Category: Healthcare

Introduction

Protecting and securing the rights of people when they are at their most vulnerable must be deemed as the quintessential responsibility of the state government, as well as respective healthcare authorities. Therefore, ensuring that patients personal data and other vulnerable information should be kept secure in the healthcare environment. Currently, the Health Insurance Portability and Accountability Act (HIPAA) serves to protect the rights of patients to retain their privacy and remain safe when using healthcare services (Cohen & Mello, 2018). Moreover, the specified regulation shapes the way in which the issue of information security is perceived in the healthcare setting, as well as the approaches used to enhance data security. By considering some of HIPAAs key provisions and the effects that it has produced on the performance of Humana, a prominent U.S. health insurance organization, one will be able to identify weaknesses in the current approach toward patients personal data and insurance options.

Humana: Rationale for the Choice

To illustrate the effects that the HIPAA standards have produced on the safety of patients and the security of their personal information once they address healthcare services, Humana has been chosen as an example to consider. Being a for-profit company that has been operating in the insurance industry, Humana is considered to be one of the largest health insurance providers in the U.S. (Cohen & Mello, 2018). By considering the effects that HIPAA has produced on Humana, one will be able to embrace the entire range of effects that information security regulations have had on the healthcare sector. Specifically, the large scope of Humana and its exclusive focus on health-related human rights were the key deciding points in selecting it as a subject of this study.

Humana: Description

Managed healthcare services remain some of the most crucial and consistently demanded ones in the U.S. setting. Due to the presence of numerous obstacles to providing healthcare of proper quality, a range of American citizens suffer from the lack of affordable and effective healthcare (Humana overview, 2021). Humana, a U.S. for-profit company providing health insurance services, strives to amend the described situation (Humana overview, 2021). Currently, Humana (2021) offers three options for health insurance, namely, group health insurance, dental plans, vision plans, and Medicare/Medicaid options. Humana has proven to perform quite impressively in the U.S. healthcare insurance market, with its stock prices increasing consistently and landing currently at $391.55 (Humana overview, 2021). Overall, the company has been demonstrating prowess and professionalism in its management of customers insurance needs. However, the company lacks the innovative approach and the ethical values that could prevent data leakage and disclosure for taking place in the corporate setting. By introducing new policies based on transparency and corporate social responsibility (CSR), Humana will be able to enhance its security an improve its data management framework.,

Humana and the Health Insurance Portability and Accountability Act (HIPAA)

When addressing the performance of Humana, one must refer to the Health Insurance Portability and Accountability Act (HIPAA) that serves as the legal framework for the company to meet and follow. HIPAA was approved of in 1994 as the tool for addressing issue associated with health insurance. According to the U.S. Department of Health & Human Services (2021, para. 1), HIPAA is used to improve the efficiency and effectiveness of the health care system. Currently, HIPAA is implemented successfully to ensure compliance with the fundamental standards of care and protection of patients privacy (U.S. Department of Health & Human Services, 2021). Developed in the way that prevents any form of discrimination from taking place when using it, HIPAA makes insurance portable by removing the connection between insurance opportunities and a particular job of an individual to be ensured (U.S. Department of Health & Human Services, 2021). However, HIPAA also suffers from the lack of insight into the role of third parties, such as digital healthcare app providers, in handling patients personal data (U.S. Department of Health & Human Services, 2021). Therefore, the efficacy of HIPAA is yet to be tested.

Legal Cases

Over the course of being implemented in the health insurance context, HIPAA has been connected to a range of legal cases. These legal issues have created premises for improving HIPAA and amending some of its provisions to ensure that all vulnerable groups are included and that the regulation is not in conflict with any of the existing legal standards. Among the most significant cases regarding HIPAA, one must mention the 2016 case of HIPAA violation in Illinois. According to the case details, the entire Illinois healthcare network proved to be compromised, exposing four million people to the threat of their personal information being misused as a result of privacy violation (Bassan, 2020). Namely, the data breach occurred after perpetrators had stolen an unencrypted laptop from the hospital employees car (Bassan, 2020). The specified case has proven the importance of complying with the principal HIPAA rules and developing a risk analysis framework that would protect patients private data (Bassan, 2020).

Another landmark case that has proven the role of maintaining a viable data protection system, the legal incident involving an imaging company in Tennessee warrants a closer look. According to the details of the case, Touchstone Medical Imaging, a healthcare organization offering imaging services in Tennessee, was proven to be guilty for violating a range of data breach management cases, failing to inform around 300,000 patients about the data leakage and, therefore, exposing them to a potential threat (HIPAA Journal, 2019). Although the case resulted in a settlement, it has proven the importance of having HIPAA as the tool for controlling compliance with the principal standards for data security and patients privacy.

Additionally, one must address the case of a company unintentionally making a misstep and placing its patient in danger due to the exposure of her personal data in a press release. In its effort to maintain transparency and update its customers on the changes within the organization, the Memorial Hermann Health System (MHHS) made the name of a patient who used a false ID card in the hospital system, public (HIPAA Journal, 2019). The described case is remarkable since it demonstrates that the threat to patients security may not necessarily target them as an external force; instead, it may come from within the healthcare organization. Thus, the case under analysis has illustrated the importance of applying HIPAA and complying with its key guidelines even in the setting where the external threat to patients personal information is minimized.

Finally, one must mention the breach of HIPAA involving Humana, the company under analysis. In July 2021, a massive data breach occurred at Humana after a subcontractor staff member leaked personal information of the patients, including their names, email addresses, IDs, and other personal details (Humana Lawsuit  Data Breach of Medical Information, 2021). The records made available to the public dated back to 2019, which meant that a tremendous number of patients were placed under a massive risk (Humana lawsuit  Data breach of medical information, 2021). The specified situation has led to Humana facing a lawsuit filed by one of its former patients (Humana lawsuit  Data breach of medical information, 2021). When disentangling the case under analysis, one should point out that the legal action filed against Humana was based not only on the data breach issue, but also on the fact that the organization failed to notify its customers about the disaster, preferring to keep the information about the data leak private before it became obvious that the issue could not be resolved promptly (Humana lawsuit  Data breach of medical information, 2021). Therefore, Humana evidently needs to revisit its standards for complying with HIPAA rules, particularly, the standards for information security and the notification of customers about the instances of data breach.

Intellectual Property Rights: Trademarks

Over the course of its performance, Humana has created several trademarks and patents. Among the most notable ones, the Medicare Pharmacy Calculator II, prescription drug prior authorization system and method, and the method for using financial incentives with member engagement metrics to reduce health care claim costs should be listed (Humana, n.d.). The specified patents represent the variety of services that Humana provides and the broad range of areas that it covers. However, the organization does not seem to have been awarded any specific IP rights for its trademarks. Therefore, it would be reasonable for Humana to consider securing its current IP rights tighter and preventing the instances of IP theft. Given the high rates of rivalry in the target market of health insurance, with juggernauts such as Medicare and Medicaid representing Humanas key competitors, it will be reasonable to create a stronger competitive advantage. In turn, securing the IP rights for the companys trademarks will help Humana to become more competitive.

Trade Secrets

The issue of trade secrets disclosure is another possible area of concern for Humana given the high rates of competition in the U.S. healthcare setting. Currently, Humana has several trade secrets, one of which is under the threat of being revealed to the general public (, 2021). Namely, the information about Humanas collaboration with the military in an attempt at launching its military insurance business has recently been made available to the audience (Humana prefers you dont know the details of its $45 billion Tricare contract, 2021). Specifically, it has been discovered that Humana has signed a $40.6 billion contract with a military organization in order to expand into the military industry and provide respective security services (Humana prefers you dont know the details of its $45 billion Tricare contract, 2021). The specified step could be interpreted as controversial given the complicated nature of its implications. Namely, since the army represents the state officials and their policies to a certain extent, Humanas involvement in the military issues could be seen as a politicized decision.

Crime and Tort Risks

Targeting the enhancement of personal security of its client, Humana has been particularly careful with the legal aspect of its performance as well. Remarkably, Humana has never been involved in any case of a tort up until the late 2000s (Humana, Inc. v. Shrader & Assocs., LLP, 2018). Remarkably, Humana has no only faced an instance of a tort breach, but has also contributed to shaping the current tort standards. Namely, Humana faced accusations of failing to offer the promised services and introduce a cost-efficient approach toward personal insurance in 2009 by Joel Kaye (Humana, Inc. v. Shrader & Assocs., LLP, 2018). The specified outcome has shape Humanas approach toward information security management to a great extent, promoting transparency and clarity in the companys transactions (Humana, Inc. v. Shrader & Assocs., LLP, 2018).

In addition, Humana has recently faced a substantial threat of a lawsuit due to the instance of a massive data breach mentioned above. Namely, due to the instance of data breach observed in 2020, Humana faced the threat of a class action lawsuit that could have been started and implemented quite successfully by the customers who had their personal information stolen (Humana, Inc. v. Shrader & Assocs., LLP, 2018). However, the company has avoided a lawsuit; furthermore, Humana has been noticed to make evident steps toward filing a legal claim against the Visionary, an organization whose employee, previously Humanas subcontractor, facilitated information leakage (Humana, Inc. v. Shrader & Assocs., LLP, 2018). Therefore, overall, Humana is exposed to external risks roughly to the same extent as any other organization operation in the legal field.

Assessment: Legal System

As the case of data breach involving Humana described above has shown, the legal system applied at Humana suffers from the lack of accurate definitions of risks and a coherent approach toward informing its customers about the incidences associated with data breach. The observed issue could also be ascribed to underdeveloped corporate ethics, namely, the lack of responsibility. Therefore, it is strongly recommended that Humana should rewrite the existing guidelines for informing customers about situations involving data breach or leakage.

Conclusion

Although the HIPAA provides a rather comprehensive overview of key risks that patients are likely to face in the healthcare context in regard to their personal data management, the regulation still lacks the tools for its reinforcement. Similarly, HIPAAs requirements for the involvement of the third party may cause certain privacy issues. Due to the involvement of third party HIPAA entities into the process of managing the needs of patients, the threat of data leakage and the resulting disclosure of personal information arises. Therefore, patient consent must be introduced as a vital step of providing respective healthcare services. Furthermore, more rigid control tools should be established to reduce the threat of ePHI being disclosed. Overall, the current HIPAA standards have proven to work quite well for Humana, yet they provide only a basic framework that should be expanded further to encompass the broad variety of threats to patients personal data.

References

Bassan, S. (2020). Data privacy considerations for telehealth consumers amid COVID-19. Journal of Law and the Biosciences, 7(1).

Cohen, I. G., & Mello, M. M. (2018). HIPAA and protecting health information in the 21st century.JAMA, 320(3), 231-232.

HIPAA Journal. (2021). Touchstone Medical Imaging fined $3 million by OCR for extensive HIPAA failures.

Humana overview. (2021).

Humana prefers you dont know the details of its $45 billion Tricare contract. (2021).

Humana, Inc. v. Shrader & Assocs., LLP. (2018). CIVIL ACTION NO. G160354.

Humana. (2021). About Humana. Web.

Humana. (n.d.). Humana patents. Web.

U.S. Department of Health & Human Services. (2021). HIPAA for professionals. Web.

Factors Causing Tensions

Hospitals can only operate efficiency when there is harmony between the governance, medical staff, board of trustees, and administration. However, modern healthcare organizations experience tensions between these stakeholders caused by several organization factors, most of which are internal to the specific hospitals. Between the medical and administrative staff, organization and job characteristics is a critical factor where agreeing on the basic parameters of the job may cause a tension. Poor management on the side of the administrative staff causes issues with both the board and the staff members (Tosanloo et al., 2019). Inefficient communication systems means that emerging problems and other issues can go unresolved, which further increases the tensions between all the four stakeholders.

Every organization has a set of values that govern all operations, practices and processes. The attitudes and perceptions of the medical staff towards these values can cause tensions, especially if the values conflict with the personal belief systems. Behavioral factors, including competition among the medical staff may cause internal problems and administrative issues where cooperation and teamwork are inhibited. Leadership and management styles can have both governance and administrative challenges and resistance from the medical staff (Polyzou and Tsiotras, 2018). The board may be responsible for the direction and practices of the hospital, which means that the administrators would be working towards meeting the board expectations. If the management styles fail to meet the expectations of the medical staff, conflicts and tension may emerge where employees could either resist or have a high turnover.

The role of the board should never be to rubber stamp ideas presented by the administration. When this happens, the hospitals end up serving limited scopes and the board may feen unsatisfied with the administration. Additionally, failure to engage in strategic dialogue may raise issues when blame games start. Insufficient orientation undermines the competence of the medical staff, who require the skills, knowledge and behavior necessary to perform as required. It is the role of the administration to ensure medical staff are properly orientated since performance issues can cause tensions between these stakeholders. Conflict of interest often emerge when the board and the administration influence decisions to suit their needs. For example, members of both the board and administration could have private practice, which could result in roosters designed to create time to manage the side business. Therefore, governance issues emerge where such issues as rules, accountability, and transparency are affected.

Other issues that cause tensions between the administration, medical staff, governance, and the board of trustees include the lack of commitment to continuous learning. The board has the responsibility to engage in strategic dialogue with the administration and cannot rely solely on the information presented by the administrators. Governance ensures that processes and practices meet set standards and comply with legal frameworks, which requires continuous learning throughout the organization. Lack of transparency can be described as governance problem, especially when the entity is under the limelight of the media and the public. Board composition is critical since it influences the direction and the strategic relationship with the other stakeholders. Such problems as conflicts of interest may arise from a poor composition of the board. Lastly, outdates board processes and materials can cause tensions across the entire organizations, especially when the administration is unsuccessful in its efforts to modernize.

Publics Readiness to Survey Information

LeapFrog Group is one of the organizations that conduct surveys on quality of hospital care and makes the findings available to the public. Such issues as hospital safety are graded using standards set by LeapFrog, including infection rates and surgical injuries (Bates & Singh, 2018). Leapfrog indicates that the findings are used to benchmark performance and assist consumers in making decisions on where to receive care. In my opinion, the public is ready for this information since we are living in an era of enlightenment where people have the right to information. The patient awareness becomes a necessity since they make the choice were they desire to receive care. The information also necessitates hospitals to become more open and transparent, especially when those that do not participate in the surveys are reported. Such organizations may appear suspicious in the eyes of public, which would force them to disclose the relevant data. The fact that healthcare practices can result in adverse events means that the public needs to be well informed.

The public is also ready to learn and understand issues relating to patient safety and quality of care. The argument is that without this understanding the public cannot make informed decisions regarding the choice of hospitals. Quality and safety encompass several aspect of care, including adverse events and human errors. Good ratings can be used by the public as a greenlight to select the hospitals with the expectation that the organization will deliver quality care. Additionally, the public represents the consumer base, which can effectively put pressure on hospitals to improve their practices. Without the information, the public can remain unaware of the critical issues in healthcare and underperforming entities would continue to provide substandard services. The public is ready to become a major player in the improvement of safety and quality of care with the use of the survey information.

Benefits of Physician Entrepreneurship

Physician entrepreneurship can be extremely beneficial for patients, especially where the resulting competition means better services. According to Greenblatt (2021), most of the physician entrepreneurship is innovation-driven, which means that new technologies and medical devices are designed, developed, and used in offering care. The result of medical innovation is that the quality and safety of patient care can be improved. The entrepreneurs are often private individuals whose concern is to solve medical problems with the aim of profiting in the process. Quality and safety of care are some of they problems facing the healthcare, which means that competitive solutions that are technology-driven will go a long way improving the overall patient experience. The entrepreneurs also invest heavily in research and development, majorly since their products have to undergo thorough scrutiny before being approved by the health regulators. Growing research and development only serves to improve the industry as new developments can be informed by research.

Physician entrepreneurship also helps to complement the services offered by public organizations. The competition between hospitals and private entities means that the prices of healthcare can reduce drastically, which makes care more affordable for the patients. Additionally, entrepreneurs often focus on offering new services, which means that patients can experience new and improved services. The process models also change, which helps organizations become more efficient. The ultimate result is that operational costs lower the prices of healthcare. New drugs and positive development in new areas of medicine is another outcome that benefits the patients. The rationale is that entrepreneurs will be seeking to fill medical gaps, which includes unlocking new practices and procedures in healthcare.

References

Bates, D., & Singh, H. (2018). Two decades since to err is human: An assessment of progress and emerging priorities in patient safety.Health Affairs, 37(11), 1736-1743. Web.

Greenblatt, W. (2021). Proportion, type, and characteristics of physician entrepreneurship in Massachusetts.JAMA Network Open, 4(1), 1-12. Web.

Polyzou, M., & Tsiotras, G. (2018). Analysis of determinant factors of conflict in Greek hospitals. International Journal of Caring Sciences, 11(1), 935-946.

Tosanloo, M., Adham, D., Ahmadi, B., Foroshani, A., & Pourreza, A. (2019). Causes of conflict between clinical and administrative staff in hospitals. Journal of Education and Health promotion, 8, 1-6. Web.

Law is a combination of procedures that a distinct nation or community identifies by conducting the engagements of its members. The health care industries have different laws that have significant consequences for the health of a designated population. These regulations analyze the authority of the government and other authority laws to advance the health of the overall population in communal parameters and customs. Considering universal healthcare, the national authority should legislate several relevant rules to protect and attend to citizens.

Globally, several lives have been lost through abortion, either self-will or communal decision by the particular partners. In Texas, the Texas abortion law was passed in May 2021 and is expected to be enforced by September 1st. The regulation prohibits pregnancy termination consequent to the discovery of fetal cardiac movement and permits nearly everyone to prosecute abortion workers and other individuals who might help individuals finding this conditions care. Individuals incapable of taking care of the children can take them to adoption centers rather than carrying out an abortion. In addition, banning termination of pregnancy helps people to be responsible for their actions and carry out the consequences.

Over the years, healthcare facilities are progressively demanding healthcare workers be vaccinated for definite diseases to decrease epidemics of vaccine-preventable diseases such as measles and influenza. Following Attwell et al. (2018), in developed countries, the current occurrence of vaccine-curable diseases and fears about vaccine rejection has pushed to enforcement of vaccine mandate law. To ensure complete protection from various conditions, vaccination is important for every individual. Additionally, through vaccination, several death cases will be overcome, maintaining the population.

The global pandemic has destabilized the economy of most countries through decreased labor. The drug pricing plan is essential in recognizing the high prices of medication. The law documents price evaluations when drug cost growth exceeds indicated edges (Sklar & Robertson, 2019). With the universal health care policy, every individual has a right to health care. The low-income individuals are disadvantaged by the law and even the middle class considering the devastating economy. Increased taxes to stabilize the economy due to the COVID-19 economy will put people in dilemmas of either basic needs or seek medical care.

Tobacco is among the commonly abused drugs in most countries with severe health impacts. FDA v. Brown & Williamson Tobacco Corp is a law that gives guidelines on tobacco usage. Recently, most youths tend to be affected by the usage of tobacco. This drugs usage is considered to be vital for the body since it has nicotine substances. The law is therefore effective in avoiding excessive use of tobacco, especially among teens.

According to Jacobson Vs. Massachusetts, the law was administered for obligatory vaccination laws. In regards to health, individual health affects another person and can generally affect all society. The regulation has been related to the recent COVID-19 results and used to determine the situation (Blackman, 2021). It is necessary for helping individuals to consider the whole society as one. Admittedly, laws are enforced to help guide the actions of every individual. A negative action can adversely affect the community, and the impact can be irreversible. The government has to ensure the laws are fully enforced; appropriate regulations in the specific sector help provide growth and proper management. Conflicts will decrease due to the obligation of the rules that act as guidelines.

References

Attwell, K., Navin, M. C., Lopalco, P. L., Jestin, C., Reiter, S., & Omer, S. B. (2018). Recent vaccine mandates in the United States, Europe and Australia: A comparative study. Vaccine, 36(48), 7377-7384.

Blackman, J. (2021). The Irrepressible Myth of Jacobson v. Massachusetts. Massachusetts.

Sklar, T., & Robertson, C. (2019). Affordability boards: the states new fix for drug pricing. New England Journal of Medicine, 381(14), 1301. Web.

Inventory management plays a vital role in the efficient work of healthcare organizations. While inventory management in business organizations primarily refers to the turnover of the products, in the healthcare system, inefficient organization of inventory can present a risk to the patients lives. The situation is worsened because it is impossible to estimate the number of necessary materials due to the unpredictable nature of patients needs. Thus, medical inventory involves a complex system of storage to ensure that the necessary items are available upon demand.

Firstly, the most common inventory items in healthcare organizations include gloves, masks, gowns, and syringes. Surgical kits and supplies include dressing materials, such as gauze pads, bandages, needles, and blades. Lastly, the healthcare organization inventory includes items of high value, such as equipment for patient transportation, anesthesia machines, and defibrillators. Thus, effectively storing the wide range of items used in a healthcare organization requires implementing a sophisticated inventory system.

Next, the ABC analysis approach to the inventory management system is based on the classification of inventory items in three categories based on their importance. The analysis presents one of the most effective tools available in the management of resources (Deressa et al., 2022). However, the system also considers the items consumption value and percentage in the total inventory. Thus, the gloves, masks, gowns, and syringes are classified in the C category with low monetary value. The items from the C category occupy a big proportion of the inventory because of their high flow and necessity for the organizations functioning. More valuable items are also used frequently in healthcare organizations, but in smaller quantities, such as surgical supplies, including gauze pads, bandages, needles, and blades, are classified as B items. Lastly, more expensive items necessary for different health care services, which also present a smaller part of the overall inventory, such as medical devices and equipment, are classified as A items.

The classification into three types is necessary for effective management of the inventory items. Depending on whether the inventory items belong to a certain group, the items can be stored in different locations or conditions and involve different levels of consumption records. Considering the location of storage for items in the A category, it should be closer because these items are critically important for patients. Thus, I would place the storage closer to the reception area or in the middle, preserving an equal distance from all departments whether the equipment is used more often. Furthermore, the organization of items on the shelves would be based on a ranking system with more important and often used items placed at hand level to facilitate their rotation. At the same time, more rarely used equipment will be placed on other levels but still ensure easy accessibility.

Furthermore, the storage of items in the B category, including surgical supplies, is complicated by the nature of surgery procedures and surgeons preferences. According to Ahmadi et al. (2018), insufficient inventory management in operating rooms and surgeons preference cards with an irrational amount of resources result in significant financial losses for the healthcare organization. I would implement a strict tracking system in the core inventory for operating rooms to estimate the difference between resources reserved for the operation and resources utilized during the procedure. The data will help me to make predictions on the required amount of resources needed for the normal functioning of the operating rooms. Lastly, I would place the items from the C category and additional emergency stock of B items near the patient reception area, where items from category C are used more often.

References

Ahmadi, E., Masel, D. T., Metcalf, A. Y., & Schuller, K. (2018). Inventory management of surgical supplies and sterile instruments in hospitals: a literature review.Health Systems, 18(2), 118. Web.

Deressa, M. B., Beressa, T. B., & Jemal, A. (2022). Analysis of pharmaceuticals inventory management using ABC-VEN matrix analysis in selected health facilities of West Shewa Zone, Oromia Regional State, Ethiopia. Integrated Pharmacy Research and Practice, 11, 47-59. Web.

Introduction

Demand and supply in health care have some specific characteristics. Factors such as price, income levels, demographics, and changing patient tastes affect how strong peoples desire for health care services will be (Wellay et al., 2018). The critical difference between the demand for health care and the demand for other goods is that patients will find it harder to refuse treatment even if it is costly. It is especially true in a situation when their health is threatened. For example, if the price of luxury goods increases, people will prefer not to buy them. However, because human health is such an important and unconditional value, people will have to pay more than they can actually afford.

Discussion

Supply is the number of medical services that doctors can provide at a given time to the population. The supply of medical services is influenced by the following factors: changes in price, improvements in medical equipment and technology, the appearance of new medical services provided by competitors, and increases in tax rates. For instance, the number of manufacturers present in the market decreases when the price falls. What distinguishes the supply of health care from the supply of other goods is that it requires a long time for new health care providers to enter the market. It takes several years before a student becomes a qualified doctor or nurse.

The uniqueness of the healthcare industry lies in its extreme importance to the survival of all humanity. The life expectancy of people and the worlds overall health depend on how effectively health care providers can treat patients. They are especially important during outbreaks of diseases, such as the coronavirus pandemic (Liu et al., 2020).

Conclusion

The unconditional importance of health care is what makes it so recession-proof. Even in times of economic downturn, people will not be able to refuse medical services because their lives depend on them. As noted earlier, increases in the price of medical services are not capable of causing patients to refuse treatment altogether.

References

Liu, Q., Luo, D., Haase, J. E., Guo, Q., Wang, X. Q., Liu, S., Xia, L., Liu, Z., Yang, J., & Yang, B. X. (2020). The experiences of health-care providers during the COVID-19 crisis in China: A qualitative study.The Lancet Global Health, 8(6), 790798. Web.

Wellay, T., Gebreslassie, M., Mesele, M., Gebretinsa, H., Ayel, B., Tewelde, A., & Zewedie, Y. (2018). Demand for health care service and associated factors among patients in the community of Tsegedie District, Northern Ethiopia.BMC Health Services Research, 18(697), 1-9. Web.

Introduction

Native Americans, often known as American Indians, refer to members of the indigenous peoples of the American Continent. It is frequently used to refer to those groups whose ancestral lands were in what is now Canada and the United States. All descendants of the indigenous inhabitants of North, South, and Central America who still identify with their tribe or local community are included in this demographic. A total of 5.7 million individuals were expected to be American Indian and Alaska Native alone or in conjunction with one or more additional ethnicities as of 2019 (Office of Minority Health, 2022). 1.7 percent of Americans identify as American Indian or Alaska Native (OMH, 2022). In several areas of mortality, American Indians continue to have higher death rates in comparison to other Americans, including chronic lower respiratory disorders, cirrhosis of the liver, diabetes mellitus, accidental injuries, assault/homicide, and purposeful self-harm/suicide.

Health Disparities and Issues

Socioeconomic Factors Affecting Health

American Indians health inequalities are brought on by the following socioeconomic factors:

1. Poverty  there are significant issues related to low income and the inability to afford crucial goods among American Indians.
2. Low levels of education and literacy  the education provided to American Indians is insufficient.
3. Unemployed  finding a job is a common problem for American Indians.
4. Language differences  tribes have different languages, and many individuals do not speak English.
5. Improper access to medical treatment.
6. Limited transportation options.
7. Difficulties related to finding nutritious food.
8. A dearth of housing alternatives.
9. Environmental circumstances.

Mines

There are several issues related to the poor health of American Indians. One in a long line of insults is the old mines on and nearby Native American territories in the western United States. The legacy will last for future generations due to the large number of sites and the vast amount of garbage (Lewis et al., 2017). Furthermore, the mines represent just one episode in the tale of environmental injustices committed on Native American territories. Similar articles might be developed concentrating on the effects of oil and gas development, military base legacy, and strip mining on tribal territory. The Standing Rock Sioux camps opposition to the Dakota Access Pipeline received support from tens of thousands of people representing tribal groups across the nation (Lewis et al., 2017). This shows the common topic felt by tribes not only in the Western USA but also across the country and the world. Their rights to guard health and heritage have been continuously eroded in pursuit of resource development.

Poverty

Since 28.3 percent of American Indians live below the poverty line, the highest rate of any group, they have a history of medical inequality (Center of American Indian Resilience, 2022). In addition to having high poverty rates, American Indians born today have life expectancies that are 73.7 years and 4.4 years shorter than those of the other races in the United States (CAIR, n.d.). The shorter life length that American Indians experience may be related to poverty. In addition, disorders including diabetes, liver disease, and others that are readily preventable are more common in American Indians.

Food Insecurity

The majority of reservations are thought to be food deserts, where it is difficult to find healthful food. Food deserts are regions of the nation that lack fresh produce and other wholesome whole foods and are typically located in underdeveloped communities. This is mostly brought on by a dearth of supermarkets, farmers markets, and sources of healthful food. A person or group of individuals with the first type of food insecurity do not possess enough to eat. The second type of food insecurity occurs when a person or group lacks access to enough nourishing and culturally acceptable food to eat. Poor health in adults and children, sadness and anxiety in adults and adolescents, and adolescent suicide thoughts have all been linked to food poverty.

Health Promotion

Current Health Promotion

Tribes and communities who identify as American Indians benefit from the traditional and cultural teachings and practices that encourage strong, resilient bodies and good lifestyles. Tribal chiefs said that neither the general public nor government authorities were in favor of these practices. Seven strategies that strengthen ties to the community, household, and culture and can lower risks for chronic illness among American Indians were identified during convenings held by CDC with tribal cultural leaders.

Suggested Health Promotion Approach

As previously mentioned, one of the primary issues for American Indians is alcohol and tobacco abuse, which leads to severe illnesses. In preventive health promotion, three types of prevention are used: primary, secondary, and tertiary. The primary strategy is dedicated to preventing issues in general, and therefore, to prevent tobacco and alcohol abuse among American Indians, social advertisements should be used (Kisling & Das, 2022). They should be widespread in the sources of information, as well as provided to schools, to prevent further development of abuse in communities. The secondary strategy is dedicated to detecting illness at an early stage, and therefore, smokers and drinkers should regularly see doctors, which is an issue for American Indians. Allowing affordable check-ups, providing more hospitals to communities, and promoting healthcare could help solve these issues. Tertiary strategies are related to treating patients who are ill already and to helping people whose health condition was affected by alcohol and tobacco, and proper medical treatment should be provided to American Indian communities.

Suggested Cultural Considerations

When developing a care plan, it is necessary to consider that:

1. Minority populations of all races, including the American Indians community, are more susceptible to developing chronic illnesses.
2. Patients with chronic diseases are more likely than other patients to attend medical facilities, which increases their contact with doctors and other healthcare professionals.
3. If initiatives to improve culturally competent results for doctors and providers are not implemented, patients may experience detrimental health effects (Nahian & Jouk, 2022).
4. A lack of cultural awareness will hinder patient-physician communication, raising the possibility of misdiagnosis and undermining public confidence.
5. In the past, ethnic minorities have expressed a lack of relationship with doctors, little engagement in medical choices, and low satisfaction.

Conclusion

The most appropriate model for developing such a plan is Purnells model for cultural competence. It focuses on giving a basis for understanding the varied cultural characteristics, enabling nurses to properly perceive patient characteristics, including motivation, experiences, and ideas about healthcare and sickness (Purnell, 2019). Twelve domains make up the Purnell model: an overview of the history, family roles, communication, workforce challenges, high-risk behaviors, bio-cultural ecology, pregnancy, nutrition, death rituals, healthcare practices, spirituality, and healthcare professionals. Considering that factors related to these domains, including workforce challenges, high-risk behaviors, ecology, and nutrition, are significant issues for American Indians, this model seems appropriate. Therefore, it can be adopted when developing a care plan for American Indians and used to design prevention strategies dedicated to addressing several issues that lead to common problems in health among American Indians.

References

Lewis, J., Hoover, J. & MacKenzie, D. (2017). Mining and environmental health disparities in Native American communities.Current Environmental Health Reports, 4, 130141.

Center of American Indian Resilience (2022). American Indian health equity/disparities.

Kisling, L.A. & Das, J. (2022). Prevention Strategies. StatPearls Publishing.

Nahian, A. & Jouk, N. (2022). Cultural Competence In Caring For American Indians and Alaska Natives.

Office of Minority Health. (2022). Profile: American Indian/Alaska Native.

Purnell, L. (2019). Update: The Purnell theory and model for culturally competent health care. Journal of Transcultural Nursing, 30(2), 98-105.

While reading about the specificities of the US healthcare system, several points stood out. First, the inaccessibility and expensiveness of healthcare in the country were concerning. Compared to the status the United States holds internationally, the frameworks for protecting its people from the disease are shockingly ineffective. As the book states, healthcare is unequal in access and only provides average outcomes at best (Shi & Singh, 2017). At the same time, the US remains among the wealthiest and most technologically advanced nations in the world. Therefore, the inability of the country to provide its people with high-quality, easily accessible healthcare appears strange. Each individual in the US is personally responsible for being able to afford medication, hospital visits, or other healthcare concerns. The surrounding social frameworks and systems of support are insufficient in promoting equitable outcomes for all classes of people. This arrangement is problematic when one considers both the health of the population as a whole and the racial-ethnic disparities in healthcare access. Some people in the country are inherently more capable of fulfilling their health needs, while others are left to rely upon themselves.

Another point that stood out to me is the relationship between culture and the systems of healthcare in the country. In particular, the relationship between a conservative, meritocratic worldview and access to healthcare services is interesting. Historically, much of the US believes that individuals are responsible for their future and well-being, disregarding the need for systematic support or improvement (Shi & Singh, 2017). However, as the text states, such beliefs are being challenged by an influx of new people and new perspectives. I think that this trend is beneficial to the development of the healthcare sphere, and the overall progression in the medical field. By understanding that communities and their people often require safeguarding and support to lead prosperous lives, it may be possible to change the healthcare sphere for the better.

References

Shi, L., & Singh, D. A. (2017). Essentials of the U.S. health care system. Jones & Bartlett Publishers.

Summary

The leading priority of all healthcare workers is to provide appropriate services to protect, manage, and improve peoples health conditions. However, this statement often leads to the fact that nurses and doctors experience is neglected. In other words, not many experts admit that these healthcare professionals can suffer from specific health issues while providing patients with the required assistance. Low back pain is among such problems, and it is relatively frequent worldwide. According to Alnaami et al. (2019), the global prevalence of the issue is between 15% and 45%. Sufficient evidence also demonstrates that healthcare workers are subject to the problem. In particular, 35%-80% of nurses stipulate that they have experienced low back pain episodes at least once during their professional practice (Richardson et al., 2018). This statement denotes that there is robust scientific interest in focusing on the issue under consideration.

Since statistical data demonstrates that low back pain is prevalent among healthcare professionals, it is reasonable to look at how these individuals manage the given condition. The rationale behind this statement is that medical workers require specific management practices or interventions that will protect them from the problem. Thus, it is necessary to conduct a particular research project to identify the most effective approaches to avoid and control low back pain. This research should follow appropriate scientific procedures and focus on a particular population. It seems rational to consider how healthcare workers from New York City address the problem and what steps they take to manage the health condition under consideration. The following paragraphs will present the basics of the suggested project, including a problem statement, literature review, proposal, goal statement, and methodology.

Problem Statement

Low back pain is a significant problem that adversely affects peoples health and overall well-being. This term stands for feelings of discomfort in the lower parts of the back, which makes individuals seek medical care (Tariq et al., 2022). When people suffer from the issue, it becomes more challenging for them to perform their work obligations and lead normal lives. This condition emerges when individuals are subject to regular physical load.

Sufficient evidence also explains why the problem should deserve attention. According to the Centers for Disease Control and Prevention (2022), people typically tend to ignore low back pain because they believe that it will resolve without interventions. However, this strategy is negative because the issue becomes a leading cause of disability, resulting in an $87-billion burden for the US healthcare industry annually (Tariq et al., 2022). In addition to that, Rezaei et al. (2021) indicate that contributing factors to the problem include the female gender, occupational factors, stress, age, and other conditions. That is why this condition is a significant problem in the healthcare industry.

The problem is widespread globally, but it is also necessary to consider its prevalence in the USA because several scholarly works present data in this format. According to Tariq et al. (2022), the prevalence of the condition among nurses in the USA can reach 90%. Richardson et al. (2018) support this statement and add that low back pain is widespread among licensed practical nurses, registered nurses, and nurse aides. Finally, other experts admit that the estimated lifetime prevalence of lower back pain in health care personnel was 54.8% (Rezaei et al., 2021, p. 102903). This high prevalence admits that it is reasonable to investigate the issue in a research project.

Preliminary Literature Review

Since low back pain is a significant and prevalent problem in the healthcare industry, it is not surprising that many scholars address the topic. The given literature review will summarize the evidence from scholarly peer-reviewed articles that were published within the last five years to ensure that the research project relies on credible and timely data. The section is divided into three sub-headings according to the number of sub-themes.

Risk Factors

It has already been mentioned that many factors contribute to the spread of the problem. The article by Rezaei et al. (2021) provides a detailed overview of these phenomena. According to the scholars, the prevalence of the problems is connected to occupational factors, stress, gender, age, involvement in physical activity, and body-mass index (Rezaei et al., 2021). However, these authors also add that a body position at work is a leading prerequisite to the condition, meaning that whether a person manages to maintain a tall back can make a difference (Rezaei et al., 2021). That is why it is reasonable to consider other sources to investigate these risk factors.

Some authors can focus on the effect of a single issue. On the one hand, Vinstrup et al. (2020) admit that stress can play a leading role because the authors identified a connection between this psychosocial issue and low back pain. Parreira et al. (2018) also support this statement and add that constant stress increases the opportunity that low back pain will emerge. On the other hand, a cross-sectional study of more than 1,100 nurses revealed that being a female is associated with greater low back pain risks (Luan et al., 2018). However, it is challenging to mention that a single factor can contribute to the problem.

Other experts admit that a workplace routine fosters the spread of the problem among healthcare professionals, meaning that a combination of different factors leads to adverse outcomes. According to Andersen et al. (2019), a high number of patient transfers is a contributing issue because this practice results in excessive physical burden. In particular, the lack of assistive devices, including sliding sheets, walking aids, and intelligent beds, is associated with the problem (Andersen et al., 2019). These scholars also admit that poor collaboration in the workplace and insufficient support from colleagues lead to negative consequences (Andersen et al., 2019). Thus, it can be challenging to admit a single contributing factor.

Consequences

The condition under analysis requires attention because it leads to multiple adverse outcomes. According to Chen et al. (2018), adverse effects can include disability, depression, and the movement of pain to other body parts (for example, limbs). This information demonstrates that a long endurance of this condition can harm various systems in the human body. It is not necessary to neglect the fact that the issue results in a significant financial burden (Hartvigsen et al., 2018). The experts also comment on versatile negative impacts and highlight the fact that recurrence is common (Hartvigsen et al., 2018). This statement denotes that once this pain disappears, there is an opportunity that this condition will return.

Other scholarly articles provide additional arguments to highlight the adverse consequences of low back pain. As Kazemi et al. (2019) admit, the condition under analysis leads to negative impacts on nurses individual, social, and occupational spheres. This finding reveals that various systems suffer from adverse processes caused by low back pain. Furthermore, Overstreet and Goodin (2018) stipulate that there is a significant connection between this type of pain and emotion deregulation. This statement denotes that people with this condition have difficulties controlling and managing their emotions (Overstreet & Goodin, 2018). That is why it is impossible to underestimate the negative effects of low back pain on peoples health.

Management

Since the findings above represent multiple adverse consequences, it is reasonable to consider how this condition can be managed. Tariq et al. (2022) admit that sufficient attention should be drawn to the prevention of this issue. According to scholars, there are different prevention levels that include changing lifestyle behaviors, risk assessment, training in manual handling, cognitive behavior therapy, and other steps (Tariq et al., 2022). Simultaneously, interventions include the provision of lifting equipment, workplace education, and a healthy diet (Tariq et al., 2022). It seems that a combination of organizational and individual interventions is needed.

Since there exist many management approaches, it is reasonable to compare their effectiveness. Traeger et al. (2019) admit that physical and psychological therapies should be prioritized over surgery, steroid injections, and pain medication. The data by the Centers for Disease Control and Prevention (2022) supports this suggestion and states that opioids are excessively prescribed even though their efficacy lacks supportive statements. Simultaneously, Foster et al. (2018) also admit that surgery, opioids, and imaging testing are overused in relation to low back pain. These experts insist that first-line treatments should be prioritized, including education, physical exercise, and psychological programs (Foster et al., 2018). It is worth admitting that these suggestions are more promising and cost-effective.

Proposal

The identified information demonstrates that it is reasonable to conduct a research project that will focus on low back pain management among healthcare workers. Firstly, sufficient evidence reveals that these individuals are subject to the given condition, and many risk factors contribute to this state of affairs. Secondly, the literature findings have demonstrated that if this issue is left untreated, negative consequences can emerge. For example, they include depression, disability, a higher financial burden, and other adverse issues. That is why it is necessary to implement specific management practices to minimize and avoid negative impacts. However, the literature review has also indicated that improper interventions are currently overused, while more efficient and cost-effective steps are ignored. It seems adequate to conduct a research project that will confirm or deny the impact of specific interventions.

In addition to that, it is reasonable to comment on the rationale behind focusing on New York City. According to the official statistics, there are more than 733 thousand people employed in the medical sphere in the given state (New York State Department of Health, 2022). These individuals perform significant tasks and provide the city with the 8-million population with essential services. Consequently, if doctors and nurses are subject to various health conditions, their ability to assist others is limited or even canceled. That is why the given proposal aims to address this situation and generate positive outcomes. If the project identifies that a specific intervention or combination thereof significantly limits the prevalence of low back pain among healthcare professionals, this fact will contribute to the emergence of evidence-based practice. Thus, it is rational to start conducting the suggested research paper.

Goal Statement

The given research project aims to achieve a specific goal. It is as follows: To determine to what extent the first-line treatments, including physical exercise, training, and psychological treatment, reduce the prevalence of low back pain cases among medical professionals in New York City. This statement denotes that it will be necessary to recruit nurses and other healthcare workers from single or many settings, subject them to the intervention, and analyze its impact.

Methodology

This project should be a prospective cohort study using a quantitative methodology.

References

Alnaami, I., Awadalla, N. J., Alkhairy, M., Alburidy, S., Alqarni, A., Algarni, A., Alshehri, R., Amrah, B., Alasmari, M., & Mahfouz, A. A. (2019). Prevalence and factors associated with low back pain among health care workers in southwestern Saudi Arabia. BMC Musculoskeletal Disorders, 20(1), 1-7. Web.

Andersen, L. L., Vinstrup, J., Villadsen, E., Jay, K., & Jakobsen, M. D. (2019). Physical and psychosocial work environmental risk factors for back injury among healthcare workers: Prospective cohort study. International Journal of Environmental Research and Public Health, 16(22), 4528. Web.

Centers for Disease Control and Prevention. (2022). Acute low back pain. Web.

Chen, Y., Campbell, P., Strauss, V. Y., Foster, N. E., Jordan, K. P., & Dunn, K. M. (2018). Trajectories and predictors of the long-term course of low back pain: Cohort study with 5-year follow-up.Pain, 159(2), 252-260. Web.

Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., Ferreira, P. H., Fritz, J. M., Koes, B. W., Peul, W., Turner, J. A., Maher, C. G., Buchbinder, R., Hartvigsen, J., Cherkin, D., Foster, N. E., Maher, C. G., Underwood, M., van Tulder, M., & Woolf, A. (2018). Prevention and treatment of low back pain: Evidence, challenges, and promising directions.The Lancet, 391(10137), 2368-2383. Web.

Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., Underwood, M., & Lancet Low Back Pain Series Working Group (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367.

Kazemi, S. S., Tavafian, S. S., Hidarnia, A., & Montazeri, A. (2019). Consequences and factors affecting work-related low back pain among nursing professionals: A qualitative study. Payesh (Health Monitor), 18(3), 291-303. Web.

Luan, H. D., Hai, N. T., Xanh, P. T., Giang, H. T., Van Thuc, P., Hong, N. M., & Khue, P. M. (2018). Musculoskeletal disorders: Prevalence and associated factors among district hospital nurses in Haiphong, Vietnam. BioMed Research International, 2018. Web.

New York State Department of Health. (2022). New York State Department of Health highlights healthcare workforce booster progress and announces additional efforts to bring boosters directly to healthcare workers. Web.

Overstreet, D., & Goodin, B. (2018). Emotion dysregulation and potential consequences in people with chronic low back pain.The Journal of Pain, 19(3), S37. Web.

Parreira, P., Maher, C. G., Steffens, D., Hancock, M. J., & Ferreira, M. L. (2018). Risk factors for low back pain and sciatica: An umbrella review.The Spine Journal, 18(9), 1715-1721. Web.

Rezaei, B., Mousavi, E., Heshmati, B., & Asadi, S. (2021). Low back pain and its related risk factors in health care providers at hospitals: A systematic review.Annals of Medicine and Surgery, 70, 102903. Web.

Richardson, A., McNoe, B., Derrett, S., & Harcombe, H. (2018). Interventions to prevent and reduce the impact of musculoskeletal injuries among nurses: A systematic review.International Journal of Nursing Studies, 82, 58-67. Web.

Tariq, R. A., George, J. S., Ampat, G., & Toney-Butler, T. J. (2022). Back safety. StatPearls Publishing.

Traeger, A. C., Buchbinder, R., Elshaug, A. G., Croft, P. R., & Maher, C. G. (2019). Care for low back pain: Can health systems deliver? Bulletin of the World Health Organization, 97(6), 423-433. Web.

Vinstrup, J., Jakobsen, M. D., & Andersen, L. L. (2020). Perceived stress and low-back pain among healthcare workers: A multi-center prospective cohort study.Frontiers in Public Health, 8, 297. Web.

Introduction/Statement of Problem

VITAS Healthcare is a hospice founded in 1798 in Florida, US, and now it offers its services throughout America in fourteen different states (VITAS Healthcare, n.d. a). The organization preserves patients dignity and provides end-of-life care to terminally ill patients (VITAS Healthcare, n.d. a). It offers spiritual, mental, physical, and emotional relief to patients and their families. Further, the agency is to advocate for the rights of end-of-life patients and their families. The organizations mission is to provide patients with limited time to live and their loved ones with the highest quality case management, human services, and products (VITAS Healthcare, n.d. a). The primary population served by the organization is terminally ill patients who have less than six months to live and their families.

The researcher will conduct process evaluations to provide an overview of VITAS Healthcares work. This approach will explore whether the organizations activities meet the goals set. Moreover, hospice evaluation aids in gathering information on the characteristics, support, and program costs. It enables health systems to identify the needs of palliative patients and create relevant, patient-centered social support and treatment options (VITAS Healthcare, n.d. b). The VITAS Healthcare agency staff can use program evaluation information to establish the best care for individual patients and their families.

The goal of VITAS Healthcare is to preserve the quality of life of terminally ill Americans who have less than six months to live. The objectives of the organization are (1) VITAS Healthcare will provide free support services to its partners in specialty and private practices, care facilities, and hospitals between 2022-2023; (2) The agency will relieve each patient and their families spiritual, emotional, physical, and mental suffering for six months before they die; (3) VITAS will promote the independence and dignity of patients and help them find 100 percent personal fulfillment in the six months palliative care period.

The researcher employs the logic model for the evaluation proposal (see table below). VITAS operations are analyzed within such fields as input or resources; activities carried out to achieve goals, outputs, outcomes, and the programs impact. Such an evaluation approach helps a researcher perform a structured and comprehensive interpretation of the research results.

Methods and Data Collection

The researcher will follow a quantitative approach and use a survey research design. The survey implies the collection of data through the use of a questionnaire. The method allows a deeper understanding of the intangible aspects of the care provided, such as patient and staff relationships, service satisfaction, and other issues (Kelley-Quon, 2018).

A questionnaire on the quality of end-of-life care for family members will be applied to collect the data for analysis. The University of Washington (n.d.) developed this tool with several other questionnaires to assess end-of-life care.

The study will apply a snowball sampling method to engage participants. Methods necessity is dictated by the potential vulnerability and desire for anonymity of families experiencing a loss (Parker et al., 2019).

The minimum number of participants from the target audience is 30 people. The researcher will attract family members of patients in VITAS Healthcare, addressing some of them and expressing a request to involve other families with whom they may know.

The survey will be conducted online on a special platform using a link invitation.

The Statistical Package for the Social Sciences (SPSS) will be used to analyze the data obtained.

Limitations and Ethical Consideration

The selected sampling method can imply selection bias, as it heavily relies on the researchers opportunities to establish contacts and engage participants.

The survey will be anonymous to preserve the confidentiality of the study participants and will require consent to use the information.

Conclusion

The current study will conduct a process evaluation of VITAS Healthcare, an organization providing end-of-life care. Following the survey design, the data will be collected using the quality of end-of-life care for family members questionnaire and analyzed using SPSS. The researcher will apply the snowball method to attract a sample of at least 30 people. The target audience is families whose relatives received care at VITAS Healthcare. The researcher will take measures to protect their privacy through the anonymity of the questionnaire.

References

Kelley-Quon, L. I. (2018). Surveys: Merging qualitative and quantitative research methods.Seminars in Pediatric Surgery, 27(6), 361-366. Web.

Parker, C., Scott, S., & Geddes, A. (2019). Snowball sampling. SAGE Research Methods Foundations. 1-13. Web.

The University of Washington. (n.d.). Instruments. End-of-Life Care Research Program at UW School of Medicine. Web.

VITAS Healthcare. (n.d. a). Values, mission, and vision. Web.

VITAS Healthcare. (n.d. b). Partner organizations. Web.

Introduction

Knowing the internal and external environment is important for healthcare facilities because it enables the management personnel to understand the possible future occurrences in the external environment that can affect the business. This provides an opportunity to formulate effective strategies to adapt the business to the changing environment. The external environment contains those factors that affect business but cannot be controlled by the organization.

Businesses can only respond to them. While influencing its internal environment, businesses can convert the external threats into opportunities. The internal environment consists of forces that can be manipulated by the organization. Businesses can manipulate these variables to influence their marketing efforts and gain a competitive advantage (Duncan, Ginter, & Swayne, 1998).

Forces in the External Environment

For businesses, the external environment is beyond the control of the organization. Despite the inability to control some of these factors, an organization can respond and adapt to the threats and incorporate the controllable elements from the internal environment to make the business sustainable. Roswell Health Center is being faced with the challenges of declining reimbursements from insurance providers and increasing demand for patient services due to the changes in the external environment. The specific forces in the external environment that will have the most impact on my organization as the administrator include the governmental policies or legislative requirements and the stakeholder environment (insurers).

Specifically, the Patient Protection and Affordable Care Act is a legislative requirement that is likely to greatly affect the Roswell Health Center. This was a federal statute that was signed into law by the president of the United States. The main objective of this law was to increase the affordability and quality of health insurance (Gruber, 2011). It also aimed at increasing the number of individuals with health insurance. This legislative requirement was meant for good.

However, it has faced resistance and has remained a matter of political debate (Blendon & Benson, 2010). The rise in insurance costs has led to fewer employers offering health insurance. Other employers are managing this cost by asking employees to make higher contributions.

The Patient Protection and Affordable Care Act is affecting Roswell Health Center in that it has increased the demand for patient services. This has led to an increase in patient numbers. This legislation has helped reduce the costs of healthcare for individuals. Some of the mechanisms in use include subsidies and mandates.

Another factor that makes up the external environment includes the stakeholder environment. All businesses depend on a number of stakeholders to survive. The stakeholders include individuals and institutions that are directly concerned with the company. Therefore, Roswell Health Center needs to learn the identity of its stakeholders in order to assess the potential impacts that they can have on the health center. Insurers are major stakeholders in healthcare.

The stakeholder environment has been determined as one of the major external forces because it is one of the major sources of funding for the health center. With the enactment of the Patient Protection and Affordable Care Act, more individuals depend on insurance covers to pay for their medical bills. For this reason, Roswell depends on reimbursements from the insurers to pay its bills and ensure the continued operation of the business. However, Roswell has experienced challenges of declining reimbursements from these insurance providers.

Internal Factors That Organizations Leaders Should Consider

Internal factors include those forces within the organization that affects business. Such factors can be manipulated in order to make a business sustainable. In the case of Roswell Health Center, one of the internal factors that may need to be considered by leaders is staffing or organizational structure. Proper staffing is required to ensure that the needs of the consumers are met. In a healthcare facility, enough medical practitioners are required to serve all the patients in time and ensure that they are satisfied. In order to provide quality care, the employees also need to be skilled. The physical capacity of individuals and their skills need to match with their job requirements so that they can work effectively.

The future of Roswell Health Center depends on staffing and the structure of the organization. This is mainly due to the dramatic changes in the external environment that led to the increase in the demand for patient services. The Patient Protection and Affordable Care Act ensured that the working poor and the unemployed could afford quality healthcare. Individuals who have low incomes also receive federal subsidies that ensure that they can access quality health care (Gruber, 2011).

For this reason, the health center will need to ensure that an adequate number of skilled personnel is available to handle a huge workload. However, it is also important to understand that staffing is an expensive agenda. Maintaining employees is one of the largest expenses in an organization. Therefore, it is also important to ensure proper staffing and not overstaffing.

Other internal factors that may have a great impact on Roswell Health Center include the internal processes that cause the increase in the costs of operation. The current environment is characterized by high operating costs and decreased reimbursements. To reverse this, it is only logical to reduce the costs as much as possible. For example, Roswell has invested heavily in real estate. This constitutes fixed costs. Several health facilities opt to sell off some of the offices to meet their financial obligations. Such costs need to be reduced in order to increase cash on the balance sheet. This also helps reduce debt and lowers operating costs. Similarly, costs incurred on equipment should be managed effectively.

Impact of the Internal and External Factors

The internal and external factors may affect Roswell Health Center in several ways. For example, developing a competitive strategy may be difficult (Duncan, Ginter, & Swayne, 1998). The legislative requirements have caused an increase in the number of patients. For this reason, the number of health practitioners available may not be adequate to meet the market needs. Since quality health care should be provided to all, proper staffing is required. The health practitioners of Roswell Health Center are skilled to handle specific areas only and are not dynamic. This implies that individuals can only handle specific issues and cannot be used to solve other organizational issues.

The declining reimbursements from insurance providers may also greatly affect the health center. With the increase in healthcare costs due to real estate, equipment, and employee insurance costs, the declining reimbursements from insurance providers only lead to increased operational costs. Since Roswell Health Center relies on reimbursements from insurance companies to offset the costs incurred during treatment of low-income or unemployed patients, this decline in reimbursements is causing a threat to the future of the clinics practices.

Recommendations

In order for Roswell Health Center to develop a competitive strategy, it must employ highly skilled and trained health practitioners. It can also introduce new technologies that can provide a competitive advantage. An operational effectiveness strategy may be used to ensure that the internal business activities outperform those of the competitors. Roswell Health Center can begin by addressing fixed costs since they are quite substantial. In particular, these costs comprise real estate investments. Roswell should sell office buildings so as to reduce these costs. Since equity builds up in such property, Roswell can sell the buildings and lease them back. This would help increase cash on the balance sheet. This strategy will help reduce debt and reduce operating costs (Harrison, 2010).

When it comes to equipment, Roswell Health Center can free up cash by leasing the equipment instead of purchasing them. This can be considered as 100% financing with no down payment. This differs from traditional financing which usually requires a significant down payment. Leasing can also help in the financing of all costs incurred in purchases. Leasing would be beneficial for Roswell Health Center because it would help maximize the available financing. It would also help in freeing up capital and enable financing of other sectors (Harrison, 2010).

Since the Patient Protection and Affordable Care Act mandates businesses that employ fifty individuals or more to provide health insurance, Roswell Health Center will ensure that employees make more contributions towards this venture. This will help in reducing the costs of insurance. The human resource managers will also ensure that proper staffing is done. This would involve the hiring of dynamic employees.

Such employees would need to be multi-skilled. Multi-skilled employees would be able to work in more than one area in the health center. Such employees may receive training in various areas so that they can increase productivity and reduce labor costs. Such individuals are flexible since it is possible to schedule them according to the needs of the business. In the absence of some employees, others can stand in for them without the need to employ an extra workforce.

Such arrangements would ensure business continuity and sustainability. It would also ensure that fewer dynamic employees are employed. Overstaffing will be avoided and costs incurred on employees will be reduced. Outsourcing of employees may also be used on some occasions. Technological advancements may also be employed to help reduce costs in the health center (Menachemi, Shin, Ford, & Yu, 2011). For example, an electronic medical records system can be installed.

Due to the increase in patient numbers and limited bed space, the use of remote monitoring tools would help reduce the need for hospital visits because the health practitioners can monitor the health of their patients in the comfort of their homes. Portal technology may also be employed to help patients and medical practitioners interact online without the need for constant physical interaction.

Conclusion

Roswell Health Center is being faced with financial challenges due to the declining reimbursements from insurance providers. The enactment of the Patient Protection and Affordable Care Act aimed at ensuring increased quality and affordability of health insurance. This has led to an increase in demand for patient service. Roswell Health Center is planning to ensure proper staffing and is introducing new technology. This would ensure that it continues to provide quality care and it would develop and maintain a competitive edge despite the numerous challenges.

References

Blendon, R., & Benson, J. (2010). Public opinion at the time of the vote on the health care reform. New England Journal of Medicine, 362(16), 55-76.

Duncan, J., Ginter, P., & Swayne, L. (1998). Competitive advantage and internal organizational assessment. Academy of Management Executives, 12(3), 6-16.

Gruber, J. (2011). The impacts of the affordable care act: How reasonable are the projections? National Tax Journal, 64(1), 893-908.

Harrison, J. (2010). Essentials of Strategic Planning in Healthcare. Chicago: Health Administration Press.

Menachemi, N., Shin, D., Ford, E., & Yu, F. (2011). Environmental factors and health information technology management strategy. Health Care Management Review, 36(3), 275-285.