Physician Practices Integration into Existing Hospital-Based Systems - Case Study Example

Primary Health Care systems of the Topic: Cultural and mission differences’ impact on physician practices integration into existing hospital based systems. INTRODUCTION: In the current business setting delivery of promised service becomes vital. Health consumers of the present age are more aware and active in their decision making as far as their health needs are concerned. Providing a meaningful and approachable medical service is more important. (Grant Phelps, 2001)The purpose of this paper is to review the journal article on Primary Health Care Practices and arrive at a plausible finding towards the impact of mission differences and culture on the practices integration. I have picked the following article for the purpose. “Understanding organizational designs of primary care practices/practitioner application” by Alfred F.Tallia, Kurt C Stange, Reuban R Mc Daniel Jr, Virginia A Aita et al, Journal of Health Care Management, Chicago: Jan/Feb 2003 Vol. 48 Issue 1, pg 45. The team had diligently dissected the research findings into three broad classifications characterized by their missions. Health System 1 possessed the mission of customer focus. ‘Patient first’ was the chief driving force of this system. A specific case study revealed that contingency focus was given more priority. Health care services being the kind of social care services are increasingly required to focus on achieving the outcomes that users aspire to, rather than on service inputs or provider concerns. (Caroline Glendinning et al, 2008) Health System 2 was with a mission of academic interest. This system proved to be inordinately theoretic in almost all of its activities and approaches leading to socially unacceptable practices. Health System 3 had a mission of highly clinical motto of prevention of illness. As this system transcends the treatment options, the goal and target of the system tends to reach the needy and hence attains a supreme position. This system since attempts to understand the patients’ psyche excels well. Patients are normally focused on perceived ‘priorities’ like access, location of services confidentiality and choice. (Tracy L Finch, et al, 2008) Nine cases under study among these three major classifications clearly depict the organizational model that would suit best. Health System 1 contained five cases, health System 2 contained three cases and the Health System 3 contained one case. The demographic coverage for all the nine case studies comprised of both growing and underdeveloped population. The locations of the cases vividly present the picture. Cases E, H, M, N and P under Health System 1 covered well grown sub urban, regionally competitive area and small towns. Rapidly grown sub urban and low competitive rural areas were covered in Health System 2. Peripheral to the downtown of a major city was covered under Health System 3. Thus Health System 3 is the most suitable to the research in which medical intervention is the most needed one. The approaches of the medical professionals in this area would be the landmark of development in any society or community. STYLES OF FUNCTIONING OF THE CASES UNDER STUDY: Cases E and H were found to function with strict and standardized protocols. Case M was found to function in an efficient interactive style while case N had interaction among cross-trained staff. Case P was interdependent between community based health services. Health system 2 with academic goal was found to be almost non-functional. This may perhaps be due to the virtual non-focusing on the needy. Additional factors for failure in this model may be due to the disruptive organizational structures involved. Lack of respect for System and leadership was the root cause of its non-functional matrix in case F. Poor communication and lack of clarity about the mission predominated in case G resulting in non-functionality. Unaffiliated practice J would have been a success but for its autocratic decision making style because the low competition rural community was the fertile soil for organizational accomplishments. Practice A as depicted by the team sounds good in organizational model and marketing success. This was because the ‘disease prevention’ goal of the practice rendered all the staff and physicians highly cooperative in their interactions keeping their mission as their motto. As such there was never found any mission confusion. The organizational strength and viability also proved to be elegant in which staffs were recruited merely on the basis of the fittest qualifications. The factor of health system affiliation and non-affiliation did not matter in the functioning style of this practice A. The pattern of decision-making in this model played a key role in which, physicians occupied the apex position. Although non-clinicians in system affiliated practices had considerable roles in decision-making, the physicians did not lose their autonomy but were experiencing varying degrees of their autonomy. RELATION AMONG THE PHYSICIANS AND STAFFS: The relationship in all the five practices under Health System 1 looks very nice. The physicians and other staffs in practice E were friendly and professional. This in no way diluted their mission but enhanced the strength of further developing and improving their goal. The family like interactions between the staffs in practice H provided longevity in their furtherance. The nice interaction among the Managers in practice M paved way for customer satisfaction in addition to patient education. The Team Spirit found in practice N was found to flourish human relations amidst a pleasant working environment. Practice P as depicted by the authors although did not talk much about the relationships between the staff and physicians sounds a well-knit team spirit. The much worried non-functional and failure resulting Health System 2 is self evident in the relationship between physicians and their staff. Practice F is surrounded by poor communication and lack of understanding. A managerial void in practice G clearly predicts its debacle. An autocratic top down communication style in practice J, which was merely money-minded, revealed the non-focusing on patients’ health care. The organizational excellence is portrayed in practice A, wherein the authors have not mentioned the inner details of staff relationship. However, the team had presented the splendid nature of the interactions between the staff by way of their success in achieving their goal of disease prevention and patient education. CULTURAL AND ETHICAL ISSUES IN RELATION TO THE LOCATIONS: The mission of the Health System 1 suits well for the locations of study selected by the team. Growing and rapidly growing sub urban area covered under practice E and H; an area of emerging regional competition for practice M; and small towns of practice N and P were the fittest locations for continuing the health care practices without aspiring for further creativity in their activities. This was because the population of such sub urban area would normally be expecting just its need be met immediately with less foresight of development of the society as a whole. As such, customer focusing was sufficient to run the show in any health care practices. The strict protocols as found in practice E and an environment of family-like interactions between the staff in practice H would generally please the patients and keep them at ease. The readiness of the managers to accept new ideas and processes in office automation in practice M, the team spirit in practice N and the community based health services in practice P were certainly the factors that filled the patient’s mind with a sort of grandiose about the medical service provided. The academic goal was found to be quite inappropriate in rapidly grown sub urban areas, sub urban areas and low competitive rural areas in case of health System 2. Practices F and G would have been a great success had they been attempted in metros or big cities. The general trend of population in such growing sub urban areas did not pay much interest in getting educated socially as far as medical services were concerned. Recuperation from illness was the just need of such societies. The utter debacle of the practice J was ascribed chiefly to the improper mission of the practice which was substituted by the money-oriented services that normally could not be met by a rural community despite the lesser competition in those areas. An other factor that health care facilities could not meet the actual needs of rural population is the Balanced Budget Act 1997. Willium J McAuley (2008) found that the loss of aides in more rural counties limit the availability of home based long term care in such locations, where the need for long-term care is considerable. (William J McAuley, et al 2008) The success in practice A that paid attention mainly on environmental viability sounded well in down town areas of major city. The customer-oriented practices in this model were found to occupy a soft corner in the minds of people of the area, since the mission of the health System 3 had an undertone of patient welfare. This type of undertone in the activities of the medical professionals strongly outweighed the explicit display of the mission on the walls of care centers and hospitals. PRUDENT DISCUSSION IN THE JOURNAL: In the discussion section of the journal the authors have placed a well-knit presentation of the ups and downs of the various health care systems irrespective of the fact if the systems were affiliated or not. The team had laid four suggestive implications of all the nine case studies. They are: - 1) Versatility is the best substitute against uniformity, 2) Freedom to attend the local environment nullifies the hardship of inhibition in practice response caused by the thrust of hierarchical designs; 3) The sense of responsibility and owning in practitioners are the aspects that steadily increases the patient flow; and 4) Managerial skills of administrators. CONCLUSION: A chronological research study conducted by Alfred F Tallia et al (2003) envisaged the different aspects of health care practices keeping the mission of the Health Systems as a central nerve of entire medical profession. The team had analyzed organizational designs in their study, which played a key role. The authors ascribed the structure and quality of these organizational designs to either the rise or fall of the system. The much concern of the team was that many hospital systems ignored the ever-important OD, the Organizational Design. They opined that reluctance to diversity and flexibility in managerial skills was the impasse in understanding the unique values, abilities, strengths and weakness of clinicians and staff. To put it in other words, Managers who are rigid and unadventurous are averse to organizational designs, which is a golden key to the prosperity in health care practices. * * * * * * Reference list – Alfred F.Tallia, Kurt C Stange, Reuban R Mc Daniel Jr, Virginia A Aita et al, “Understanding organizational designs of primary care practices/practitioner application” Journal of Health Care Management, Chicago: Jan/Feb 2003 Vol. 48 Issue 1, pg 45 Caroline Glendinning, Susan Clarke, Philippa Hare, Jane Madison and Liz Newbronner, 2008, “Progress and Problems in developing outcomes-focused social care services for older people in England”, health and Social Care in the Community, Vol.16. Issue 1: pp54-63 Grant Phelps, 2001, “Quality Assessment in Private Practice:The Clinician as Service Provider”, Journal of Quality In Clinical Practice, Vol. 21, Issue 4, pp 118-119 Tracy L Finch, Maggie Mort, Frances S Mair and Carl R May, 2008, “Future Patients? Telehealthcare, roles and Responsibilities”, health and Social Care in the Community, Vol. 16. Issue 1, pp 86-95 William J McAuley, William Spector and Joan Van Nostrand, 2008, “Home Healthcare Agency Staffing Patterns before and after the Balanced Budget Act 1997, by Rural and Urban Location”, The Journal of Rural Health, Vol. 24: Issue 1, pp 12-23 Read More