Question

two external environments and the forces that affect HSOs/HSs. How do these forces affect HSOs/HSs? Are there others?

Answer 1

Health Service Organizations (HSOs)

HSOs are the entities that provide the organizational structure within which the delivery of health servies is made directly to consumers, whether the purpose of the services is preventive, acute, chronic, restorative or palliative. HSOs were predominantly independent, freestanding organizations. Begining in teh 1970's and continuing through the 80's and 90's, many HSOs have joined together to form systems of organizations. Few of examples are adult ambulatory services, adult inpatient hospital services, standalone cancer units, ambulatory and inpatient rehabilitation services, skilled and intermediate nursing services, family planning services, and ambulatory and inpatient psychiatric services.

Health Sytems (HSs)

HSs are unfied organizational arrangements or a system of organizaitons. HSOs working together to provide a seamless continuum of care. Defined as formally linked HSOs, possibly including financing arrangements, joined together to provide more coordinated and comprehensive health services.

Three main components of HSOs/HSs

1. Governing Body (GB)
2. Chief Executive Officer (CEO)
3. Professional Staff Organization (PSO)

Governing Body are the ultimate authority and decision maker of HSOs/HSs. They determine the organizational mission and evaluated progress toward accomplishing that mission.

Functions of the Governing Body

• Establishing the mission
• Monitoring progress toward accomplishing the mission
• Approving the strategic plan and annual budgets
• Ensuring the quality of care by approving quality of care goals
• Monitoring overall performance

Chief Executive Officer are Selected by and receives authority from the GB. They act as the GB's agent to: Organize inputs, Achieve organizational missions and objectives, Adopts corporate titles like president and executive vice president, orks in a competitive, economically demanding environment, Manages inputs in order to achieve desired outputs (the HSO/HS mission and objectives), Human resources, Material, Technology, Information, Capital.

Professional Staff Organisation are comprised of clinical staff who deliver healthcare and health-related services. Individual LIPs and the PSO as a whole perform technical services that must be integrated into a total effort if the organization is to achieve its objectives. Non-LIP managers neither deliver clinical services nor judge quality independently; they must obtain the expert advice and technical assistance of LIPs to make informed judgments about individual and aggregate PSO practice.

Factors influencing the quality of medical services

Patient related factors

• Patient socio-demographic variables
• Patient cooperation
• Patient illness

Physician related factors

• Physician socio-demographic variables
• Physician competency
• Physician motivation and satisfaction

Environmental factors

• Healthcare system
• Resources and facilities
• Collaboration and partnership development

Healthcare system
Patients are free to choose the healthcare settings or providers. Therefore, there is a tendency, in patient choice from a GP to a medical consultant: “Lack of a referral system resulted in a shift of patient choice from general practice to sub-speciality practice. Most patients prefer to be seen by a medical specialist. Nowadays, a GP has fewer patients than a medical consultant. Low medical tariff makes it easier for patients to see a medical specialist: “The disparity between the service fee of a GP and a [medical] consultant is not too much. Therefore, patients prefer to be seen by a medical specialist.” Medical insurance companies make it even more affordable for patients to see a medical specialist. Furthermore, the fee for service of a doctor visit is the same for simple or more complicated cases. It leads to competition between the GP and the specialist, with the latter being perceived as holding the upper hand. Hence, there is no motivation for medical consultants to convince patients to be seen by a GP first. This can also cause a competition between a GP and a medical consultant. As a result, medical consultants are overwhelmed by patients. Moreover, lack of patient trust in medical doctors and lack of familiarity with medical practices increases uncertainty and leads to repeated medical visits. As a result, the demand for specialised healthcare is increasing which is beyond the resources of healthcare organisations or even payers. Medical doctors who took part in the study complained that they were overworked and that there were staff shortages. Providers have to limit their flexibility and adaptability to the patients’ individual needs due to staff shortages and time constraints.

Resources and facilities
Availability of resources affects the quality of medical services. The demand for medical services is beyond the capacity of healthcare organisations: “Healthcare resources are limited but people expectations are very high.”. Insufficient infrastructures, resources, and equipment inhibit delivery of quality medical services. For instance, a good patient information system is necessary for effective patient diagnosis and treatment: “We need an information system. We need to have a record of patient history. It is very useful, especially for patients with blood pressure or diabetes. Thus, we will be able to see the effect of the treatment on patient by re-viewing his or her record.”

Collaboration andpartnership development
Medical doctors expect their colleagues or co-workers to be more responsible and be empowered enough to perform the job well. “A nurse spends more time with patients than a doctor. S/he should tell the doctor the patient problem to help him/her with a proper decision. Physicians highlighted the importance of cooperation and teamwork among healthcare providers as an important component of high quality healthcare services. Practitioners’ ability to effectively communicate and collaborate with other health professionals or institutions was also considered essential to the delivery of high quality medical services.