Fluent Essays

Functions of Management - Resources and Tools: (Week 1 Supporting Tools) Links to Articles and Publications from the UMGC Library:   Deming Article on Profound Knowledge Knowledge Overview Donabedian Model Overview  Fayols Innovative Theory of Management Maintaining Management During Disaster: COVID 19 Article       2020 Scientific Management Article 2017 Solving a Whale of a Problem: Four Function of Management       Article 2019 Total Quality Management in Healthcare. Article 2019 Functions of Management -External Websites, General Articles,      and Other Sources: External Website: The W. Edwards Deming       Institute External Website: Patient Safety and Healthcare Quality       (PSQH): https://www.psqh.com/ External Website: The Deming Philosophy https://deming.org/the-deming-philosophy/ External Website for Six Sigma: https://www.isixsigma.com/ External Link to Article       on Drucker: https://www.business.com/articles/management-theory-of-peter-drucker/ External Article from Peoplefluent.com: 5 Leadership Skills External Article from the Journal of Healthcare Leadership: Effective Leadership 2017 Article PLEASE USE THE READINGS NOTHING ELSE. 4 Lessons Learned Posting by Tuesday at 11:59 pm EST: You will  share the information that you learned  from your course readings, your peers, and your own research .  Assess how your initial understanding of the topic differs from your present views. Define the lessons (minimum 1) learned and provide an outstanding questions (minimum 1) that you still may have on the topic.  Topic: Scientific Management            Scientific management is management theory that analyzes work flows to improve economic efficiency, especially labor productivity. It was developed by Frederick Winslow Taylor from 1856-1915 and was commonly known as Taylorism.             According to a research article Bisconti, T. (2020), Taylor specialized in maximizing worker efficiency by streamlining factory layouts and redesigning the relationship between workers and management. Scientific management increased the efficiency and output of factory workers by breaking complex tasks into smaller parts. It also proposed that workers be compensated relative to their productivity. Scientific management was not always well received, however. Many skilled laborers protested the movement, claiming that it gave management unfair power over workers. Today in our working arena we enjoy team work. It is because of the Principles of Taylors Scientific Management Theory. It has become widely practiced, and the resulting cooperation between workers and managers eventually developed into the teamwork. Scientific management did provide many significant contributions to the advancement of management practice. it introduced                       ● Systematic selection and training procedures,                       ● It provided a way to study workplace efficiency, and                       ● It encouraged the idea of systematic organizational design. Reference Biscontini, T. (2020). Taylorism. Salem Press Encyclopedia.   https://www.mindtools.com/pages/article/newTMM_Taylor.htm reply to this post half a page Topic: Administrative Management Administrative Management refers to the person who runs and maintains the business to ensure it operates effectively and efficiently. The Administrative Manager is in charge of coordinating the workflow, supervising the staff, and creating policies and procedures to provide an efficient workplace. Administrative management theory attempts to find a rational way to design an organization as a whole. The theory generally calls for a formalized organizational structure, a clear division of labor, and delegation of power and authority to administrators relevant to their areas of responsibilities (Administrative Management Theory, n.d.). As an Administrative Manager, it is my responsibility to make sure the office runs smoothly, effectively, and efficiently. Each staff has a job description with quarterly training. Decision-making is a huge factor of my job as it involves the financial component to increase the revenue and reduce the budget. I also make sure to stay on top of marketing by sending out newsletters and keeping active on social media. For example, I opened a unit for COVID-19 patients to get the monoclonal antibody treatment, and with social media advertisement, I was able to get the word out. I also had to implement the Policy and Procedures with training for the nurses to infuse the covid patients Half a page response 1 2 Administrative Management Name Institution Professor Course Date Administrative Management Administrative Management is a theory that is utilized in the establishment of a structure as well as the division of labor and effective authority in the most appropriate way probable within a firm. It helps in offering contributing key ideas for better management in the firm. It helps in offering findings as well as information that attempts to seek a rational way to help in the designing a firm as an entity. The identified theory usually calls for a formal kind of administrative structure as well as a clear and comprehensive division of labor and even delegation regarding power and even authority to administrators essential to their key area of accountabilities. This is vital in ensuring effective storage as well as distribution of information that is necessary for the success of the company. It is applied in many areas especially in firms. The key aim of its application is to have efficiency as well as effectiveness in management aspects of the corporate world. The principles that are entailed in the theory are essential in being utilized by the administrators to effectively coordinate the identified internal activities regarding the firm. Firms managerial practices are key for enhancing predictability as well as effectiveness in the operations of the firms. Its application can also be wide enough to extend to the management of the employees for efficiency in the company in overall terms. It is vital in ensuring that the firms that use attain higher competitive advantage in the companies. References Deming Article on Profound Knowledge Overview Donabedian Model Overview  Fayols Innovative Theory of Management Maintaining Management During Disaster: COVID 19 Article 2020 Scientific Management Article 2017 Solving a Whale of a Problem: Four Function of Management Article 2019 Total Quality Management in Healthcare. Article 2019 1 L e a r n I n g o b j e c t I v e s C H A P T E R 1 H E A LT H , H E A LT H C A R E , A N D H E A LT H C A R E O R G A N I Z AT I O N S Strike a balance between population health and individual health. Howard R. Grant, CEO of Lahey Health Studying this chapter will help you to ➤ explain what health and population health are, ➤ describe the major forces that determine the health of a population, ➤ identify types of health services in the continuum of care, ➤ identify types of healthcare organizations, ➤ explain the external environment and how it affects healthcare organizations, ➤ describe trends that will affect management of healthcare organizations in the future, and ➤ appreciate the variety of healthcare management jobs and careers. C o p y r i g h t 2 0 1 9 . H e a l t h A d m i n i s t r a t i o n P r e s s . A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w . EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS AN: 2144509 ; Peter Olden.; Management of Healthcare Organizations: An Introduction, Third Edition Account: s4264928.main.eds M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s2 Here’s WHat HaPPeneD Partners HealthCare is an integrated healthcare delivery system that owns and oper- ates numerous healthcare organizations (HCOs), including community health centers, physician practices, hospitals, urgent care clinics, and home care businesses. Together, these HCOs provide the continuum of care from prenatal to end-of-life. Based in Boston, Partners is committed to its community, and it values innovation, technology, openness, and preparation. Its managers have watched developments in the external environment, such as demographic trends, the growth of social media, the empha- sis on population health, and value-based payment for healthcare. They have been transforming Partners HealthCare to better fit the changing external environment in which it operates. For example, the managers have been forming patient-centered medical homes and are striving to keep the local population healthy through proac- tive preventive care (rather than reactive cure). Managers implemented a Connected Cardiac Care program that uses telehealth to connect with remote patients and help them care for their heart disease. People are living healthier lives because of what Partners HealthCare’s executives, managers, supervisors, and staff have done. A s the opening example shows, healthcare organizations need managers. We will follow managers at Partners HealthCare throughout this book as a management case study. A brief example from Partners HealthCare opens each chapter to demonstrate that chapter’s subject. (These examples are based on a lengthy case study that is presented in “A Management Case Study: Partners HealthCare” later in this book.) This book will help you learn how to manage HCOs to help people live healthier lives, as managers at Partners do. You will be able to do important work (while earning a good paycheck). This chapter explains health and population health and examines the main forces that determine them. It identifies health services in the continuum of care and the types of HCOs in the healthcare sector. The chapter then describes the external environment and important trends that are affecting HCOs, the healthcare industry, and the healthcare sector. The chapter ends with information about healthcare management jobs and careers, for which this book will prepare you. After reading this chapter, you will better understand why communities need HCOs—and why HCOs need people like you to manage them. He a Lt H a n D WH at De t e r m I n e s It What is health? In a classic definition still widely used today, the World Health Organization (WHO 1946, 100) states that health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Note that the definition of health is based on being well rather than just not having a health problem. health A state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use C h a p t e r 1 : H e a l t h , H e a l t h c a r e , a n d H e a l t h c a r e O r g a n i z a t i o n s 3 An individual’s health status may be measured by how well that person feels and functions physically, mentally, and socially. Health status can be evaluated through many measures, such as physical ability, emotions, socialization, blood pressure, and absence of pain. For a group or population, health status may be measured by birth rates, life expec- tancy, death rates, prevalence of diseases, and group averages for individual health measures. In recent years, healthcare leaders, clinicians, policymakers, and others have become more concerned about population health. The well-established definition of this concept used by the Institute of Medicine (2018) and a population health book (Caron 2017) comes from Kindig and Stoddart (2003, 381): “the health outcomes of a group of individuals, including the distribution of outcomes within the group.” A population can be a group of people identified by their shared community, occupation, ethnicity, geographic region, or other characteristic. Kindig (2017) emphasized that distribution of outcomes in a group is important because although a population can be healthy on average, some people may have bad outcomes. Population health has gained prominence because of population health provisions in the Affordable Care Act of 2010 and because it is one of the three goals in the Institute for Healthcare Improvement’s (IHI 2018) widely accepted Triple Aim. The concept focuses on the health of a population or group rather than on the health of a patient or person. Managers of HCOs historically focused on the health of their individual patients. Now they also are addressing the health of their local populations (Morrison 2017). Managers must strive to improve health at both the community population level and the individual person level. You will have to do the same when you are managing an HCO. The techniques presented in this book will help you manage programs, activities, and services to improve population health and individual health in your community. This chapter’s opening quote reflects this approach to managing HCOs. As we learned in the opening Here’s What Hap- pened, Partners HealthCare’s managers are using this approach. D e t e r m I n a n t s o f H e a Lt H Many forces determine (influence) the health status and health outcomes of populations and individuals. To understand these forces, consider the main determinants of health as described by various sources: ◆ Heredity, medical care services, lifestyles, and environment (fetal, physical, and sociocultural) (Blum 1983) ◆ Genetics, medical care, behavior, physical environment, and social circumstances (McGovern, Miller, and Hughes-Cromwick 2014) ◆ Social and economic environment, physical environment, individual characteristics and behaviors, and health services (WHO 2018) population health The health outcomes of a group of individuals, including the distribution of outcomes within the group. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s4 ◆ Policymaking (by governments), social factors (including physical environment), health services, biology (genetics), and individual behavior (HealthyPeople.gov 2018) ◆ Biology (genetics), individual behavior, social environment, physical environment, and health services (Centers for Disease Control and Prevention 2014) ◆ Healthcare, individual behavior, genetics, social environment, and physical environment (Kindig 2017) Exhibit 1.1 shows Kindig’s (2017) five determinants influencing the health outcomes of a person or population. Though not shown in the exhibit (to avoid too many arrows cluttering the exhibit), these determinants interact; they are not independent of each other. For example, the social environment in which someone lives affects that person’s individual behavior and healthcare, and those three determinants all affect the person’s health. Another point is that the five determinants do not all have an equally strong influence on health. Genetics is the starting point of health. Genes and characteristics inherited from parents make a person more likely or less likely to develop certain health problems, such as heart disease or cystic fibrosis. Perhaps your parents have mentioned genetic traits and characteristics that run in your family. Although scientists in research laboratories can modify a gene to avoid a disease-causing mutation, genetics is not yet a practical approach exHIbIt 1.1 Five Determinants of Health Model Health Outcomes Individual Behavior Healthcare Genetics Physical Environment Social Environment Source: Data from Kindig (2017). EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use C h a p t e r 1 : H e a l t h , H e a l t h c a r e , a n d H e a l t h c a r e O r g a n i z a t i o n s 5 to improving health. That might change in the future as science and ethics evolve (Reardon 2017). For now, managers have to modify the other four determinants to improve health. Healthcare is “the maintaining and restoration of health by the treatment and pre- vention of disease [and injury] especially by trained and licensed professionals” (Merriam- Webster Medical Dictionary 2018). (The definition of medical care is similar but often limited to care performed by physicians.) Healthcare services exist for all ages and stages of life, from womb to tomb. Together, they form a continuum of care that is explained later in this chapter. Managers can improve people’s health by helping to ensure people’s appropriate use of quality healthcare. Most healthcare spending in the United States has been for diagnosis and treatment of health problems. However, other determinants, such as behavior and social environment, often have a larger effect on health (Caron 2017; McGovern, Miller, and Hughes-Cromwick 2014). Researchers, HCO managers, clinicians, policymakers, and others are realizing this. They are giving more attention and allocating more resources to the other three determinants of health: individual behavior, physical environment, and social environment. Individual behaviors, such as smoking, seat belt use, diet, flossing, handwashing, and exercise, strongly affect health. For example, heart disease has been linked to behaviors that include smoking, eating unhealthy foods, and not exercising. Healthcare managers can improve people’s health by helping them improve their lifestyle and behavior. Some HCOs offer smoking cessation programs, nutrition classes, and fitness walks. Physical environment is the physical setting (natural and built) in which someone lives. Many elements of the physical environment affect health, such as sanitation, climate, parks, nighttime lighting, forests, safe roads, and air pollution. We can understand the importance of the physical environment by considering the health problems caused by floods and hurricanes. Healthcare managers can improve people’s health by helping them improve their physical environment. For example, HCOs have helped their communities reduce air pollution, build parks, and remove garbage. The social environment includes factors such as socioeconomic status, availability of fresh food, job opportunities, social interaction and support, discrimination, education, language, poverty, prevailing attitudes, and neighbors. Many of these factors vary based on location. Thus, a person’s zip code is a stronger predictor of health than is his genetic code (Hinton and Artiga 2018). The effect of these factors on health has gained recognition in recent years. Healthcare managers can improve people’s health by helping them improve their social circumstances. Healthcare providers are entering more of this information into patients’ medical and health records to monitor and address it with patients (McCulloch 2017). These determinants can lead to differences in the health of specific groups or subpopulations (e.g., those based on ethnicity, gender, and other characteristics). A health disparity is “a health difference that is closely linked with social, economic, or environmental disadvantage” (HealthyPeople.gov 2008). Health disparities are com- mon among groups that face barriers based on their gender, race, ethnicity, disability, healthcare The maintaining and restoration of health by the treatment and prevention of disease and injury, especially by trained and licensed professionals. health disparity A health difference that is closely linked with social, economic, or environmental disadvantage. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s6 location, and other factors. The US population is becoming more diverse, and many healthcare managers are striving to reduce disparities so that everyone can live healthy lives. You too will do that in your career. How can healthcare managers use determi- nants of health to improve people’s health? Realize that factors other than healthcare are important. For example, HCO managers in Wichita can improve people’s health by improving their behav- ior, physical environment, and social environment. These three determinants can help prevent dis- ease, illness, and injury from occurring in the first place. HCOs such as sports medicine clinics, hos- pitals, health insurers, physician practices, mental health clinics, and others have implemented many interesting approaches. Examples include offer- ing wellness programs to seniors, helping children adopt healthy lifestyles, building walking trails and playgrounds, and using social media to guide behavioral change. Think about your community. What have HCOs done there (besides delivering medical care) to improve health? He a Lt H c a r e a n D He a Lt H se r v I c e s There are many different kinds of healthcare and health services. Which ones have you heard of? Some prevent problems, some diagnose problems, some treat problems, and some support people at the end of life. Some are short-term; others are long-term. The many CHECK IT OUT ONLINE The US Department of Health and Human Services develops health objectives for the country to pursue during each decade. The objectives are designed to help the country become a “soci- ety in which all people live long, healthy lives” (HealthyPeople. gov 2018). The 2020 health objectives are available at www. healthypeople.gov/2020/About-Healthy-People. These objec- tives pertain to dozens of health topics and aspects of health, some relevant to college students. Several new topics were added for 2010–2020, including adolescent health, dementia, genomics, global health, and sleep health. Information provided for each topic includes an overview, objectives, data, and resources. You can also see early work on developing objectives for the 2020– 2030 decade. Check it out online and see what you discover. TRY IT, APPLY IT Suppose you are asked to serve on a college task force whose mandate is to recom- mend what the college should do to help students improve their health. Using what you have learned in this chapter about the determinants of health, suggest how students’ individual health and population health can be improved. Discuss your ideas with other students. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use C h a p t e r 1 : H e a l t h , H e a l t h c a r e , a n d H e a l t h c a r e O r g a n i z a t i o n s 7 kinds of healthcare and health services can be grouped into categories, such as preventive, diagnostic, curative, rehabilitative, and so on. Exhibit 1.2 lists several types of healthcare and services. (It is beyond the purpose and scope of this book to explain all these services. If necessary, you can research any unfamiliar services online.) Some types of care, such as home care, take place in only one kind of HCO. Yet most types of care occur in more than one kind of HCO. For example, diagnostic care occurs in freestanding diagnostic centers, outpatient clinics, physician practices, hospitals, urgent care centers, and other HCOs. Acute care Health promotion Preventive care Adult day care Home care Primary care Ambulatory care Hospice/palliative care Public health services Assisted living Hospital care Rehabilitative care Behavioral health care Inpatient services Respite care Chiropractic care Long-term care Self-care Chronic care Mental health care Skilled nursing care Community health services Office-based care Specialty care Complementary care Outpatient services Sports medicine Dental care Personal lifestyle care Subacute care Diagnostic care Physician care Urgent care Emergency care Post-acute care Virtual care exHIbIt 1.2 Types of Healthcare Services Healthcare and health services together can be thought of as a continuum of care (CoC) or care continuum with a range of services needed to care for a person or popula- tion (Buell 2017). A comprehensive “womb-to-tomb” CoC begins with prenatal care, ends with palliative end-of-life care, and includes all other health services in between that people might use during their lifetime. Some HCOs extend the CoC into the community and call it a “health continuum” to more fully improve the population health (not merely patient health) of their communities. The health continuum extends beyond direct healthcare services to include housing, food support, employment, and other social determinants of health that come from outside the usual healthcare system (Buell 2018). Exhibit 1.3 shows an example of a general CoC with a comprehensive sequence of services that many patients might follow. It begins with prenatal and preventive care, fol- lowed by primary care, specialty care, diagnostic care, acute care (outpatient and inpatient), continuum of care A range of services needed to care for a person or population. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s8 subacute care, chronic care, rehabilitative care, long-term care, and end-of-life care (Barton 2010; Shi and Singh 2015). Preventive care and specialty care occur at multiple stages of the continuum. The continuum can be considered a person’s journey through the healthcare system and related community services that are needed to care for that individual (Buell 2017). The complete continuum provides physical health services and mental and behavioral health services throughout the individual’s life. Smaller CoCs exist for particular kinds of patients or stages of life, such as CoCs for obstetrics, HIV (human immunodeficiency virus), rehabilitation, or behavioral health. For example, the University of Pittsburgh Medical Center Rehabilitation Institute uses a rehabilitation CoC that includes inpatient, outpatient, and community services. A CoC shows in a typical sequence the types of care and services needed for a specific patient population. Health professionals use CoC models as tools to plan how to meet the healthcare needs of a person or population in the most cost-effective way (Buell 2017). All services in a CoC should be seamlessly coordinated to work together. Thus, managers of HCOs must consider their place in their patients’ CoCs and form effective links with other services and organizations in those CoCs. Recent changes in how providers are paid have been driving HCOs, particularly hospitals and post-acute care HCOs, to use a CoC approach with their patients (Buell 2017; Van Dyke 2017). These changes include value-based payment for care, incentives to keep patients out of hospitals, requirements for discharge planning, bundled payments for episodes of care, and plans for unified post-acute payment. Driven by these new payment methods, hospitals are trying to avoid patient admission and readmission to the hospital. Their approaches include providing preventive, primary, specialty, and diagnostic care early Pr en at al C ar e Pr ev en ti ve C ar e* Pr im ar y Ca re Sp ec ia lt y Ca re ** D ia gn os ti c Ca re A cu te C ar e S ub ac ut e Ca re Ch ro ni c Ca re Re ha bi lit at iv e Ca re Lo ng -t er m C ar e En d- of -l ife C ar e exHIbIt 1.3 Continuum of Care Source: Adapted from Barton (2010) and Shi and Singh (2015). *Preventive Care occurs at many stages of the continuum to prevent occurrence and reoccurrence of disease, illness, and injury. **Specialty Care occurs at many stages of the continuum. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use C h a p t e r 1 : H e a l t h , H e a l t h c a r e , a n d H e a l t h c a r e O r g a n i z a t i o n s 9 in the continuum to prevent admission, and then subacute, chronic, rehabilitative, and long-term care later in the continuum to prevent readmission. Managers are trying to more closely connect mental and behavioral healthcare with physical healthcare in the continuum. Besides payment changes, stakeholder demands for population health and coor- dinated, integrated (rather than fragmented) care are driving HCOs to develop optimal CoCs for patients and communities. This goes beyond the services that HCOs provide. HCOs must focus on social determinants of health (discussed earlier in this chapter) and the patient’s role in self-care to keep people healthy and avoid expensive healthcare (Bosko and Gulotta 2016; Buell 2018). Thus, some HCOs are trying to gather data about patients’ housing, food security, education, income stability, and other social factors that strongly affect health. He a Lt H c a r e or g a n I z at I o n s The Here’s What Happened at the beginning of the chapter introduced Partners Health- Care—a large, complex HCO (made up of smaller HCOs) that we will follow throughout the book. What HCOs have you heard of, worked at, or volunteered at? Some HCOs, such as large general hospitals, provide a wide range of services spanning many parts of the CoC. Other HCOs, such as hospices, specialize and provide only a narrow range of services in one part of the continuum. Hospitals may also specialize, such as hospitals for only psychiatric care or for only rehabilitation services. Ambulatory HCOs provide healthcare services to people who obtain care but do not stay overnight. Medical group practices and physician offices provide many ambulatory medical services in specialties such as cardiology, pulmonology, and neurology. They might offer diagnostic testing, on-site therapy services, outpatient surgery, and other services. Outpatient diagnostic centers perform lab tests, medical imaging, and other services to diagnose health problems. Other outpatient HCOs are ambulatory surgery centers, urgent care facilities, mental health clinics, public health agencies, sports medicine businesses, dental practices, and counseling offices. Some retail stores operated by large companies (e.g., Walmart, Target, CVS, Kroger) offer basic urgent care. Home care organizations provide an array of nursing care, therapy, and health services in people’s homes. Telehealth and virtual care methods have expanded the range of health services delivered in people’s residences. Some organizations—such as skilled nursing facilities, personal care homes, and assisted living communities—provide services for people (not all of whom are elderly) who need care for an extended period of time. In addition to HCOs that provide hands-on healthcare services to patients, other types of HCOs are essential for improving individual health and population health. Orga- nizations such as the American Cancer Society and the American Lung Association improve people’s health by funding research, developing educational programs, reducing risk fac- tors, and assisting people who need treatment. Medical supply firms and pharmaceutical EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s1 0 companies such as Johnson & Johnson produce and distribute supplies, drugs, and equip- ment that other HCOs use for their healthcare. Companies such as General Electric and Philips make complex medical equipment. Some companies make catheters, intravenous solutions, antibiotics, bandages, and many other daily supplies. Health insurance companies, such as Blue Cross, are another type of HCO. These businesses assist in the financing of and payment for healthcare services. Trade organizations (e.g., the Medical Group Manage- ment Association) and professional associations (e.g., the American College of Healthcare Executives) are other types of HCOs. Colleges and universities educate people to work in dozens of types of healthcare jobs. Professional and governmental organizations such as The Joint Commission and the Ohio Department of Health accredit, license, and regulate HCOs. Philanthropic organizations such as The Commonwealth Fund and the Kaiser Family Foundation provide research, education, and financial grants to improve health. The list of HCOs could go on and on. Try to think of other kinds of HCOs. There is no distinct boundary between HCOs and non-HCOs. For example, Amazon, Apple, and Uber have announced their intentions to get involved with healthcare (Michelson 2018). Managers of HCOs should realize that their organizations must interact with many others to produce a CoC and healthcare services for their population. tH e ex t e r n a L en v I r o n m e n t o f He a Lt H c a r e or g a n I z at I o n s An HCO exists in an external environment of people, organizations, industries, trends, forces, events, and developments that are outside of the HCO. Most of these external ele- ments are beyond the HCO’s control. The external environment of a specific HCO includes all the other HCOs along with citizens, schools, colleges, banks, information technology (IT) companies, labor unions, competitors, stock markets, governments, venture capital- ists, and more. This environment includes economic, demographic, technological, cultural, legal, social, and other kinds of developments in society. For example, in the opening Here’s What Happened, the external environment of Partners HealthCare includes the invention of new devices for mobile technology. Let’s analyze the external environment of a home care business in Baltimore. The other home care businesses around the city are part of the environment. They exist in the healthcare realm, which also includes public health agencies, subacute care facilities, health insurers, and all the other HCOs in and around Baltimore. The larger society, including government, banking, transportation, education, housing, and many other elements, are all part of that home care business’s external environment. In addition, that environment includes potential customers, volunteers, employees, student interns, donors, and suppliers. We can also think of this environment in terms of forces and influences, such as cultural diversity, local employment trends, 24/7 mobile communication, and opioid addiction rates, that affect the home care business. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use C h a p t e r 1 : H e a l t h , H e a l t h c a r e , a n d H e a l t h c a r e O r g a n i z a t i o n s 1 1 These other organizations, forces, and people affect HCOs in many ways. For exam- ple, the home care business depends on people to use its services, but those clients may want more weekend services and social media interaction. They can use a different home care business if their preferences are not met. The government could force the business to make changes to maintain its license and stay open. The home care business depends on other businesses to provide services and … 1 L e a r n I n g o b j e c t I v e s C H A P T E R 1 H E A LT H , H E A LT H C A R E , A N D H E A LT H C A R E O R G A N I Z AT I O N S Strike a balance between population health and individual health. Howard R. Grant, CEO of Lahey Health Studying this chapter will help you to ➤ explain what health and population health are, ➤ describe the major forces that determine the health of a population, ➤ identify types of health services in the continuum of care, ➤ identify types of healthcare organizations, ➤ explain the external environment and how it affects healthcare organizations, ➤ describe trends that will affect management of healthcare organizations in the future, and ➤ appreciate the variety of healthcare management jobs and careers. C o p y r i g h t 2 0 1 9 . H e a l t h A d m i n i s t r a t i o n P r e s s . A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w . EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS AN: 2144509 ; Peter Olden.; Management of Healthcare Organizations: An Introduction, Third Edition Account: s4264928.main.eds M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s2 Here’s WHat HaPPeneD Partners HealthCare is an integrated healthcare delivery system that owns and oper- ates numerous healthcare organizations (HCOs), including community health centers, physician practices, hospitals, urgent care clinics, and home care businesses. Together, these HCOs provide the continuum of care from prenatal to end-of-life. Based in Boston, Partners is committed to its community, and it values innovation, technology, openness, and preparation. Its managers have watched developments in the external environment, such as demographic trends, the growth of social media, the empha- sis on population health, and value-based payment for healthcare. They have been transforming Partners HealthCare to better fit the changing external environment in which it operates. For example, the managers have been forming patient-centered medical homes and are striving to keep the local population healthy through proac- tive preventive care (rather than reactive cure). Managers implemented a Connected Cardiac Care program that uses telehealth to connect with remote patients and help them care for their heart disease. People are living healthier lives because of what Partners HealthCare’s executives, managers, supervisors, and staff have done. A s the opening example shows, healthcare organizations need managers. We will follow managers at Partners HealthCare throughout this book as a management case study. A brief example from Partners HealthCare opens each chapter to demonstrate that chapter’s subject. (These examples are based on a lengthy case study that is presented in “A Management Case Study: Partners HealthCare” later in this book.) This book will help you learn how to manage HCOs to help people live healthier lives, as managers at Partners do. You will be able to do important work (while earning a good paycheck). This chapter explains health and population health and examines the main forces that determine them. It identifies health services in the continuum of care and the types of HCOs in the healthcare sector. The chapter then describes the external environment and important trends that are affecting HCOs, the healthcare industry, and the healthcare sector. The chapter ends with information about healthcare management jobs and careers, for which this book will prepare you. After reading this chapter, you will better understand why communities need HCOs—and why HCOs need people like you to manage them. He a Lt H a n D WH at De t e r m I n e s It What is health? In a classic definition still widely used today, the World Health Organization (WHO 1946, 100) states that health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Note that the definition of health is based on being well rather than just not having a health problem. health A state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use C h a p t e r 1 : H e a l t h , H e a l t h c a r e , a n d H e a l t h c a r e O r g a n i z a t i o n s 3 An individual’s health status may be measured by how well that person feels and functions physically, mentally, and socially. Health status can be evaluated through many measures, such as physical ability, emotions, socialization, blood pressure, and absence of pain. For a group or population, health status may be measured by birth rates, life expec- tancy, death rates, prevalence of diseases, and group averages for individual health measures. In recent years, healthcare leaders, clinicians, policymakers, and others have become more concerned about population health. The well-established definition of this concept used by the Institute of Medicine (2018) and a population health book (Caron 2017) comes from Kindig and Stoddart (2003, 381): “the health outcomes of a group of individuals, including the distribution of outcomes within the group.” A population can be a group of people identified by their shared community, occupation, ethnicity, geographic region, or other characteristic. Kindig (2017) emphasized that distribution of outcomes in a group is important because although a population can be healthy on average, some people may have bad outcomes. Population health has gained prominence because of population health provisions in the Affordable Care Act of 2010 and because it is one of the three goals in the Institute for Healthcare Improvement’s (IHI 2018) widely accepted Triple Aim. The concept focuses on the health of a population or group rather than on the health of a patient or person. Managers of HCOs historically focused on the health of their individual patients. Now they also are addressing the health of their local populations (Morrison 2017). Managers must strive to improve health at both the community population level and the individual person level. You will have to do the same when you are managing an HCO. The techniques presented in this book will help you manage programs, activities, and services to improve population health and individual health in your community. This chapter’s opening quote reflects this approach to managing HCOs. As we learned in the opening Here’s What Hap- pened, Partners HealthCare’s managers are using this approach. D e t e r m I n a n t s o f H e a Lt H Many forces determine (influence) the health status and health outcomes of populations and individuals. To understand these forces, consider the main determinants of health as described by various sources: ◆ Heredity, medical care services, lifestyles, and environment (fetal, physical, and sociocultural) (Blum 1983) ◆ Genetics, medical care, behavior, physical environment, and social circumstances (McGovern, Miller, and Hughes-Cromwick 2014) ◆ Social and economic environment, physical environment, individual characteristics and behaviors, and health services (WHO 2018) population health The health outcomes of a group of individuals, including the distribution of outcomes within the group. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s4 ◆ Policymaking (by governments), social factors (including physical environment), health services, biology (genetics), and individual behavior (HealthyPeople.gov 2018) ◆ Biology (genetics), individual behavior, social environment, physical environment, and health services (Centers for Disease Control and Prevention 2014) ◆ Healthcare, individual behavior, genetics, social environment, and physical environment (Kindig 2017) Exhibit 1.1 shows Kindig’s (2017) five determinants influencing the health outcomes of a person or population. Though not shown in the exhibit (to avoid too many arrows cluttering the exhibit), these determinants interact; they are not independent of each other. For example, the social environment in which someone lives affects that person’s individual behavior and healthcare, and those three determinants all affect the person’s health. Another point is that the five determinants do not all have an equally strong influence on health. Genetics is the starting point of health. Genes and characteristics inherited from parents make a person more likely or less likely to develop certain health problems, such as heart disease or cystic fibrosis. Perhaps your parents have mentioned genetic traits and characteristics that run in your family. Although scientists in research laboratories can modify a gene to avoid a disease-causing mutation, genetics is not yet a practical approach exHIbIt 1.1 Five Determinants of Health Model Health Outcomes Individual Behavior Healthcare Genetics Physical Environment Social Environment Source: Data from Kindig (2017). EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use C h a p t e r 1 : H e a l t h , H e a l t h c a r e , a n d H e a l t h c a r e O r g a n i z a t i o n s 5 to improving health. That might change in the future as science and ethics evolve (Reardon 2017). For now, managers have to modify the other four determinants to improve health. Healthcare is “the maintaining and restoration of health by the treatment and pre- vention of disease [and injury] especially by trained and licensed professionals” (Merriam- Webster Medical Dictionary 2018). (The definition of medical care is similar but often limited to care performed by physicians.) Healthcare services exist for all ages and stages of life, from womb to tomb. Together, they form a continuum of care that is explained later in this chapter. Managers can improve people’s health by helping to ensure people’s appropriate use of quality healthcare. Most healthcare spending in the United States has been for diagnosis and treatment of health problems. However, other determinants, such as behavior and social environment, often have a larger effect on health (Caron 2017; McGovern, Miller, and Hughes-Cromwick 2014). Researchers, HCO managers, clinicians, policymakers, and others are realizing this. They are giving more attention and allocating more resources to the other three determinants of health: individual behavior, physical environment, and social environment. Individual behaviors, such as smoking, seat belt use, diet, flossing, handwashing, and exercise, strongly affect health. For example, heart disease has been linked to behaviors that include smoking, eating unhealthy foods, and not exercising. Healthcare managers can improve people’s health by helping them improve their lifestyle and behavior. Some HCOs offer smoking cessation programs, nutrition classes, and fitness walks. Physical environment is the physical setting (natural and built) in which someone lives. Many elements of the physical environment affect health, such as sanitation, climate, parks, nighttime lighting, forests, safe roads, and air pollution. We can understand the importance of the physical environment by considering the health problems caused by floods and hurricanes. Healthcare managers can improve people’s health by helping them improve their physical environment. For example, HCOs have helped their communities reduce air pollution, build parks, and remove garbage. The social environment includes factors such as socioeconomic status, availability of fresh food, job opportunities, social interaction and support, discrimination, education, language, poverty, prevailing attitudes, and neighbors. Many of these factors vary based on location. Thus, a person’s zip code is a stronger predictor of health than is his genetic code (Hinton and Artiga 2018). The effect of these factors on health has gained recognition in recent years. Healthcare managers can improve people’s health by helping them improve their social circumstances. Healthcare providers are entering more of this information into patients’ medical and health records to monitor and address it with patients (McCulloch 2017). These determinants can lead to differences in the health of specific groups or subpopulations (e.g., those based on ethnicity, gender, and other characteristics). A health disparity is “a health difference that is closely linked with social, economic, or environmental disadvantage” (HealthyPeople.gov 2008). Health disparities are com- mon among groups that face barriers based on their gender, race, ethnicity, disability, healthcare The maintaining and restoration of health by the treatment and prevention of disease and injury, especially by trained and licensed professionals. health disparity A health difference that is closely linked with social, economic, or environmental disadvantage. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s6 location, and other factors. The US population is becoming more diverse, and many healthcare managers are striving to reduce disparities so that everyone can live healthy lives. You too will do that in your career. How can healthcare managers use determi- nants of health to improve people’s health? Realize that factors other than healthcare are important. For example, HCO managers in Wichita can improve people’s health by improving their behav- ior, physical environment, and social environment. These three determinants can help prevent dis- ease, illness, and injury from occurring in the first place. HCOs such as sports medicine clinics, hos- pitals, health insurers, physician practices, mental health clinics, and others have implemented many interesting approaches. Examples include offer- ing wellness programs to seniors, helping children adopt healthy lifestyles, building walking trails and playgrounds, and using social media to guide behavioral change. Think about your community. What have HCOs done there (besides delivering medical care) to improve health? He a Lt H c a r e a n D He a Lt H se r v I c e s There are many different kinds of healthcare and health services. Which ones have you heard of? Some prevent problems, some diagnose problems, some treat problems, and some support people at the end of life. Some are short-term; others are long-term. The many CHECK IT OUT ONLINE The US Department of Health and Human Services develops health objectives for the country to pursue during each decade. The objectives are designed to help the country become a “soci- ety in which all people live long, healthy lives” (HealthyPeople. gov 2018). The 2020 health objectives are available at www. healthypeople.gov/2020/About-Healthy-People. These objec- tives pertain to dozens of health topics and aspects of health, some relevant to college students. Several new topics were added for 2010–2020, including adolescent health, dementia, genomics, global health, and sleep health. Information provided for each topic includes an overview, objectives, data, and resources. You can also see early work on developing objectives for the 2020– 2030 decade. Check it out online and see what you discover. TRY IT, APPLY IT Suppose you are asked to serve on a college task force whose mandate is to recom- mend what the college should do to help students improve their health. Using what you have learned in this chapter about the determinants of health, suggest how students’ individual health and population health can be improved. Discuss your ideas with other students. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use C h a p t e r 1 : H e a l t h , H e a l t h c a r e , a n d H e a l t h c a r e O r g a n i z a t i o n s 7 kinds of healthcare and health services can be grouped into categories, such as preventive, diagnostic, curative, rehabilitative, and so on. Exhibit 1.2 lists several types of healthcare and services. (It is beyond the purpose and scope of this book to explain all these services. If necessary, you can research any unfamiliar services online.) Some types of care, such as home care, take place in only one kind of HCO. Yet most types of care occur in more than one kind of HCO. For example, diagnostic care occurs in freestanding diagnostic centers, outpatient clinics, physician practices, hospitals, urgent care centers, and other HCOs. Acute care Health promotion Preventive care Adult day care Home care Primary care Ambulatory care Hospice/palliative care Public health services Assisted living Hospital care Rehabilitative care Behavioral health care Inpatient services Respite care Chiropractic care Long-term care Self-care Chronic care Mental health care Skilled nursing care Community health services Office-based care Specialty care Complementary care Outpatient services Sports medicine Dental care Personal lifestyle care Subacute care Diagnostic care Physician care Urgent care Emergency care Post-acute care Virtual care exHIbIt 1.2 Types of Healthcare Services Healthcare and health services together can be thought of as a continuum of care (CoC) or care continuum with a range of services needed to care for a person or popula- tion (Buell 2017). A comprehensive “womb-to-tomb” CoC begins with prenatal care, ends with palliative end-of-life care, and includes all other health services in between that people might use during their lifetime. Some HCOs extend the CoC into the community and call it a “health continuum” to more fully improve the population health (not merely patient health) of their communities. The health continuum extends beyond direct healthcare services to include housing, food support, employment, and other social determinants of health that come from outside the usual healthcare system (Buell 2018). Exhibit 1.3 shows an example of a general CoC with a comprehensive sequence of services that many patients might follow. It begins with prenatal and preventive care, fol- lowed by primary care, specialty care, diagnostic care, acute care (outpatient and inpatient), continuum of care A range of services needed to care for a person or population. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s8 subacute care, chronic care, rehabilitative care, long-term care, and end-of-life care (Barton 2010; Shi and Singh 2015). Preventive care and specialty care occur at multiple stages of the continuum. The continuum can be considered a person’s journey through the healthcare system and related community services that are needed to care for that individual (Buell 2017). The complete continuum provides physical health services and mental and behavioral health services throughout the individual’s life. Smaller CoCs exist for particular kinds of patients or stages of life, such as CoCs for obstetrics, HIV (human immunodeficiency virus), rehabilitation, or behavioral health. For example, the University of Pittsburgh Medical Center Rehabilitation Institute uses a rehabilitation CoC that includes inpatient, outpatient, and community services. A CoC shows in a typical sequence the types of care and services needed for a specific patient population. Health professionals use CoC models as tools to plan how to meet the healthcare needs of a person or population in the most cost-effective way (Buell 2017). All services in a CoC should be seamlessly coordinated to work together. Thus, managers of HCOs must consider their place in their patients’ CoCs and form effective links with other services and organizations in those CoCs. Recent changes in how providers are paid have been driving HCOs, particularly hospitals and post-acute care HCOs, to use a CoC approach with their patients (Buell 2017; Van Dyke 2017). These changes include value-based payment for care, incentives to keep patients out of hospitals, requirements for discharge planning, bundled payments for episodes of care, and plans for unified post-acute payment. Driven by these new payment methods, hospitals are trying to avoid patient admission and readmission to the hospital. Their approaches include providing preventive, primary, specialty, and diagnostic care early Pr en at al C ar e Pr ev en ti ve C ar e* Pr im ar y Ca re Sp ec ia lt y Ca re ** D ia gn os ti c Ca re A cu te C ar e S ub ac ut e Ca re Ch ro ni c Ca re Re ha bi lit at iv e Ca re Lo ng -t er m C ar e En d- of -l ife C ar e exHIbIt 1.3 Continuum of Care Source: Adapted from Barton (2010) and Shi and Singh (2015). *Preventive Care occurs at many stages of the continuum to prevent occurrence and reoccurrence of disease, illness, and injury. **Specialty Care occurs at many stages of the continuum. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use C h a p t e r 1 : H e a l t h , H e a l t h c a r e , a n d H e a l t h c a r e O r g a n i z a t i o n s 9 in the continuum to prevent admission, and then subacute, chronic, rehabilitative, and long-term care later in the continuum to prevent readmission. Managers are trying to more closely connect mental and behavioral healthcare with physical healthcare in the continuum. Besides payment changes, stakeholder demands for population health and coor- dinated, integrated (rather than fragmented) care are driving HCOs to develop optimal CoCs for patients and communities. This goes beyond the services that HCOs provide. HCOs must focus on social determinants of health (discussed earlier in this chapter) and the patient’s role in self-care to keep people healthy and avoid expensive healthcare (Bosko and Gulotta 2016; Buell 2018). Thus, some HCOs are trying to gather data about patients’ housing, food security, education, income stability, and other social factors that strongly affect health. He a Lt H c a r e or g a n I z at I o n s The Here’s What Happened at the beginning of the chapter introduced Partners Health- Care—a large, complex HCO (made up of smaller HCOs) that we will follow throughout the book. What HCOs have you heard of, worked at, or volunteered at? Some HCOs, such as large general hospitals, provide a wide range of services spanning many parts of the CoC. Other HCOs, such as hospices, specialize and provide only a narrow range of services in one part of the continuum. Hospitals may also specialize, such as hospitals for only psychiatric care or for only rehabilitation services. Ambulatory HCOs provide healthcare services to people who obtain care but do not stay overnight. Medical group practices and physician offices provide many ambulatory medical services in specialties such as cardiology, pulmonology, and neurology. They might offer diagnostic testing, on-site therapy services, outpatient surgery, and other services. Outpatient diagnostic centers perform lab tests, medical imaging, and other services to diagnose health problems. Other outpatient HCOs are ambulatory surgery centers, urgent care facilities, mental health clinics, public health agencies, sports medicine businesses, dental practices, and counseling offices. Some retail stores operated by large companies (e.g., Walmart, Target, CVS, Kroger) offer basic urgent care. Home care organizations provide an array of nursing care, therapy, and health services in people’s homes. Telehealth and virtual care methods have expanded the range of health services delivered in people’s residences. Some organizations—such as skilled nursing facilities, personal care homes, and assisted living communities—provide services for people (not all of whom are elderly) who need care for an extended period of time. In addition to HCOs that provide hands-on healthcare services to patients, other types of HCOs are essential for improving individual health and population health. Orga- nizations such as the American Cancer Society and the American Lung Association improve people’s health by funding research, developing educational programs, reducing risk fac- tors, and assisting people who need treatment. Medical supply firms and pharmaceutical EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s1 0 companies such as Johnson & Johnson produce and distribute supplies, drugs, and equip- ment that other HCOs use for their healthcare. Companies such as General Electric and Philips make complex medical equipment. Some companies make catheters, intravenous solutions, antibiotics, bandages, and many other daily supplies. Health insurance companies, such as Blue Cross, are another type of HCO. These businesses assist in the financing of and payment for healthcare services. Trade organizations (e.g., the Medical Group Manage- ment Association) and professional associations (e.g., the American College of Healthcare Executives) are other types of HCOs. Colleges and universities educate people to work in dozens of types of healthcare jobs. Professional and governmental organizations such as The Joint Commission and the Ohio Department of Health accredit, license, and regulate HCOs. Philanthropic organizations such as The Commonwealth Fund and the Kaiser Family Foundation provide research, education, and financial grants to improve health. The list of HCOs could go on and on. Try to think of other kinds of HCOs. There is no distinct boundary between HCOs and non-HCOs. For example, Amazon, Apple, and Uber have announced their intentions to get involved with healthcare (Michelson 2018). Managers of HCOs should realize that their organizations must interact with many others to produce a CoC and healthcare services for their population. tH e ex t e r n a L en v I r o n m e n t o f He a Lt H c a r e or g a n I z at I o n s An HCO exists in an external environment of people, organizations, industries, trends, forces, events, and developments that are outside of the HCO. Most of these external ele- ments are beyond the HCO’s control. The external environment of a specific HCO includes all the other HCOs along with citizens, schools, colleges, banks, information technology (IT) companies, labor unions, competitors, stock markets, governments, venture capital- ists, and more. This environment includes economic, demographic, technological, cultural, legal, social, and other kinds of developments in society. For example, in the opening Here’s What Happened, the external environment of Partners HealthCare includes the invention of new devices for mobile technology. Let’s analyze the external environment of a home care business in Baltimore. The other home care businesses around the city are part of the environment. They exist in the healthcare realm, which also includes public health agencies, subacute care facilities, health insurers, and all the other HCOs in and around Baltimore. The larger society, including government, banking, transportation, education, housing, and many other elements, are all part of that home care business’s external environment. In addition, that environment includes potential customers, volunteers, employees, student interns, donors, and suppliers. We can also think of this environment in terms of forces and influences, such as cultural diversity, local employment trends, 24/7 mobile communication, and opioid addiction rates, that affect the home care business. EBSCOhost - printed on 10/14/2021 6:54 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use C h a p t e r 1 : H e a l t h , H e a l t h c a r e , a n d H e a l t h c a r e O r g a n i z a t i o n s 1 1 These other organizations, forces, and people affect HCOs in many ways. For exam- ple, the home care business depends on people to use its services, but those clients may want more weekend services and social media interaction. They can use a different home care business if their preferences are not met. The government could force the business to make changes to maintain its license and stay open. The home care business depends on other businesses to provide services and …