independently that they frequently provide care without the benefit of complete information about patients conditions, medical histories, or treatment received in other settings.
-moreover, the collaboration and teamwork called for by the rise of chronic diseases seem to occur more frequently among non-physicians than among physicians, whose training and socialization prepares them for roles as autonomous and independent practitioners rather than as collaborators
why are changes in demographics important to health organizations?
-patients tend to want doctors from their own community origin, therefore the more hispanic patients, there is a higher demand for more hispanic physicians
-must encourage people from different ethnicities to go to medical school
Why is the potential for the use of information technologies in health care limited?
-currently, public and private payers of medical services do not reimburse providers for many applications that have demonstrated value such as tele-medicine or patient-provider interactions over the internet
-decision-support tools can provide critical links between a current patient's condition and previous clinical studies, but such systems await investment
-the biomedical community "has tended to rely on information technology innovations that are produced by investments in other industries and other parts of government"
On what does an institutional perspective on health communication focus?
-emphasizes the rules, values and beliefs that surround organizations and their members as critical components of behavior and communication practices within organizations
-structures and routines that make up organizations are reflective of rules & structures in wider environments
-development of beliefs, values and behavioral expectations
-looks to the external environment for the logic of organizational structure rather than to to the internal
-institutionalized meanings: portable beliefs we have about how organizations should look and what they typically do--pervade organizations
-recognizes the drift toward "rationalization" of organizational forms
What issues were illuminated by the case of Dr. Smalley?
-Dr. Smalley was a neonatologist (worked with premature babies) & got put out of work when the 2 hospitals (Linford & Pearl) decided to not have a joint center for neonatologists anymore
-Non-compete clause: can't practice within 60 miles of your previous work location
-It was an issue for Linford to staff their own center because you need a physician on duty 24/7
-Being put out of work like Dr. Smalley can happen to someone who works for a large group and has a specialized practice
What were the categories of statements that Vogwill and Reeves used to code "bullet round interaction?"
What was the most common type of statement Vogwill and Reeves found?
who talked the most in bullet rounds?
what is the name of the health reform law signed in March 2010 by president obama?
affordable care act
what are the relative advantages of solo practices?
-establishing long-term patient-provider relationship
-independence: from other practitioners, healthcare
-determine location of their practice
-arrange offices to their liking
-hire their personnel they think they need and who they want to employ
-select the labs that will perform their tests
-set their own office hours, fees, and many other elements associated with the practice
-determine the extent of the success of their practice
what are the relative disadvantages of solo practices?
-hold all responsibility: not only physician, but business owner
-uncertainty about how rapid practice will grow
-uncertainty about frequency of referrals
-unpredictable rate of growth of income
-initially income may be less than that of salaried practitioners whose expertise is paid for by their employers
-full liability for overhead
-need for coverage on days off or vacations
what are the alternatives to solo practices?
-sell services to group practice
-join group practice
-locum tenens: place holders, work for replacements, work for doctors on leave
Putnam and Stohl identified two aspects of bona fide groups, and Lammers and Krikorian added what others?
-Putam and Stohl- stable yet permeable boundaries and interdependence
-Lammers and Krikorian- network centrality, institutional environment, membership pool characteristics, emergent nature of the tasks, connectivity using analytic networks
What is the distinguishing structural feature of the traditional hospitals in the US?
dual hierarchy- there are two command structures (medical staff and administration) that are equal in power in hospitals unlike other organizations that only have one (like military)
What did Gross and Budrys discover about physicians' contro over their work in a prepaid group practice
-do not recognize the effect that administrative processes can have on their efforts on what they are trained to do, which is patient care
-decline in their control over work, relative strength of other factors (job security) compensated for it
what distinguishes hospice in contrast to other health organizations?
-purpose of hospice is to provide exclusively palliative rather than curative care
-provide "medical social emotional and spiritual services to terminally ill patients and their family members"
-care provided in hospice setting is interdisciplinary
-hospice relies heavily on volunteer workforce
based on insurance principles, why does law now require everyone to purchase health insurance?
people are required to get health insurance because it is legal to tax people, but not legal to require people to do it for the reasons they carry their health over interstate lines
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