Healthcare Organization Essay

A health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations. There are two widely known and used healthcare organizations that deliver insurance to the vast majority of the population, Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). This document will further compare these organizations in how they communicate, management style, motivation, culture, conflict resolution and ongoing management development.

Communication skills Health Management organization (HMOs) and the Preferred Providers Organization (PPOs) are service providers and require effective communication skills to reach out to the consumers and sustain business. Effective communication is often top of the list of attributes employer look for in a job (Lombardi D. M. , & Schermerhorn J. R. , 2007), whereas for service and goods consumers communication skills and style are effective tools to sell services. HMOs and PPOs use both incoming and outgoing communication skills to sell health products.

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Outgoing communication skills include giving of “directives, directions, consultation, demands, expectation, guidance, feedback and referrals” (Lombardi D. M. , & Schermerhorn J. R. , 2007) for services provided. Here the consumer or subscribe is critical to incoming communication as the health providers provided the needed information for the consumers care. Outgoing communication comprises of, “compliance, professional development, action, growth team insight, leadership, contribution and, expertise, satisfaction and, expectation, fulfillment (Lombardi D. M. , & Schermerhorn J. R. , 2007) to achieve efficiency and reliability in services. In outgoing communication the employees are mainly under consideration. Nonverbal communication is communication tool available to the HMOs and PPOs, nonverbal communication show cases the work behaviors and culture and how user perceives the services. Communication in both organizations is written and verbal and both require that the organizations build effective way of sending and receiving information. HMOs and PPOs use same communication skills to achieve business goals.

As service providers, communication should be effective for consumer’s patronage. Patronage is likely id consumers decode messages sent. The incoming and outgoing communication strategies are pertinent to both organizations Management style Health management Organizations (HMOs) and Preferred Providers Organizations (PPOs) are types of insurance that provide managed care through a group of health care providers for the subscribers. HMOs subscribers choose a Personal -Care -Physician (PCP) also called gatekeepers.

The gatekeeper manages the health needs of the consumer. However, the subscriber determines accessibility to a PCP within his or her territory. Location of the health provider is critical as treatment out of network chain attracts extra cost. Health Management Organizations provides annual premium because cost is shared among members. This is an added advantage to the subscriber. HMOs key into the paperless office and they do less paperwork. HMOs focusing more on preventive health, and this of value as preventive services promotes a healthier life .

HMO scheme are beneficial to users with medical conditions, who receive routine care as access to care attracts little extra cost. A known disadvantage of subscribing to HMOs is that access to specialist care is limited, this so as “ health care costs running at 11-12 percent of our gross national product, cutting the cost of health care has become a national priority” (Kennedy D. W ,1990). Increased cost if treatment is sought outside network and subscribers view sticking to a PCP as a sign of inflexibility. PPOs allow consumers to seek care outside the network coverage but this allowance attracts extra fee.

PPOs provide prescription services at a reduced cost; have a larger network covering larger geophysical areas. PPOs management style has advantages over HMOs as they less restrictive and affords the consumers opportunity to use out of network facilities with prior approval at a cost. PPOs are located in more geographical areas and makes access easier. Subscribers are not stuck with a PCP nor require referrals to see providers outside the network.

Consumers file for claims for reimbursement when visit is made to out of network health provider Motivational Methods. There are as many different methods of motivating employees today as there are companies operating in the global business environment. Still, some strategies are prevalent across all organizations striving to improve employee motivation. The best employee motivation efforts will focus on what the employees deem to be important. It may be that employees within the same department of the same organization will have different motivators. Many organizations today find that flexibility in job design and reward systems has resulted in employees’ increased longevity with the company, improved productivity, and better morale.

Conflict Resolution With the need for constant change comes conflict. There are several strategies for handling conflict, avoidance, pressing, accommodation, collaboration, and negotiation to name a few. (Week Three reading from Health Care Management Strategies). There is also another type of conflict which can be very damaging to an organization; this conflict is known as interdepartmental conflict. Office politics is a very serious type of conflict and leads to mistrust, avoidance and incorporative behavior between team members. Week Three reading from Health Care Management Strategies). Organization Culture Healthcare organizations cannot only rely on one culture within their organization. “The Competing Values Framework has been used in health services research to assess organizational culture as a predictor of quality improvement implementation, employee and patient satisfaction, and team functioning, among other outcomes” (Helfrich, Mohr, Meterko ; Sales, 2007, p 1). In health care, culture does play a big part in providing exceptional care.

When an organization is stable and successful, it has had many cultures involved; because there is such a diverse range of cultures, the staff of an organization learns to cope with all different types of demands A good example of a large PPO is Regence BlueShield. Regence is the largest health insurer in the Northwest / Intermountain Region, offering health, life and dental insurance. Regence serves nearly 2. 5 million members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (selected counties in Washington).

The culture at Regence is focused on improving the health of their members and their communities, and to transform the health care system. There are advocates for change. Accountability, teamwork, leadership, customer focus, trust, commitment and leadership are the core values. An example of a large HMO is Group Health Cooperative or formally known as Kaiser Permanente. Group Health Cooperative began in 1947 as a community coalition dedicated to making quality health care available and affordable. Today it is one of the few health care organizations in the country governed by consumers.

Its 11-member Board of Trustees — all health-plan members elected by other members — work closely with management and medical staff to ensure that the organization’s policies and direction put the needs of patients first. Group Health is heralded as a national model for health care that actually focuses on and delivers better health. Practices such as electronic medical records, a strong relationship with your doctor, and an emphasis on prevention and early screening are already at work, creating an exceptional care experience our members rave about. The two organizations both have divisional structures and adaptive organization model.

They both are focusing on improving the health of their members. The biggest difference is that Group Health has a Board of Trustees that are members of the health plan. Group Health further sites their focus on early prevention. Regence focus is on change and their ability to transform the healthcare system. Management Staff Development The first key to developing management staff is to completely understand the culture, vision and the direction of the company. In the example of the HMO, Group Health, they state their culture is to focus on improving the health of their members.

The management staff would need to be inline with that vision. The development of future staff would have to understand that the focus is on the members improving health. The example of the PPO, Regence BlueShield has a focus on their ability to transform healthcare. Future management would need to be knowledgeable about healthcare and have the ability to redirect old thought processes to make that happen. Health maintenance Organizations and Preferred Provider Organizations’ are looking toward a future with a lot of changes because of the healthcare reform.

The management staff of these organizations will need to continually find ways to keep their staff in a constant mode of learning to adapt to these changes Conclusion These two organizations are very similar. They both provide similar services to their members. The biggest difference in them is how they are organized. Group Health is run by a board of their own members. Where Regence structure is still set up like a business. This could allow an advantage for Group Health. The decisions of the board will directly affect them and they will be more in tune with the other members.

Reference

Regence BlueShield. (2011). Our Culture. Retrieved from http://www. regence. com/about Lombardi, D. M. , and Schermerhorn, J. R. , (2007): Health care management: Tools and techniques for managing in a health care environment. Hoboken, NJ: John Wiley & Sons Kennedy, D. W (1990): HMOs: What every Consumer Should Know. Priorities for Health, 2(2), 22. Retrieved form EBSCO Helfrich, C. , Li, Y. , Mohr, D. , Meterko, M.  & Sales, A. (2007). Assessing an organizational culture instrument based on the Competing Values Framework: exploratory and confirmatory factor analyses. Implementation Science: IS, 213. Retrieved April 15 2011, from MEDLINE with Full Text database. University of Phoenix. (2011). Strategies for Handling Conflict. Retrieved April 7, 2011 from University of Phoenix, Week Three reading, HCS/413-Health Care Management Strategies

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