Break-Out Clinic - Goals and Objectives for Attendees - Case Study Example

Running Head: Break-Out Clinic Student’s name: Instructor’s Name: Course Code and Name: University: Date of submission Break-Out Clinic Introduction This is a brief content outline for a break-out clinic to be held in a 2-day workshop at the Greater Metropolitan Hospital. The hospital’s council have commissioned an an expert consultant in health care management to design the break-out outline for the clinic that facilitates a discussion on the appropriate role of health care leadership in the relationships of patients to providers, patients to payers, and providers to payers. This workshop will target three types of audience constituting the representatives from for-profit, not-for-profit, and governmental health care organizations. Of special interest to the workshop will be the ethical considerations associated with determining the proper role of healthcare leadership in the creation and maintenance of healthy and cordial relationships between healthcare providers and their patients, between the providers and the payers and also between the payers and the patients. Further the workshop will attempt to achieve specific goals and objectives for each of the attendees in the information clinic. To facilitate a comprehensive coverage of the issues that concern each of the audiences, the information clinic will be structured in three forums, each catering for the type of attending audience. As such the following are three outlines designed for the for-profit, the not-for-profit and the governmental health care organizations’ representatives. Outline for the For-Profit Organisations Overview Profit-based healthcare organisations have a unique role in the healthcare industry in which they have to juggle between quality healthcare as a service to the community and making returns for their investment (Porter and Teisberg, 2006). In modern day society, for-profit healthcare organisations have increased in both size and number. While considering their mandate as helping patients to retain and promote optimal health, these organisations have to go further and consider the financial implications of their services (Herzling, 2006). To such institutions, patients become customers. This unique scenario is suspect to a lot of ethical considerations and issues (George, Sillup and Porth, 2008; Almgren, 2007). Towards that front, the information clinic for profit-based healthcare institutions shall primarily aim at a discussion of ethics and responsibility as regards the relationships existing between patients and providers, patients and payers and payers and the providers. Goals and Objectives for Attendees The goals of the clinic shall be five: a) To Facilitate a discussion by the representatives of how healthcare leadership in for-profit establishments can foster good relationships between patients and providers In the discussion, the forum moderator should channel contributions words the following concern points. Patients visit for-profit healthcare establishments to seek care and they are concerned that what they get is worth their money. Because they are paying, they also expect to be treated well as customers. Patients are also concerned that the providers will act in their own interest and not simply to make more money by unnecessary referrals and treatments (Williams, 2009). The providers themselves have to think about patients as needy of help as well as paying customers (Almgren, 2007). In this role, it is essential the healthcare organisation enables a good relationship to bloom between the service providers and the patients by ensuring that neither of them ignores the needs and expectations of the other. There are several ways to do this. For one, the healthcare leaders may educate their staff to improve their customer relations attitude and practice in ways that cater for the customer’s interest fully and then proceed to ensure that the service providers insist on quality delivery (Porter and Teisberg, 2006). These, two are the only needs of the patient and they will greatly benefit the relationship of the patient and the service provider. There should also be clear communication channels between the providers and their patients, so that the patients can voice their needs and concerns, and get appropriate feedback. b) To Facilitate a discussion by the representatives of how healthcare leadership in for-profit establishments can foster good relationships between providers and payers Payers have completely different needs from those of patients. The payers’ interest is how much the patients are charged and not really the quality of the services they get. For payers, openness of the healthcare programs, access to patient’s records (Dick and Steen, 2006) and the reasonableness of healthcare costs are the most important needs that healthcare leaders must ensure served (Jasper and Jumaa, 2005). The leaders have a mandate to ensure that the payers know what they are paying for and why, as well as the alternatives existing (Chaudron et al, 2006). This can easily be achieved by automating and systematically documenting patient records well (Dick and Steen, 2006) and then making them accessible to the patient’s payers in a timely and efficient manner (Almgren, 2007). On the other hand, providers are interested in knowing whether the patient is covered for the costs of the healthcare services they need and whether the patient can afford the treatment needed. It is the responsibility of the healthcare leaders to cultivate and maintain clear and expedient communication channels that will allow them access such confirmation from the payers. As noted above, for-profit healthcare providers work in a business setting and the patient’s ability to afford treatment is of grave concern. c) To Facilitate a discussion by the representatives of how healthcare leadership in for-profit establishments can foster good relationships between patients and payers Many times, hostilities in the relationship between payers and patients accrue due to misinformation and lack of information. The patients do not know what they are covered for and the patients do not know the medical needs of the patients. Healthcare leaders have a role to play in mediating this information gap, by ensuring that after confirmation with the payers, the providers clearly inform the patients the treatment needed, its cost and what the payers are ready to pay for. The providers should also promptly inform the concerned payers of the medical needs of the patient and the probable cost. In mediating the information gap, healthcare leaders will ensure that both the patients and the payers are on the same page and their relationship is cordial. d) To elaborate on the role of the healthcare leadership in ensuring these three relationships complement each other within the organisation. As noted, the relationships existing in the patient-provider-payer axis mostly depends on the role of the leadership in the profit-based healthcare institutions. Leaders in most cases play a mediation role, a role that demands they be in a constant contact with the three parties. How well they do this, will determine the kind of relationships that emerge between the three parties. The clinic should therefore aim at discussing the essential qualities and responsibilities of the leadership in the profit-based healthcare institutions, in view of this pivotal mediation and monitoring role. e) To elaborate on the possible ethical issues that may arise in each of these three relationships In all the three relationships highlighted above, numerous ethical concerns emerge. These ethical concerns are pertinent to the establishment and maintenance of good relationships between the three parties involved (George, Sillup and Porth, 2008). During the clinic, participants should be able to identify and discuss all the ethical concerns in each relationship. A guide on these ethical issues is elaborated hereafter. Ethical Considerations It is important that during the information clinic, the participants be able to consider the set of ethical issues involved between patients and providers, providers and payers and payers and patients in profit-based healthcare organisations. The following are some possible ethical issues that may arise in each of these three relationships. a) In Patient- Providers relationship, the question of subjecting patients to unnecessarily treatments to raise the costs of medical care, question of providers sharing patient information with other parties unethically (confidentiality), questions of patient consent and questions of decency should be discussed (George, Sillup and Porth, 2008). b) In Provider-Payer relationships, the ethical concerns of hiked medical costs, disclosure of patient information, malpractices and payment of claims should be discussed (George, Sillup and Porth, 2008). c) In Patient-Payer relationships, the ethical concerns of non-disclosure of medical condition, hiked medical costs, patient information confidentiality and payment of claims should be discussed (George, Sillup and Porth, 2008). Session Schedule To achieve the objectives highlighted above, the clinic session should have the following schedule. Activity Discussion Time 1 Introductions 5 Minutes 2 A general exposure by the convener on the objectives of the forum and the issues to be discussed 20 Minutes 3 Discussion on Patient-Provider relationships in profit-Based healthcare organisations 10 Minutes 4 Discussion on Patient-Payer relationships in profit-Based healthcare organisations 10 Minutes 5 Discussion on Payer -Provider relationships in profit-Based healthcare organisations 10 Minutes 6 Discussions on the general role of healthcare leadership in establishment and maintenance of good relationships between the three parties 30 Minutes 7 Discussions on Ethical Considerations in each relationship 30 minutes 8 Conclusion 5 Minutes Outline for the Not-For-Profit Organisations Overview Not-for-profit healthcare organisations have the benefit of gaining trust from patients and payers because they are not in a business setting. Their mandate spans up to providing healthcare as a service to the community. They are more concerned in helping patients to retain and promote optimal health. But several concerns arise in their practice such as the limitations of funding, qualifications (Ubel et al, 2005) and expertise of their medical teams as well as the delivery of their services (Wurman, 2009). The information clinic for the not-for-profit healthcare institutions shall primarily aim at a discussion of effective ethical and service delivery concerns in the relationships existing between patients and providers, patients and payers and payers and the providers. Goals and Objectives for Attendees The goals of the clinic shall be five: a) To Facilitate a discussion by the representatives of how healthcare leadership in not-for-profit establishments can foster good relationships between patients and providers In the discussion, the forum moderator should channel contributions words the following concern points. Patients visit not-for-profit healthcare establishments to seek care mostly when their ailments are not so serious as to seek specialized care or when they lack the financial ability to go elsewhere. As medical care costs rise beyond the rich of majority, these institutions have to deal with the bulk of the population today (Woolhandler, Campbell and Himmelstein, 2008). The result is that a single physician in these institutions sees so many patients in a day that, he or she cannot possible create a good relationship with any of them. Instead of caring about the relationship with patients, providers here only care about the number they attend to versus the number waiting for them in the waiting bay (American Hospital Association, 2010). It is important that healthcare leaders help reduce the bulk that providers attend to and improve the quality of time spent with each patient (Porter and Teisberg, 2006; Wurman, 2009). Patients on the other hand must appreciate the then workload of the providers. The leaders should also insist on provider’s performance based on quality service instead of patient numbers. b) To Facilitate a discussion by the representatives of how healthcare leadership in not-for-profit establishments can foster good relationships between providers and payers Payers in this case are interested in how much the patients are charged (Wurman, 2009). The leaders should ensure that the payers know what they are paying for and why, as well as the alternatives existing (Chaudron et al, 2006). Providers are interested in knowing whether the patient is covered for the costs of the healthcare services they need and whether the patient can afford the treatment needed. They use this information to seek alternatives with their superiors on how to help the patient. A good and expedient communication channel between payers and providers will help cater for the interests of each party, where the payer and the provider agree on the best interest of the patient. c) To Facilitate a discussion by the representatives of how healthcare leadership in not-for-profit establishments can foster good relationships between patients and payers Again, even in the not-for-profit establishments, hostilities in the relationship between payers and patients accrue due to misinformation and lack of information. The patients do not know what they are covered for and the payers do not know the medical needs of the patients. Healthcare leaders have a role to play in mediating this information gap. The providers should also promptly inform the concerned payers of the medical needs of the patient and the probable cost. Healthcare leaders should adjudicate in the understanding of both the patients and the payers such that they act to the interests of the patient. d) To elaborate on the role of the healthcare leadership in ensuring these three relationships complement each other within the organisation. The relationships existing in the between the three parties depends on how well the leadership in the not-for-profit healthcare institutions. The greatest role the leaders can play in this scenario is highlighting the best interests of the patients and finding a middle ground in which providers can help, payers can participate and the patients can benefit. e) To elaborate on the possible ethical issues that may arise in each of these three relationships During the information clinic, the participants should actively participate in identifying and discussing all the ethical concerns in each relationship. A guide on these ethical issues is elaborated hereafter. Ethical Considerations It is important that during the information clinic, the participants be able to consider the set of ethical issues involved between patients and providers, providers and payers and payers and patients in not-for-profit-based healthcare organisations. The following are some possible ethical issues that may arise in each of these three relationships. a) In Patient- Providers relationship, the question of each patient getting equal and quality treatment, the question of the providers trying to lower their cost in the treatment alternatives offered, the question of provider’s commitment to patient’s well-being, the question of proper diagnosis and follow up, the question of confidentiality and the questions of patient consent should be discussed (George, Sillup and Porth, 2008). b) In Provider-Payer relationships, the ethical concerns of hiked medical costs, disclosure of patient information, proper diagnosis and payment of claims should be discussed (George, Sillup and Porth, 2008). c) In Patient-Payer relationships, the ethical concerns of non-disclosure of medical condition, hiked medical costs, patient information confidentiality and payment of claims should be discussed (George, Sillup and Porth, 2008). Session Schedule To achieve the objectives highlighted above, the clinic session should have the following schedule. Activity Discussion Time 1 Introductions 5 Minutes 2 A general exposure by the convener on the objectives of the forum and the issues to be discussed 20 Minutes 3 Discussion on Patient-Provider relationships in non-profit-based healthcare organisations 10 Minutes 4 Discussion on patient-Payer relationships in profit-Based healthcare organisations 10 Minutes 5 Discussion on Payer -Provider relationships in profit-Based healthcare organisations 10 Minutes 6 Discussions on the general role of healthcare leadership in establishment and maintenance of good relationships between the three parties 30 Minutes 7 Discussions on Ethical Considerations in each relationship 30 minutes 8 Conclusion 5 Minutes Outline For Governmental Health Care Organizations Overview Government healthcare organisations are public institutions charged with the responsibility of serving the community as part of the governments mandate to its people. Government healthcare institutions are subject to policy development in the country as well as government funding (Ubel et al, 2005). While they are trusted in financial matters since they are not in a business setting, they are mainly under scrutiny in regards to the quality of service they deliver to patients due to limitations of funding (Ubel et al, 2005) and qualifications and expertise of their medical teams. In recent times, there have been claims of the providers engaging in unethical partnerships with specialist and healthcare plans (Hellman et al, 2009; Almgren, 2007). At times, practitioners in government hospitals have unnecessarily referred their patients to specialists from whom they get a commission and at other times, the practitioners have been known to inflate medical bills to scam the payers. The information clinic for the government-run healthcare institutions shall primarily aim at a discussion of ethical practices and quality service delivery concerns in the relationships existing between patients and providers, patients and payers and payers and the providers. Goals and Objectives for Attendees The goals of the clinic shall be five: a) To Facilitate a discussion by the representatives of how healthcare leadership in government healthcare establishments can foster good relationships between patients and providers In the discussion, the forum moderator should channel contributions words the following concern points. Patients visit government healthcare establishments with a feeling of entitlement to government services. Again, most patients in these institutions lack the financial ability to go elsewhere. Same as with the not-for profit establishments, government hospitals have had to deal with the bulk of the population today due to rising medical costs (Woolhandler, Campbell and Himmelstein, 2008). The result is that a single physician in these institutions sees so many patients in a day that, he or she cannot possible create a good relationship with any of them. Instead of caring about the relationship with patients, providers here only care about the number they attend to versus the number of patients waiting for them (American Hospital Association, 2010). It is important that healthcare leaders help reduce the bulk that providers attend to and improve the quality of time spent with each patient. Spending some time with each patient to explain their conditions and the (Chaudron et al, 2006), treatments available can help eliminate the concerns in the patients and help then providers build good relationships with their patients. Patients on the other hand must appreciate the then workload of the providers. Leaders should insist on performance based on quality service instead of patient numbers (American Hospital Association, 2010). b) To Facilitate a discussion by the representatives of how healthcare leadership in government healthcare establishments can foster good relationships between providers and payers Payers in this case are interested in how much the patients are charged (Wurman, 2009). The leaders should ensure that the payers know what they are paying for and why, as well as the alternatives existing. Providers are interested in knowing whether the patient is covered for the costs of the healthcare services they need and whether the patient can afford the treatment needed. Having a clear cut policy in the institutions as regards patient’s medical costs can help reduce areas of conflict between providers and the payers. A good and expedient communication channel between payers and providers will help cater for the interests of each party, where the payer and the provider agree on the best interest of the patient. c) To Facilitate a discussion by the representatives of how healthcare leadership in government healthcare establishments can foster good relationships between patients and payers The patients in government healthcare establishments rarely know what they are covered for and the payers do not know the medical needs of the patients. Healthcare leaders have a role to play in mediating this information gap. The providers should also promptly inform the concerned payers of the medical needs of the patient and the probable cost. Healthcare leaders should adjudicate in the understanding of both the patients and the payers such that they act to the interests of the patient. d) To elaborate on the role of the healthcare leadership in ensuring these three relationships complement each other within the organisation. The relationships existing in the between the three parties depends on how well the leadership in the government healthcare institutions (Pelote, Pelote and Route, 2007). The greatest role the leaders can play in this scenario is highlighting the best interests of the patients and finding a middle ground in which providers can help, payers can participate and the patients can benefit. e) To elaborate on the possible ethical issues that may arise in each of these three relationships During the information clinic, the participants should actively participate in identifying and discussing all the ethical concerns in each relationship. A guide on these ethical issues is elaborated hereafter. Ethical Considerations It is important that during the information clinic, the participants be able to consider the set of ethical issues involved between patients and providers, providers and payers and payers and patients in government healthcare organisations. The following are some possible ethical issues that may arise in each of these three relationships. a) In Patient- Providers relationship, the question of each patient getting equal and quality treatment, the question of unnecessarily referrals, the question of the providers trying to lower their cost in the treatment alternatives offered, the question of provider’s commitment to patient’s well-being, the question of proper diagnosis and follow up, the question of confidentiality and the questions of patient consent should be discussed (George, Sillup and Porth, 2008). b) In Provider-Payer relationships, the ethical concerns of hiked medical costs, disclosure of patient information, proper diagnosis and payment of claims should be discussed (George, Sillup and Porth, 2008). c) In Patient-Payer relationships, the ethical concerns of non-disclosure of medical condition, hiked medical costs, patient information confidentiality and payment of claims should be discussed (George, Sillup and Porth, 2008). Session Schedule To achieve the objectives highlighted above, the clinic session should have the following schedule. Activity Discussion Time 1 Introductions 5 Minutes 2 A general exposure by the convener on the objectives of the forum and the issues to be discussed 20 Minutes 3 Discussion on Patient-Provider relationships in government healthcare organisations 10 Minutes 4 Discussion on patient-Payer relationships in profit-Based healthcare organisations 10 Minutes 5 Discussion on Payer -Provider relationships in profit-Based healthcare organisations 10 Minutes 6 Discussions on the general role of healthcare leadership in establishment and maintenance of good relationships between the three parties 30 Minutes 7 Discussions on Ethical Considerations in each relationship 30 minutes 8 Conclusion 5 Minutes References Almgren, G. (2007). Health care politics, policy, and services: a social justice analysis. New York: Springer Publishing Company. 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Frequency and costs of diagnostic imaging in office practice—a comparison of self-referring and radiologist-referring physicians. New England Journal of Medicine. Vol. 323 (3), pp. 604–608. Herzling, R. (2006). Consumer-driven health care: implications for providers, payers, and policy makers. San Francisco: John Wiley & Sons. Jasper, M. & Jumaa, M. (2005). Effective healthcare leadership. Oxford: Blackwell Publishing. Kerr, E., Mittman, B., Hays, R., Siu, A., Leake, B. & Brook, R. (2009). Managed care and capitation in California: how do physicians at financial risk control their own utilization? Ann Intern Medicine. Vol. 123 (1). pp. 500–504. Pelote, V., Pelote, V. & Route, L. (2007). Masterpieces in health care leadership: cases and analysis for best practice. London: Jones and Bartlett Publishers Inc. Porter, M. & Teisberg, E. (2006). Redefining Health Care: Creating Value-Based Competition on Results. New York: Harvard Business Press. Ubel, P., Arnold, R. & Gramelspacher, G. (2005). Acceptance of external funds by physician organizations: issues and policy options. Journal of General Intern Medicine. Vol. 10 (3). pp. 624–30. US Institute of Medicine (2008). Leadership by example: coordinating government roles in improving health care quality. Committee on Enhancing Health Care Quality. Washington, D,C: The National Academies Press. Williams, J. (2009). Textbook of Healthcare Ethics. Journal Ethics & Behaviour. Vol. 8 (1). pp. 85 – 87. Woolhandler, S, Campbell, T. & Himmelstein, D. (2008). Costs of Health Care Administration in the United States and Canada. New England Journal of Medicine. Vol. 349 (8). pp. 768–775. Wurman, R. (2009). Understanding Healthcare. New York: Top. Read More