The primary populations targeted by Kaiser Permanente are employees and families with no specific disease or condition being targeted; rather, Kaiser provides a broad array of medical services that are customized based on the needs of a particular client. For example, the health plans provided for employees by a company utilizing the services of Kaiser may be broader as compared to the plans for families that have specific hereditary conditions (i.e. a history of heart disease, cancer, etc.) (Strandberg-Larsen et al. 2012). The primary population targeted by Kaiser within California is usually 23 to 55-year-olds with its secondary client base consisting of individuals 18 and below and 60 and above (Strandberg-Larsen et al. 2012).
Participating Payers
Participating payers under Kaiser Permanente consist of Medicare, individual payments or prior contracts with local businesses. Due to the size and number of facilities that Kaiser has, this enables the company to enter into different types of specialized payment contracts as compared to other care providers. This means that Kaiser is not limited to Medicare insurance, rather, it allows individuals and businesses to custom design their payment plans based on their needs (Strandberg-Larsen et al. 2012). In fact, a person can apply for a specialized insurance plan online through Kaiser via their website and get medical insurance within a few minutes.
Type of Insurance Product
It is interesting to note that Kaiser Permanente provides both HMO and PPO plans on a per-client or a per business basis. What must be understood is that Kaiser is one of the largest health care service providers in the world with a network of 37 medical centers and 14,600 active physicians (Strandberg-Larsen et al., 2010). As a result, it can leverage its resources at a far more effective rate as compared to other healthcare service providers. As such, the type and scale of coverage depends on the needs of an individual or business in question. On average, businesses normally opt to have a broad HMO for their employees that allow for low to mid-level deductions on consultations and surgeries or even cost-free services (Strandberg-Larsen et al., 2010). Though such plans do have a set limit and are often lacking when it comes to more specialized needs and services. On the other hand, PPOs are usually utilized by families or individuals that require more specialized services or need to be able to visit any doctor they choose.
Participating Providers
Since Kaiser Permanente is an integrated managed care consortium, this means that it has its own medical care facilities and subsidiaries. Its health care providers primarily consist of its various foundation hospitals and as well as its autonomous medical groups located in various states in the U.S. These establishments are primarily located in Northern and Southern California, Colorado, Georgia, Hawaii, Washington D.C. Maryland, Virginia, Oregon and Ohio. All in all, Kaiser has roughly 8.9 health plan members that are spread across the various states that have just been mentioned.
How are the participating providers reimbursed?
Due to its nature as an integrated managed care consortium, reimbursement within the participating providers of Kaiser Permanente is done through its integrated online system which tracks and records patient visits (Paige et al. 2012). What must be understood is that under an integrated managed care consortium, the same problems related to reimbursement are minimized since the provider of the plan and the owner of the medical center are a single entity. This enables a more seamless payment process as soon as a patient gives their insurance information to the front desk (Paige et al. 2012).
PCMH program
It is interesting to note that one of the most progressive aspects of the Kaiser PCMH program is that it is a step forward from the gatekeeper model that was originally utilized by HMOs as a means of coordinating patient care. The PCMH program places a greater emphasis on quality patient care through team-based medical management as compared to the “gatekeeper” model. The problem with primary care physicians acting as gatekeepers is that it actually places more financial risk on physicians through the process of referrals resulting in a situation where it is more cost-effective to provide less care to the patient (i.e. saying specialists do not need to be brought in).
As you can imagine, such a state of affairs would result in a gradually declining level of patient care which shows why the PCMPH program is a step in the right direction towards provisioning proper care to patients. In terms of progress, Kaiser can be stated as moving towards greater levels of digitization and automation in its PCMH program. This can be seen through its online website wherein patients can choose their doctors online, custom design their treatment plans and view the progress of their tests and results without having to physically go to the doctor to get the results. This as described by Cheadle et al. (2010), helps to create a more efficient and practical system for patient care since it enables patients to choose the treatment processes they undergo while at the same time saves them significant amounts of time in regards to having to be referred to various specialists for their condition when it can all be done online.
What kind of payment method is more suitable for reimbursing PCMH?
The problem with HMOs in general as a possible method of reimbursing PCMH is that patients can only get to see specialists for particular conditions (i.e. a cardiologist, a rheumatologist, etc.) only if they can get a referral from their primary care physician. This falls under the gatekeeper model and, as a result, severely constrains the choices and capacity of patients to choose the type of healthcare they receive. Because the PCMH program is supposed to allow patients the capacity to choose their doctor without having to go through a “gatekeeper” so to speak, a standard HMO would probably be the worst possible means of reimbursing PCMH since it would in effect render the very principles of PCMH null and void. One possible solution to this would be to create a similar system as seen in the case of Kaiser Permanente wherein through its network of 36 medical centers and 14,000 medical professionals it does allow patients to choose their physicians and specialists to a certain degree. This “choice” though is limited to select list of physicians for specializations, however, it still is better than the current gatekeeper model utilized by most HMOs wherein a referral through a primary care provider is still needed whereas through Kaiser an appointment can be set up via a person’s online account without having to go through a referral via a primary care physician.
It should be noted though that one of reasons why Kaiser is capable of providing such a service is because as an integrated managed care consortium, it is capable of provisioning more specialized services in a far more efficient and cost-effective way since the doctors under its network of hospitals and care centers are paid a set salary per month regardless of the number of patients they see as compared to other doctors who are paid on the number of patients they see. As a result, “extra procedures” (i.e. methods of inflating a patient’s bill without sufficient due cause) are rare in Kaiser resulting in the healthcare provider being better equipped to handle specialized cases of healthcare as compared to other HMO providers. It is based on this that an HMO method of payment would work if it is done through integrated managed care consortiums that have networked services that allow patients to choose their method of care. If such a system cannot be implemented, then it would be unwise to implement an HMO based payment system.
PPOs can be considered a more ideal method of paying for PCMH since it allows patients to see doctors that are outside of the range of its current network. For example, if a patient had a rare skin condition and needed to be sent to a dermatologist that was outside of the current network, then a PPO would enable a patient to choose that particular doctor. The important correlation between a PPO and PCMH is the concept of choice wherein patients are given a choice as to the type of doctor and treatment they can undergo which is at the core of PCMH.
Reference List
Cheadle, A., Schwartz, P. M., Rauzon, S., Beery, W. L., Gee, S., & Solomon, L. (2010). The Kaiser Permanente Community Health Initiative: Overview and Evaluation Design. American Journal Of Public Health, 100(11), 2111-2113.
Paige, S. B., Bourcier, E., Cahill, C., Hsu, C., & Kabel, C. (2012). Evaluating the Kaiser Permanente Community Fund’s Social Determinants of Health Portfolio. Foundation Review, 4(1), 68-80.
Strandberg-Larsen, M., Frølich, A., Krasnik, A., Bellows, J., Kristensen, J. K., &… Hsu, J. (2012). Self-Management Support to People with Type 2 Diabetes – A comparative study of Kaiser Permanente and the Danish Healthcare System. BMC Health Services Research, 12(1), 160-167.
Strandberg-Larsen, M., Schiøtz, M. L., Silver, J. D., Frølich, A., Andersen, J. S., Graetz, I., &… Hsu, J. (2010). Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system. BMC Health Services Research, 1091-103.
With scientific and technological progress, the mechanistic approach began to dominate the human touch in modern health care. Following the principles of mind-body dualism, most physicians are inclined to focus on the diseased body and its physiological mechanisms, disregarding the patients’ suffering and psychological conditions. Compassion needs to be reintroduced into modern health care practice for humanizing biomedicine and improving the quality of the provided health care services.
The moral of Christ’s parable about the Good Samaritan
Christ’s lessons about the Good Samaritan can be regarded as an example of human compassion which should be followed by everyone and especially healthcare providers who need to serve the best interests of their patients.
The discussed parable about the Good Samaritan who took care of the victim’s wounds was Jesus’ answer to a question concerning our neighbors. Through Christ’s parable does not answer the question directly, it teaches people how they should behave like neighbors. This lesson is especially valuable for healthcare providers who have the moral obligation to act by the patients’ best interests.
However, in contrast to the man lying on the side of the street whose needs were obvious to the passing Good Samaritan, modern physicians may have difficulties with understanding the needs of their clients. With the pluralism of modern society, morality is the matter of personal preference and most individuals have become moral strangers and black boxes to each other (Welie 1995, 476). Thus, analyzing the application of black-box anthropology for establishing the relationship between healthcare providers and their patients, it can be stated that the principle of distancing to show respect for the patient’s privacy as the primary principle of modern healthcare contradicts the moral of the discussed parable.
Disregarding the present decline in people’s ability to feel compassion, sharing the patients’ feelings and establishing the interpersonal rapport with them is necessary for modern healthcare providers for acting beneficently.
Various definitions of the concept of compassion
Though the concept of compassion has various definitions that make its meaning rather controversial, healthcare practitioners should nurture their ability to feel compassion as one of the greatest virtues.
Analyzing the etymology of the word “compassion”, it can be stated that it originates from the Latin “co-pati” which means “suffer with” (Thomasma and Kushner 1995, 416). The element of suffering which is bad adds shades of a negative meaning to the concept of compassion. However, taking into account its antonyms, including cruelty, indifference, hard-heartedness, it can be logically assumed that compassion is attractive at least by contrast (Comte-Sponville 2009).
By the way, the word sympathy as the synonymic doublet for compassion in modern Romance languages means “fellow feeling” which can be regarded as the more appropriate translation for compassion as well. In general, the definitions of compassion can be divided into two basic subgroups, including those which present compassion as an individual’s ability and willingness to understand person’s suffering by entering deep into his/her situation and those which define compassion as a virtue of willing to alleviate another person’s suffering if it is possible (Dougherty and Purtillo 1995, 427).
Most theoreticians treat the word compassion either as a feeling or as the moral principle and the greatest virtue of humanity. In that regard, the individual cannot be forced to feel compassion, but he/she can nurture their ability to enter the world of another person which would be especially beneficial for medical workers who need to gain knowledge on the best interests of their patients before serving them.
Compassion and medicine
The concept of compassion plays an important role in modern healthcare and has been incorporated even into the official AMA principles of Medical Ethics, saying that a physician has to provide healthcare services with compassion.
Humanizing biomedicine has become the central issue of the modern healthcare industry aimed at overcoming the current quality-of-care crisis. The shift from a mechanistic approach to healthcare in the form of logos (rationality) towards medicine based on pathos (passion) is suggested as a solution for improving the quality of modern Western medicine (Marcum 2008, 399).
Then, instead of using a solely mechanistic approach and viewing the patient’s diseased body as an object, a humane practitioner not only focuses on the inner bodily structure but also empathizes with the patient and takes into account his/her experience of suffering. In that regard, the traditional goals of modern medicine have been updated and complemented with the professional objectives to relieve patients’ suffering from maladies and care for those who cannot be cured for preventing premature death and ensuring peaceful death (“An International Project of the Hastings Center: The Goals of Medicine: Setting New Priorities”).
Integration of compassion as the basic principle of healthcare not only into official manifestations but also into educational programs and professional practice is required for humanizing modern biomedicine and improving the quality of healthcare services.
Compassion and the patient with chronic illness or the dying patient
Disregarding all the benefits of compassion for providing high-quality healthcare services, the issue concerning empathizing patients in all cases as a great challenge and a source of pressure is rather controversial.
In most cases, suffering is subjective and cannot be identified with bodily pain only (Van Hooft 1998). On the one hand, the bodily disease cannot be separated from the overall patient’s condition and modern medicine obtains a more extended view of its mission than mere treatment of physical diseases (Cassell 2004). On the other hand, in particular, situations, when the patients’ claims do not belong to the domain of medicine and cannot be solved through the implementation of healthcare intervention strategies, the doctor should draw the line. For example, the problems of managing the meaning of life and death cannot be handled through medical interventions (Callahan 2004, 101).
There are two levels of human suffering, including those of uncertainty of an ill person if he/she will be able to cope with the disease and the second level which touches upon the links between suffering and the meaning of life itself. Though the struggle against aging and death is a utopian idea, patients’ thoughts about the meaning of life and death can make patients suffer (Callahan 2009). This second level of suffering involves the solution of philosophical and religious issues which are more fundamental than psychological problems, and the physician’s interference into this level would be inappropriate.
Though relieving the suffering of dying patients is one of the central objectives of modern healthcare services, the medical workers cannot handle the issues which are outside the medical domain. It can be stated that compassion can be irrelevant in certain cases with dying patients or patients who have chronic diseases when the problems go beyond the physician’s competence.
Compassion and the physician: a virtue or a duty?
Disregarding the ethical aspect of compassion and taking into account its importance for improving the quality of modern health care services, it should become a duty of every physician.
The main argument which can support the claim that compassion should become every physician’s duty instead of a preferred virtue or an elective element of the physician-patient relationship is the strong link between compassion and physicians’ professional responsibilities (Dougherty and Purtillo 1995, 429). The changes in healthcare educational programs and medicine paradigms need to foster compassion as a part of physicians’ professional duty.
Compassion and ethics
Despite all its benefits and the fact that compassion should be made a part of physicians’ professional duties, it can conflict with other professional responsibilities of an individual physician. For example, compassion to one patient can become a hurdle for identifying and satisfying the needs of other clients. The same goes for the ethical issue of preserving the confidentiality of the patient’s information. In their professional practice, physicians make decisions concerning the appropriateness and usefulness of certain intervention strategies. However, in hard cases, when physicians regard the further treatment as useless, the decision to stop treatment is a real ethical dilemma (Chwang 2009). In general, compassion may require different conduct in various situations and cannot be identified with the rest of the physicians’ professional duties.
Characteristics of a compassionate physician
The main characteristics of a compassionate physician include the ability to obtain a humane gaze upon their patients and take into account the experience of suffering for providing high-quality health care services. A compassionate physician can establish interpersonal rapport with patients, obtain knowledge on their experience of suffering including not only physical but also psychological pain and find the most appropriate strategies for alleviating the patients’ suffering.
Another significant side is the prevention of futile treatment, taking into account the following patients’ disillusionment. Thus, in case if the treatment is not likely to work, a compassionate doctor will never prescribe it (Ten Have and Janssens, 2002, 213). Recognizing compassion as a significant element of their professional duties, compassionate physicians manage to reach a compromise between their empathy with an individual patient and the rest of their professional duties and use rational consideration for making the most appropriate professional decisions.
Benefits of compassion
Integration of compassion as one of the significant physician’s duties into the modern health care paradigm would be beneficial for humanizing biomedicine and improving the quality of the provided services. Compassion can provide a source of motivation for alleviating the patients’ suffering (Crisp, 2008, 245). Recognizing the fact that psychological conditions can have a significant impact on the patient’s overall well-being, physicians cannot separate mental suffering from the patients’ bodily pain. The main advantage of compassion for modern medicine is an opportunity to extend the mechanistic biomedical approach by taking into account the aspects of the patients’ feelings and implementing a complex approach to treatment.
Barriers to compassion
Though the benefits of making compassion one of physicians’ professional duties may seem obvious, there are certain barriers to implementing this approach in healthcare practice. First of them is the perception of compassion as a source of suffering for physicians and their natural willingness to avoid it. However, rejecting compassion, physicians deprive themselves of opportunities to develop their professional skills and see the gratitude of their clients because the interpersonal rapport is responsible for not only negative but also positive implications. “They will miss the experience of human openness and vulnerability and the chance to experience unconditional love and the power of human connection” (Connelly, 2009, 386). Physicians need to overcome the barriers to compassion for implementing a complex approach to treatment and improving the quality of healthcare services.
Teaching of compassion
Taking into account the fact that the inability to feel compassion and share emotions can harm not only physicians’ competence but also their well-being. Not responding to suffering and not acknowledging their emotions, physicians put at risk not only the quality of healthcare but even their wellbeing (Connelly, 2009, 386). It explains the importance of teaching compassion. The doctor-patient interpersonal relationship presupposes a high level of confidentiality and vulnerability. For this reason, the teaching of compassion and developing skills of finding rational consideration for selecting the most appropriate strategies are recognized as lifetime learning. Learning to recognize their emotions and respond to suffering is significant for improving the quality of healthcare services and physicians’ well-being.
Conclusion
In general, taking into account the drawbacks of the mechanistic approach to treatment and the integrity of physiological and psychological processes, it can be concluded that compassion should be reintroduced into healthcare educational programs and practice. As one of the physician’s professional responsibilities, compassion requires different conduct in various situations and rational consideration for selecting the most appropriate intervention strategies for improving the quality of the provided services as well as physicians’ wellbeing.
Reference List
“An International Project of the Hastings Center: The Goals of Medicine: Setting New Priorities”. Hastings Center Report 26(1996): S 1-27.
Callahan, Daniel. “Death, mourning, and medical progress”. Perspectives in Biology and Medicine 52(2009): 103-115.
Callahan, Daniel. The Troubled Dream of Life: In Search of a Peaceful Death. Georgetown University Press, 2004.
Cassell, Eric. The Nature of Suffering and the Goals of Medicine. New York: Oxford University Press, 2004.
Chwang, Eric. “Futility Clarified”. Journal of Law, Medicine & Ethics 2009: 487-495.
Comte-Sponville, André. “Compassion”, in Comte-Sponville, André. A Small Treatise on the Great Virtues. New York: Henry Holt & Company, 2001: 103-117.
Connelly, Julia. “The Avoidance of Human Suffering”. Perspectives in Biology and Medicine 52(2009): 381-391.
Crisp, Roger. “Compassion and Beyond”. Ethical Theory and Moral Practice 11 (2008): 233-246.
Dougherty, Charles and Ruth Purtilo: “Physicians’ Duty of Compassion”. Cambridge Quarterly of Healthcare Ethics 4 (1995): 426-433.
Marcum, James. “Reflections on Humanizing Biomedicine”. Perspectives in Biology and Medicine 51 (2008): 392-405.
Ten Have, Henk and Rien Janssens. “Futility, Limits and Palliative Care” in Ten Have, Henk and David Clark (eds.): The Ethics of Palliative Care. Buckingham: Open University Press, 2002.
Thomasma, David and Tomasine Kushner. “A dialogue on Compassion and Supererogation in Medicine”. Cambridge Quarterly of Healthcare Ethics 1995: 415-425.
Van Hooft, Stan. “The Meanings of Suffering”. Hastings Center Report 28(1998): 13-19.
Welie, Jos. “Sympathy as the Basis of Compassion”. Cambridge Quarterly of Healthcare Ethics 4 (1995): 476-487.
Healthcare problems attract enormous attention to the public today. They are not already only contemporary issues that are discussed by the scientists and professionals, which underlines that they reached criticality level. Acquired immune deficiency syndrome (AIDS) is among the conditions that are discussed so widely that almost every person in the world knows about its existence. Even though healthcare professionals investigated the syndrome and virus that causes it (HIV) for a long time and found medicines that can help to prevent and control it, HIV/AIDS is still spreading.
In her news report, Wendy Lemeric (2016) discusses the most recent HIV/AIDS cure, trying to show how close the scientists are to discover it. The author throws light on the collection of studies and reports made by Mary Ann Liebert, Inc. She describes one of them in brief (adding an anti-retroviral drug to an existing anti-retroviral therapy) to prove that steps forward are made, and a cure for HIV infection is likely to be found soon, as researchers are not going to stop and continue deepening into the topic.
Martin Duberman (2016) provides a more focused view of the problem. He discusses the spreading of AIDS among African American males who are engaged in same-sex conduct. The author believes that people in color become more affected by this issue than others. Duberman (2016) pays attention to the lower-income populations, as they have high rates of deaths because of AIDS in comparison to the whites with a decent income. He is highly concerned that African American gay people lost a sense of urgency as they believe AIDS to be manageable. As a result, no positive changes are seen among this population, and the problem fails to be solved.
A recent news report presented by Dan Taylor (2016) questions the effectiveness of HIV treatment and taking AIDS under control. He shares the information about the prevention pill, known as Truvada, and emphasizes the fact that it has different effects on male and female populations. The author is concerned that scientists give the general public a false sense of security. Still, he is sure that they made a great step forward since the time the disease first emerged. Taylor (2016) believes that much more work should be done before it could be said that the goal is achieved.
Catharine Paddock (2016) investigates the problem of HIV/AIDS from a financial perspective. She pays attention to the countries in sub-Saharan Africa where a lot of people suffer from this problem. Paddock discusses the report prepared by the scientists from Harvard T.H. Chan School of Public Health. They calculated the funding these countries require and claimed that it would be impossible to provide them because domestic financing will not have an estimated amount of money available. Thus, it is emphasized that it is time to search for a range of innovative sources of finance that will allow improving the situation. The author points out that such an approach was already used about ten years ago, and it was effective, which proves that such a change is likely to be advantageous even today.
Analysis of News Reports
All four news reports present the problem faced by individuals all over the world that are known as AIDS. The authors mainly discuss it along with HIV, as it is the cause of this health-related issue. They show their concern about the spreading of AIDS and speak about HIV/AIDS treatment that is currently available or/and will be needed with the course of time.
The epidemic of HIV/AIDS is the issue that is tightly related to primary and community health care because it is an essential treatment that should be available for all. Of course, there are particular populations that are at high risk of having AIDS, but every person may suffer from this problem today regardless of one’s social, financial state, race, and sexual orientation. There is even a possibility of being infected in the healthcare facility. As a result, people can get infected and can spread HIV/AIDS even not knowing that something is wrong. Thus, it is critical that every person has an opportunity to be tested for it and receive needed treatment that will be able to help to prevent or control it.
In the report provided by Lemeric (2016), HIV/AIDS is seen as a problem that receives enormous attention from the scientists and medical experts, which makes the general public believe that they are highly concerned. Because of the media’s representation, people are likely to think that the cure is almost found, and there is no need to be worried.
Duberman (2016) imposes another opinion on the issue. His report makes the population of the USA believes that even though all people are at risk of having AIDS, African Americans suffer the most. In this way, the public is worried about the condition of the colored individuals and is likely to pay less attention to other populations.
In Taylor’s report, HIV/AIDS is presented as a health related problem that does not have any decent treatment right now; however, the attempts are made to find it. Such representation makes people think that HIV/AID is the problem that should be avoided if possible because once being infected one will be ill during the whole life.
Paddock (2016) underlined that being spread all over the world, HIV/AIDS became a crucial problem in sub-Saharan Africa. Nine countries that belong to it require funding, but the required amount can be received only from innovative sources of finance. As a result, Americans my think that the problem is critical only for these countries and no efforts should be spent on trying to prevent it in other countries before Africa receives needed assistance.
Issue within a Historical Context
Today, the general public is provided with the enormous amount of information related to HIV/AIDS, which allows it to know not only the information about the current situation in the world but also the ways of prevention and control. Of course, it was not always so, and people used to have limited knowledge about his health related problem. Except for that, professionals discussed it in different perspectives that altered with the course of time being both disproved and developed.
In her recent work, Carla Tsampiras (2014) investigated the way AIDS was discussed in South Africa at the end of 20th century. She paid attention mainly to the political perspective of the issue during the transition and based her work on the stories of two men who fought with biased views of the government to support vulnerable communities.
The countries of South Africa were affected by homophobia that led to the moral panic in the 1980s. Medico-scientific and political leaders who worked in America and Britain were claimed to influence and streamline politicization of homosexuality in this region. Soon homosexuality became tightly connected with AIDS in the eyes of the public. Such fear and prejudice were spreading quickly after the report made by the Centers for Disease Control in Atlanta. Government departments and ministers formed people’s relations towards this issue by influencing research and responses about it.
As a result, negative views and attitudes shared in parliament got leaked to the population. Even being considered as illegal unities, gay organizations were created to support vulnerable populations. They cooperated with AIDS education organizations to make the public aware of this problem and its peculiarities. Still, individuals were greatly discriminated because of their HIV status and sexual orientation. Politicians divided gay males into two groups (white and black) on the basis of their status. A threat of police and military violence was faced by many homosexual males declared to be black while those named white could be even supported.
However, no decent help was received from the government by these populations. All steps towards improvement were made by the homosexual organizations, including a gay doctors’ group. They wanted to be sure that people were up to date with HIV news. With the course of time, a National Law Reform Fund was created. It was meant to support gay males and address AIDS. The HIV Clinic started to work even though it was not legally integrated for some time. Because of political intervention, the public associated sexuality, race and AIDS for a long time, being unable to overcome stereotypes.
I believe that such view on the problem is true to life and support this perspective of discussing AIDS. Politics really have the power to control the information received by the population. Their attitudes are often undertaken by the public without any decent consideration. In this case, it resulted in discrimination and lack of sufficient treatment. The division of gays on whites and blacks seems to be a tool to manipulate people and distract them from a real problem known as AIDS.
In their work, Rennie, Siedner, Tucker, & Moodley (2015) discussed HIV/AIDS treatment in ethical perspective. The authors emphasized that scientists started to talk about curing HIV rather often even though it is considered to be untreatable and only measures for prevention and control are really proven to exist. They tend to believe that the global mass media bases such claims on the cases observed several years ago. Thus, a man who had a stem-cell transplant and a child who received anti-retroviral treatment soon after being born were claimed to have no HIV/AIDS detected. Professionals tend to speak about these cases as of remarkable clinical developments, but Rennie et al. (2015) question such approach.
The authors conducted a great research discussing the issue in philosophical, ethical and historical point of view. They pay attention to ‘functional’ and ‘sterilizing’ cure in relation to epidemic problems that were not previously considered along with HIV/AIDS but seemed to be more appropriate for such conditions as cancer. It is underlined that the concept of cure is not as simple as it is mainly perceived in biomedical terms that are analyzed apart from the social and psychological aspects of the health problem.
Having conducted their own investigation, professionals came up with the decision that it is unethical to talk about HIV cure both in general and when discussing previously described cases. They believe that HIV/AIDS stakeholders may utilize the concept of the cure for their own benefit. The fact of curing HIV in individual situations they offer to treat as remission. Still, they do not deny that the work ‘cure’ can be used. The thing is that the context should be not the clinical one.
Personally I totally agree with the perspective presented by Rennie and his colleagues. The general public is likely to believe in a kind of medicine that can easily release all people form HIV/AIDS when they hear a word ‘cure’. As such remedy does not exist, it would be better to prevent possible dissatisfaction with healthcare services because of misunderstanding and not to misinform the population that can fall into a trap of individuals looking for easy pickings. I also agree that the usage of this concept outside the clinical context may alter people’s attitudes towards HIV-positive individuals. Still, the mishmash might occur due to such complications. Thus, I believe that it would be better if the concept of ‘HIV cure’ would not be used at all before a real cure is really found.
Significance for the Profession of Nursing
The discussed issue holds significance for the profession of nursing. First of all, it is critical for them to know about HIV/AIDS, their prevention, and treatment to educate and treat patients with such diagnosis and ensure safely of the community. Except for that, nurses are to address their clients as ethically as possible. They should know ethical principles to conduct professional behavior. They are expected not to make promises that they will not keep, which requires a decent knowledge of the issue. Finally, nurses should be responsible for their physical safety, which presupposes knowledge of HIV/AIDS transmission.
Comparative Analysis
HIV/AIDS is the problem discussed by both the media and medical experts. They tend to have some similar views on this issue. For example, they believe that AIDS is a serious health problem that can be only prevented and controlled. It is mainly spread among African American males who are engaged in homosexual relations. The number of people with AIDS fails to be significantly reduced, and the epidemic can be stopped only with substantial funding. Still, the media tends to present the information in the way that appeals to the general public more.
The information is often exaggerated and is not supported by scientific works, which makes it less authoritative. AIDS is often presented as a problem faced only by misfits and the issue that is of everybody’s concern at the same time. The professional nursing literature focuses more on the explanation of trends while the media reports provide facts. It also has numerous references that support the discussed position. Professionals describe AIDS as other health issues without dramatizing. Unlike the media, they underline not the drawbacks but achievements.
Implications
Taking into consideration everything mentioned, it seems to be critical to involve healthcare professionals in the process of active education the general public about AIDS. Education programs should be implemented to explode myths about HIV/AIDS and its transmission. The rights of people with HIV/AIDS should be ensured as many people still follow stereotypes. Nutrition security policies should be implemented to reduce risks of being infected.
Tsampiras, C. (2014). Two tales about illness, ideologies, and intimate identities: Sexuality politics and AIDS in South Africa, 1980–95. Medical History, 58(2), 230-256.
GE Healthcare is a well-established subdivision of General Electric (GE) that specializes in offering different diagnostic equipment to healthcare providers (Singh, 2014). In the recent past, it started its operations in the Indian market while discovering it as a potential source of the skilled and talented workforce (Singh, 2014). Nonetheless, it faced several challenges when conquering this geographical segment. Consequently, the primary goal of the paper is to assess emerging trends, internal and external barriers, steps, and contribution of the established strategy to the value chain development.
Emerging Trends
To enter the Bottom of the Pyramid Market (BOP), GE Healthcare implemented an entirely new strategy and introduced inexpensive Electroencephalography (EEG) equipment (Singh, 2014). The development of this instrument was triggered by several external trends. One of the main reasons was the projected growth of the Indian healthcare industry with its value of $30,000 that was expected to double in the recent future (Singh, 2014). This trend provided a rationale for choosing India as one of the opportunities due to its rapid growth and favorable economic environment.
Meanwhile, another trend was linked to the structure of the market. The domestic competition was represented by low-cost products such as catheters while the equipment was fully imported by international brands such as Siemens (Singh, 2014). This tendency created disparities in healthcare, as people were not able to afford expensive screening procedures. In this case, the development of a low-cost EEG machine helped the company create a distinct competitive advantage and satisfy the needs of the target audience.
Internal Barriers
Nonetheless, as mentioned earlier, the company had to face several challenges, and some of them were associated with its internal structure. One of them was the fact that GE Healthcare heavily relied on push strategy while not creating value but simply “pushing” the existent products to the market. This approach implied that the major focus was on developed customers. These actions resulted in the inability to meet its financial goals such as reaching $5 billion in revenues in the following year (Singh, 2014).
This internal barrier slowed the growth of the enterprise in the Indian segment. Thus, another challenge was the marketing strategy of the company. Initially, when entering the emerging market, the company continued aiming at globalization and did not take into account the special needs of the selected geographical regions. Not creating different strategies for dissimilar areas also slowed the development of GE Healthcare. Overall, it could be said that a combination of these internal obstacles resulted in low-profit margins and shrunk market shares.
External Barriers
It could be said that the company had to address different external obstacles. One of them was the lack of awareness of the Indian population about a newly developed product (Singh, 2014). Along with compliance with Indian regulations, it was one of the major obstacles, as this aspect was directly linked to the growth of market shares and revenues of the company (Butler & Tischler, 2015). One of the possible ways to address it would be creating partnerships with medical institutions to distribute information about a new inexpensive service. At the same time, it would be logical to organize different educational sessions for similar purposes.
In turn, it could be said that another external barrier was associated with limited distribution channels, as the company experienced hardships when creating new partnerships (Singh, 2014). To resolve this issue, it was reasonable for the enterprise to design an effective integrated strategy that would not only include product development but also its marketing and promotion. Distributing prototypes could be viewed as one of the solutions to attract new partners and acquire feedback simultaneously.
Specific Steps to Develop in BOP Market
To summarize, the first step to growing in the BOP market was devoting more attention to the Indian market while creating individual approaches for each region and developing its profit-and-loss center (Singh, 2014). These activities entirely comply with the concepts of strategic thinking and planning, as they implied increasing control over operations in India in the long-term perspective.
Developing products such as MAC 400 to cater to the need of the BOP market and distributing them via the joint venture with Wipro and other partners could be viewed as subsequent strategic steps. Along with estimating high financial returns, these actions were rational since they not only defined the company’s development and pathway in the recent future but also stimulated the interest of the employees by increasing their motivation and setting high expectations.
Contribution of Strategy to the Value Chain
Lastly, it is essential to evaluate the ability of the identified strategy to influence the value chains in both developed and emerging markets. In the first place, a designated focus on India assisted the company in designing an entirely new value proposition by occupying an empty market niche. With the help of a novel approach, the company was able to make its products affordable for the layers of the population with low socioeconomic status. This aspect assisted the company in creating a unique low-cost product. As for developed countries, this strategy could be defined as reversed innovation (Singh, 2014).
Making products light and inexpensive contributed to the development of an entirely different competitive advantage and value proposition in the developed markets while triggering more demand and creating additional value. Overall, it could be said that the BOP market strategy turned out as mutually beneficial for all geographical areas of operation of GE Health.
References
Butler, D., & Tischler, L. (2015). Design to grow: How Coca-Cola learned to combine scale and agility (and how you can too). New York, NY: Simon & Schuster, Inc.
To successfully measure the efficiency of the intervention, it is necessary to determine the information that is directly relevant to the identified goals and objectives. In this particular case, 30-day readmissions are one of the reliable indicators of the hospital’s discharge process’ success rate. Therefore, the information can be defined as data on the admission of the patients previously discharged from the hospital in question and admitted to the respective hospital with a complaint that corresponds to the condition stated as an initial health issue. The scope includes data on both planned and unplanned admissions and uses an inclusion criterion of the index admission as a baseline.
However, it should be stressed that the principal diagnosis should not be used as one of the inclusion criteria since it is irrelevant in terms of the quality of the discharge process. In simple terms, the readmission contains risks for the patient and creates adverse effects for the healthcare provider with no regard for the cause of the event. Therefore, such an approach would allow for a stronger emphasis on patient-centered care and at the same time ensure an overall increase in quality of care within the hospital.
Considering the nature of the identified information, it would be reasonable to choose medical records as the main source of data. Medical records contain relevant and definitive information that can be quantified and analyzed to produce highly reliable results. The data in question should be collected in three tiers. First, the inpatient data can be retrieved. This set includes the information on the diagnoses, dates of service, diagnosis-related groups, procedures with respective ICD codes, the information about the care provider, and the demographic information of the patients. Second, the outpatient data is necessary to collect.
This set would include a range of non-inpatient services such as emergency room care, diagnostic procedures, and surgical interventions, as well as services conducted in the ambulatory diagnostic centers and outpatient department of the hospital. Third, the records of the physician services performed face-to-face with the patient (CMS, 2016). As such, this source would not include laboratory tests and ambulatory services. Besides, the third source would disregard the setting of the provided service. Such disaggregation would allow for a comprehensive nature of the retrieved data and ensure the inclusion of all relevant aspects of the readmission process.
The source of the data suggests that all patients within a certain timeframe would be subject to sampling procedure as long as they meet the inclusion criteria of being readmitted to the hospital within the 30-day timeframe. Therefore, as long as the project is confined to a single hospital, the size of the sample is determined by the amount of the medical records pertinent to the issue. However, it should be mentioned that such sampling size choice is subject to several limitations.
First, the size of the sample depends primarily on the number of occurring readmissions within a single organization, which, in turn, opens up the possibility of inconsistencies with the average rates. While this limitation can be addressed by measuring the relative readmission rate and comparing it to the respective results of other organizations, such adjustment is outside the scope of this project and should be performed separately. Second, the actual size of the sample depends directly on the size of the hospital and the demographics of the local population, which may or may not be representative of the total population of the state or a country.
In other words, the obtained data and the conclusions on the success of the intervention cannot be reliably used until the sample is established as representative of the audience of interest. The principal characteristics of the sample include the age (younger than 65 years), length of stay (the exclusion of same-day readmissions due to incompatibility), the absence of transfers to another facility, the occurrence of in-hospital death during the initial admissions, and the additional admissions (due to their differences from readmissions).
Based on the identified criteria and characteristics, the following methodology is suggested. The data will be collected from the hospital databases that contain information on the hospitalization of the patients from 2016 and 2017. The hospitalization data is expected to include the information on the index admission of the patients, their eventual discharge, and a medical record of 30 days following the event. The retrieved set is further refined by excluding the individual entries which do not comply with the stated exclusion criteria such as age and same-day readmissions. The cases where the principal and readmission diagnoses do not match are not excluded to further stress the quality improvement side of the project.
The sample is then further refined by identifying the cases where additional admissions were part of the outcome and thus cannot qualify as a gap in the quality of the discharge process. Finally, the data is verified through the comparison with the administrative data available on the selected patients. If the administrative data produces a reliable estimation of the results derived from the medical records data, the data is considered valid and can be used for analysis. In this way, the compliance of the discharge tool with the standards of clinical research can be established.
To meet the deadlines of the project, the entire data collection process is planned for six weeks. The location of the necessary records is expected to last for one week, followed by the verification process and the location of the administrative data, with the final week reserved for the establishment of the discharge tool compliance and the confirmation of the initial calculations.
Data Analysis Plan
Once the necessary data is retrieved and validated, it is possible to proceed with the analysis procedures. Quantitative analysis has been chosen to perform the analysis since it yields more reliable results and demonstrates greater efficiency when applied to the large data samples (e.g. the cohort within a single hospital). The data analysis procedure is expected to illustrate the readmission rate within the hospital which, in the context of the study, can be viewed as an intercept specific to the hospital in question as well as a function of the organization’s characteristics and the demographics observed at a patients’ level.
In this way, the procedure would acknowledge the outcomes observed at the hospital level and determine the correlation between them (McIlvennan, Eapen, & Allen, 2015). Also, it would allow substantiating the modeled suggestion that the difference in the outcomes within a specific healthcare facility can be used to evaluate the systematic improvements in outcomes on a larger scale. To ensure the applicability of findings, risk adjustments need to be introduced into the procedure. Specifically, the inpatient and outpatient data will be used in the analysis, backed by the face-to-face encounters with the physicians and a range of secondary diagnoses.
The multi-faceted nature of the dataset would allow for the calculation of the risk-adjusted covariates. The ICM codes would then be grouped into mutually exclusive categories, which, in turn, can be utilized for the formulation of the condition categories and, by extension, the introduction of the variables for risk adjustment. Once these variables are available, it would be possible to estimate the risk factors and determine the presence of random effect within the facility.
Using the model above, it would be reasonable to evaluate the possibility of readmission for any given individual patient within 30 days. After this, it becomes possible to calculate the average probability of the readmission by summing up the results for all patients within the hospital and dividing the result by the summed probabilities of each specific condition category. The obtained result would illustrate the average readmission in a scenario where any given patient would be exposed to the risk of readmission with a random diagnosis. Finally, based on the received result it would be possible to calculate a standardized readmission rate by multiplying the obtained ratio by the overall rate available from the data. Such a procedure would mitigate the limitations of the possibly inadequate sample by scaling the findings to the degree where they would apply to both smaller and bigger hospitals.
The primary data analysis tool used in the project is a hierarchical regression model. The rationale for this choice is the suitability of the tool for the chosen data collection methods and the expected reliability of the results. Specifically, the regression coefficients will be estimated for each patient in the dataset, multiplied by the characteristics of the readmission, and added to the in-hospital intercepts. In this way, quantity can be converted to probability and, after summing the respective outcomes of all patients, the average probability can be derived (Mull et al., 2013).
With this information on hand, it would be possible to model the predicted number of readmissions by summing the individual predicted readmission rates of all patients. According to the hierarchical model, the individual predicted readmission rate could be calculated by adding the specific condition categories to the estimated regression coefficients for each participant about the observed characteristics. The described tool would summarize the observations within a single hospital. The risk factors of the hospital-specific random effect would have to be introduced to exclude the distortion of results due to the clustering of observations.
To summarize the obtained data in the accessible format, the run chart will be used as an additional tool. The run chart has several benefits that make it highly suitable for the project. First, it summarizes the progress of a project in a visually comprehensible manner and allows for a flexible adjustment depending on the frequency of the data retrieval. Next, it provides the means of identifying the onset and termination of a cycle or a time-specific trend during the project’s duration. Finally, given sufficient time and frequency of the inquiry, it can reveal a non-random pattern in the project’s development, which can be used for the elimination of undesirable effects or the identification of the overlooked benefits (Houser, 2016).
Considering the stated goal of decreasing the hospital readmissions by 50% in the six months of the project duration, it is possible to suggest the following run chart as an example of the project’s outcomes.
Figure 1. Readmission rate run chart.
The x-axis, in this case, corresponds to the duration of the project and is marked by month. The y-axis identifies the average discharge rate. For exemplary purposes, the initial value is set at 19%, which transpires to the target line of 9.5%. The data in the example is retrieved every month.
Action Plan
To reach the desired level of quality, a specific methodology is recommended for implementation. Considering the complexity of the issue and the number of factors involved, a cyclical method such as plan-do-study-act (PDSA) is deemed the most viable option. Such a method allows for a systematic improvement due to the seamless nature of the process. Also, its effectiveness is widely recognized in the field of healthcare. PDSA has been successfully used in similar projects in the past with the documented positive results (Poston, Dumas, & Edlund, 2014). For the current project, its use can be outlined by its principal components.
First, the goals and objectives of the project must be laid out clearly and concisely, with quantifiable milestones and reasonable deadlines for each stage. Each area of improvement should be addressed by a specific evidence-based practice followed by the rationale for its choice and the estimates of the expected benefits. Importantly, the data collection measurements also need to be identified at this stage, with specific dates for each inquiry.
Second, the planned changes are set in motion by a designated team. Simultaneously, the observation of the immediate outcomes and compliance with the deadlines is to be performed. The former can provide an additional level of control of the process as well as a possibility of readjusting minor details in the case when they are incompatible with the expectations. The latter ensures the consistency of the project’s implementation and, by extension, the reliability of the outcomes.
Third, the obtained results are analyzed and laid out in an accessible manner for the participants to detect the causes for shortcomings if the objectives are not met.
Fourth, based on the conclusions derived from the observations, adjustments are developed for implementation in the following cycle. In the scenario where all objectives are successfully met, this stage can include the development of a more effective version of the intervention or, in some cases, the decision to use the unaltered version.
The main criterion of the project’s success is the decreased patient readmission rate. Therefore, the assessment and measurement of progress both during and after the intervention can be based primarily on this metric. The process for assessment will include the retrieval of data from the medical records, the verification of data through the administrative sources, and the analysis using a hierarchical regression model. Once the results are available, they will be laid out in the form of a run chart. In this way, the progress achieved by the project as well as the dynamics of the process can be assessed. The evaluation process should then be repeated in three and six months following the intervention to determine the long-term effectiveness of the intervention. Such an approach would improve the understanding of the procedure’s effects and allow for more precise modeling before its implementation in similar settings.
References
CMS. (2016). Readmissions reduction program (HRRP). Web.
Houser, J. (2016). Nursing research: Reading, using and creating evidence (4th ed.). Burlington, MA: Jones & Bartlett Learning. Web.
McIlvennan, C. K., Eapen, Z. J., & Allen, L. A. (2015). Hospital readmissions reduction program. Circulation, 131(20), 1796-1803. Web.
Mull, H. J., Chen, Q., O’Brien, W. J., Shwartz, M., Borzecki, A. M., Hanchate, A., & Rosen, A. K. (2013). Comparing two methods of assessing 30-day readmissions: What is the impact on hospital profiling in the veterans health administration? Medical Care, 51(7), 589-596. Web.
Poston, K. M., Dumas, B. P., & Edlund, B. J. (2014). Outcomes of a quality improvement project implementing stroke discharge advocacy to reduce 30-day readmission rates. Journal of Nursing Care Quality, 29(3), 237-244. Web.
Today, more than ever before, it has become increasingly apparent that the daily functioning of a healthcare institution fundamentally depends on the integrity, availability and dependability of its information systems. Patient health information, research, operations, and finance all depend on highly accessible, reliable, and robust software applications, data, and information technology infrastructure (Glaser & Aske, 2010).
Consequently, healthcare providers are required by law to strictly observe a complexity of standards as outlined in the privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA). This paper reviews some underlying issues related to organizational policies, procedures and documentation requirements governing health entities for HIPAA compliance.
Issues in Information Technology & Reporting Data
One of the underlying issues covered in the document is the need for covered entities to tighten internal and external compliance procedures by ensuring that their business associates subscribes to a set of standards and requirements aimed at ensuring the integrity and reliability of the electronic protected health information (EPHI).
This objective is achieved by ensuring that the covered entity obtains signed privacy agreements with the business associates, particularly on the use and disclosure of EPHI (HIPAA, 2007).
The second issue concerns the need for the covered entity and its associates to conduct regular audits on EPHI not only to ensure compliance with the requirements and standards outlined in the Act, but also to guarantee that EPHI is used for the intended purposes. Business associates, such as software developers, must therefore develop and implement record-level security aimed at restricting access to EPHI sorely to those who are allowed by the Act (Sarrico & Hauenstein, 2011).
The variables of EPHI that requires safeguarding as outlined in rules and regulations of HIPAA also comes out strongly in this document. Indeed, the Act requires all stakeholders – covered entities, sponsors, business associates, and subcontractors – to always ensure the confidentiality, integrity, and availability of EPHI (HIPAA, 2007).
For example, a sub-agent contracted by a business associate of a covered entity to create a component of the electronic health register (EHR) must not only ensure the confidentiality, integrity and availability of EPHI under its possession, but must agree to sign compliance agreements that appropriate the task of implementing reasonable and appropriate safeguards to the subcontractor (HIPAA, 2007; Cannoy & Salam, 2010).
Fourth, the article has comprehensively discussed how breaches to the security of patient health information should be addressed either by the covered entity or by the business associates, sponsors, or subcontractors.
Lastly, the document has outlined how policies and procedures required by the Security Rule should be incorporated with the organization’s mission and culture to enable effective implementation. Here, the covered entities are given a leeway to modify the rules and procedures of the Security Rule to fit their current business practices for policy development and implementation, as long as the modifications are documented and implemented in accordance with the requirements of the Act (HIPAA, 2007).
Security Breaches
The Health Information Technology for Economic and Clinical Health (HITECH) defines a breach as the “…acquisition, access, use, or disclosure of protected health information in a manner not permitted under [the HIPAA privacy rule] which compromises the security or privacy of the protected health information” (Brown, 2009, p. 27).
As such, any use, disclosure of, or access to, electronic patient health information that is not expressly permitted by the HIPAA privacy rule constitutes a security breach.
For example, improperly disclosing patient health information that contains the name of the patient and dates of his/her appointments to a third party who is not allowed by the HIPAA security rule to have access to such information constitutes a violation of the privacy rule but not a substantial risk; however, the improper use or disclosure of sensitive patient information, such as the type of services received by the patient, constitutes a breach since such disclosure could result in harm to the patient (Brown, 2009)
Technologists working in the covered entity should report the breaches to the individuals who could be harmed as a direct consequence of the breach. Serious breaches, such as those involving more than 500 patients in a given state or jurisdiction, must be reported to the media and the Secretary to the Department of Health and Human Services (HHS).
For breaches involving less than 500 patients, however, the technologists need to report to the administration of the covered entity, who then maintain a log of the reported breaches with the aim to notify the HHS not late than 60 days after the expiry of the calendar year (Brown, 2009).
Requirements
The requirements noted in the document include: organizational requirements; requirements for group health plans, and; policies, procedures and documentation requirements.
Under the organizational requirements, the covered entity is required to enter into binding contracts or other arrangements with business associates who will have direct access to the covered entity’s EPHI with a view to ensure the effective implementation of administrative, physical, and technical safeguards that realistically and correctly protect the confidentiality, integrity, and availability of EPHI.
This requirement also outlines ways through which the business associates should report breaches to the security and privacy of patient data, and the consequences for non-compliance (HIPAA, 2007).
The standard on the requirements for group health plans obliges the “…group health plan to ensure that its plan documents require the plan sponsor to reasonably and appropriately safeguard EPHI that it creates, receives, maintains or transmits on behalf of the group health plan” (HIPAA, 2007, p. 5).
This implies that the plan sponsor of the group health plan who has access to sensitive electronic patient health data is required by the Security Rule to plan documents using a language which is similar to that already required by the Privacy Rule.
Consequently, the sponsor must not only ensure reasonable and appropriate safeguards to the confidentiality, integrity, and availability of EPHI under its disposal, but must also ensure that any agent, including a subcontractor, to whom it avails this data is obliged to implement rational and appropriate security directives to safeguard the information (HIPAA, 2007).
Lastly, the requirements deal with issues of how a covered entity may modify its policies and procedures to fit its mission and organizational culture, provided that the modifications are documented and implemented in accordance with the Security Rule (HIPAA, 2007).
According to Withrow (2010), these requirements provide the covered entities with the flexibility they need to implement the policies and procedures of the Security Rule according to their standard business practices, but they must take caution not to circumvent the requirements as enshrined in the Security Rule.
In documentation standard, covered entities are not only required to retain documentation for a specified number of years (6 years) from the date of its creation or up to the date when the document was last in effect, but they are also supposed to make the documentation available to the individuals responsible for implementing the procedures to which the documentation pertains (HIPAA, 2007). Reviewing and updating the documentation as needed is also a requirement.
IT Workers
To ensure adherence to the requirements discussed above, the covered entities must embrace extensive and regular training of all employees, but with particular emphasis to employees in their information technology departments (Sarrico & Hauenstein, 2011).
The rules, standards, and requirements contained in the HIPAA are complex, thus the need for IT workers to undertake comprehensive training aimed at enlightening them on scenarios that may compromise the security and privacy of EPHI to a level that may make the entities non-compliant. Indeed, the extensive training and education should be extended to the employees of the business associates.
Non-Compliance of the Requirements
Organizations are often found to be non-compliant to the standards and requirements discussed in this paper due to a number of reasons, with the major one being the lack of proper understanding of what may be considered as a breach to the security and privacy of EPHI (Withrow, 2010).
For example, healthcare organizations may not know that some simple acts such as a nurse giving a hospital discharge sheet to the wrong patient may constitute a breach if the health information (e.g., treatment for drug abuse) of the rightful owner is included in the discharge sheet.
Varied interpretations of the standards have also been cited as a major cause of non-compliance (Sarrico & Hauenstein, 2011). Lastly, failure on the part of the covered entity to implement policies and strategies that lead to reasonable and appropriate protection of the confidentiality, integrity, and availability of EPHI occasions non-compliance.
Conclusion
The legal liability for non-compliance of HIPAA may be a turning point for any healthcare organization – from a profit-making entity to sudden demise (Sarrico & Hauenstein, 2011). Equally, EPHI is sensitive in nature and all efforts should be made to protect and safeguard this information with a wider scope of safeguarding the character and reputation of individuals. It is therefore imperative for health institutions to follow the standards and requirements contained in HIPAA to the latter if they are to kill the two birds with one stone.
Reference List
Brown, B. (2009). Notification requirements for breaches of protected health information. Journal of Health Care Compliance, 11(6), 27-30.
Cannoy, S.D., & Salam, A.F. (2010). A framework for healthcare information assurance policy and compliance. Communications of the ACM, 53(3), 126-131.
Glaser, J., & Ake, J. (2010). Healthcare IT trends raise bar for information security. Healthcare Financial Management, 64(7), 40-44.
HIPAA. (2007). Security standards: Organizational, policies and procedures and documentation requirements. Web.
Sarrico, C., & Hauenstein, J. (2011). Can EHRs and HIEs get along with HIPAA security requirements? Healthcare Financial Management, 65(2), 86-90.
Withrow, S.C. (2010). How to avoid a HIPAA horror story. Healthcare Financial Management, 64(8), 82-88.
Nowadays, the healthcare industry is immense and provides an array of services to different layers of the population. To ensure its sufficient functioning, one could not underestimate paramount importance of Human Factors that aims at enhancing the quality of the provided services with the help of teamwork, tasks, workforce and its collaboration, culture, and organization of the hospital, as the sufficient knowledge of these elements has a vital impact on safety and quality (Rosenorm-Lanng 2015). Consequently, the primary goal of this paper is to discover recent researches in Human Factors, understand their impact on healthcare, evaluate the possible absence of this phenomenon, and suggest new ideas for its development with the help of the literature review. In the end, conclusions are drawn to summarize the main findings of the paper.
Latest Researches in Human Factors
To establish a foundation for discussion, World Health Organization (2017) states that Human Factors is a complex science that integrates a variety of disciplines such as leadership, medicine, management, anatomy, and physics to ensure effective collaboration of the workforce with equipment while prioritizing efficiency and creativity. These aspects underline that this discipline has a dramatic influence on the healthcare system and beneficial impact on its optimization. The integrity and unity of this phenomenon along with its dramatic effect on patient safety make this topic highly interesting for research.
Continuous technological development makes this discipline more advanced and complicated. For example, many researchers attempt to review interactions from dissimilar angles and discover a potential collaboration of humans with robots (Sheridan 2016). The individuals experience challenges in this segment due to the lack of know-how (Sheridan 2016). Thus, discovering this topic in the context of Human Factors is essential since it is the key to success and increases levels of safety and quality. At the same time, other studies tend to review the role of automated equipment and vehicles and sufficient coordination of processes as other critical spheres of Human Factors (Butchibabu et al. 2016; Erikson & Staton 2017). It is believed that making these transitions smooth will have a positive impact on the healthcare system while stating that Human Factors has an array of topics for research.
Impact of Human Factors on Healthcare
The previous sections show that Human Factors has a vital effect on the healthcare industry, and it makes processes more efficient and minimizes the percentage of medical mistakes. Without this discipline, the healthcare segment could not be as effective as it is today and would not experience continuous progress in a positive direction. One of the bright examples is the ability of this science to assist in redesigning the discharge process and planning (Carayon & Wood 2010).
Making this transition (a discharge) is always complicated, and it requires taking into account a plethora of disciplines such as engineering and leadership to make this process effective and advance collaboration between different members of the team. With the assistance of Human Factors, Boston Medical Center enhanced the flow and coordination of these processes while decreasing the number of dissatisfied patients and medical errors and improving patient safety.
Other examples can be related to designing an effective schedule to avoid shortage and burnout of the workforce, providing a plan of the communication process to new employees, and developing new software and equipment for surgeries such as IV pumps and electronic scalpels (World Health Organization, 2017). Overall, the cases mentioned above are only some examples of the positive effects of Human Factors. Nonetheless, their advantageous effects cannot be underestimated and pertain to the enhanced working environment, efficiency, and decreased levels of medical errors while triggering technological development and progress.
The Absence of Human Factors in the Healthcare Segment
The examples highlighted in the previous sections display that Human Factors play a pivotal role in the healthcare industry while having a positive impact on their innovation and development. Apart from that, it is possible to consider a “what-if” scenario when Human Factors is not an irreplaceable element in the industry. It could be assumed that not adopting this discipline from other spheres such as the military would lead to adverse consequences (World Health Organization 2017).
One of them could be the fact that the processes and planning would not be highly efficient since the management would not be able to review them from dissimilar perspectives and propose mutually beneficial solutions for the employees, management, and patients. Another aspect might pertain to the fact that the healthcare industry would disregard the technological progress and development and not adopt the life-changing inventions such as database systems. A combination of these matters would make hospitals and other medical institutions less flexible and could increase the number of medical errors and deaths. Overall, it could be said that the potential absence of Human Factors in Healthcare would lead to a high prevalence of different illnesses and diseases and escalating mortality and morbidity rates.
New Ideas for Human Factors in Healthcare
Due to the linkage of Human Factors to technological progress, its opportunities will continue to grow with this sphere. Consequently, there is an extended variety of options for its development. For example, it could continue researching Robot-Human interactions, as robots are the future of the world (Sheridan 2016). Focusing on the design and development of the implementation and integration plans can help automated systems and robots become important helpers in the healthcare segment. With the assistance of Human Factors, robots soon can appear in hospital wards and prescribe relevant medications and treatments to patients.
Other new ideas can be related to diversifying screening procedures and using Cloud Storage to maximize access to health records. Nonetheless, apart from a plethora of new opportunities, Human Factors should continue optimizing existent procedures and equipment such as alarms, checklists, and pumps to increase the overall levels of safety (Sheridan 2016). It could be said that Human Factors define a positive future of medicine and assists it is becoming more advanced and safe than it is today.
Conclusion
In the end, this research paper helped me understand that Human Factors could be considered as an irreplaceable and pivotal component of the healthcare segment. Its innovative nature assists this industry is becoming more advanced and developed, as it implies improving the quality of the provided services and levels of safety by ensuring sufficient collaboration between human beings and equipment. Its major benefits are not only connected to improved levels of safety but also imply the continuous development and optimization of the system and procedures. It could be assumed that without it, mortality and morbidity would increase, as medical institutions would not be able to comply with the rapid changes in technology.
Currently, the researchers review the possibilities to improve human-robot interactions and enhance the overall collaboration. These concepts could be considered as the future of healthcare, as successfully integrating robots in hospital wards will increase efficiency and safety. Overall, it could be said that Human Factors has a bright future since this discipline is vehemently linked to technological progress and innovation.
Reference List
Butchibabu, A, Sparano-Huiban, C., Sonenberg, L & Shah, J 2016, ‘Implicit coordination strategies for effective team communication’, Human Factors and Ergonomics Society, vol. 58, no. 4, pp. 1-11.
Carayon, P & Wood, K 2010, ‘Patient safety: the role of human factors and system engineering’, Studies in Health Technology and Informatics, vol. 153, no. 1, pp. 23-46.
Erikson, A & Staton, N 2017, ‘Takeover time in highly automated vehicles: noncritical transitions to and from manual control’, Human Factors and Ergonomics Society, vol. 59, no. 4, pp. 1-17.
Rosenorm-Lanng, D 2015, Human factors in healthcare: level two, Oxford University Press, Oxford.
Sheridan, T 2016, ‘Human-robot interaction: status and challenges’, Human Factors and Ergonomics Society, vol. 58, no. 4, pp. 1-8.
World Health Organization 2017, What is human factors and why is it important to patient safety?. Web.
This study uses a quantitative survey technique, and summarized data collected is used to correlate results with listening skills as its fundamental principle (Punch, 1998). A survey was sent out on the Internet and yielded results from various gender, socioeconomic backgrounds and education levels. Communication issues have been maintained by employing a number of methods.
Pain faces scale training of participants and research assistants and maintaining good relationships with participants are used in our recruitment to further develop partnership between the study population and researchers and to maintain feedback.
Each step undertaken to gather and analyze data, validate findings and present research outcomes in which comprehensive and accessible findings will be used to facilitative growth and continued development. The purpose of this research is to develop a better understanding of listening skills and how better listening skills well as ability to recognize nonverbal expressions will assist the healthcare industry and its consumers.
Introduction
The merriam-webster dictionary defines pain as “suffering or distress of body or mind”. It is argued that effective communication between healthcare provider and patient is an important element in improving treatment compliance. Holmes et al, (2007) on the other hand provides that pain interferes with person’s ability to communicate by altering normal patterns of verbal and nonverbal communication.
Listening skills is something that has been emphasized in the medical field for years. Professors in medical schools have been attempting to teach their students to be better listeners to their patients (Holmes at al, 2007).
As we seek to integrate effective communication skills in healthcare, the best question, and yet difficult to ask, is: does listening skills, as well as purposeful nonverbal communication, while being applied, more likely to improve the relationship between healthcare providers and patients?
Listening skills is something that has been emphasized in the medical field for around 2,500 years and the problem of communication challenges often leading to misdiagnosis has always been an issue. Frischenschlager and Pucher (2002) argue that describing pain to a physician falls solely on the patient. And in most cases, physicians often lack the skills to read patient’s nonverbal signs or even interpret the slang they use.
Therefore communication problems between providers and patients remain to be a major problem in the healthcare professional. The provider-patient as demonstrated by the pain scale (figure 1-Appendix) illustrates their interrelationships. The research conducted sought to answer the question, “Can pain faces be distinguished from other emotional expressions?”
Literature reviews on the ability to recognize facial expressions and listening skills issues facing both patients and health care providers in social dynamics of healthcare professional will be discussed. A thorough investigation on communication of health issues affecting these communities are illustrated which provides a synthesis of the existing problems.
This literature review is coined around personal and situational issues, as well as empirical research on the communication concerns with support of reviewed of population studies and themes are summarized. As the cultural context of health issues has a major influence on our communities, sociological literature on this pandemic is highlighted.
To affirm this analysis, researchers linked various responses to research from the related areas and concluded with references for future research on the health and sociological dimensions. The current literature was reviewed using Communication & Mass Media Complete database and searched online article using listening skills and facial expressions in healthcare as key words using Google.
The research concentrated on both young, middle and old age population as my headline and designed my research article around a pain face scales instruments to perform a thorough analysis on how participants can identify non-verbal signs to communicate their pain issues.
The finding being that if a “Lay” person could do it WELL then with a little training, a Healthcare Provider could do it as well. Training that included spending more time with their patients. Our careful analysis and research will then be used to identify the validity and applicable evidences that can be used in health care practices
Objective
This paper seeks to explore the relationship between healthcare provider and the patient, highlighting difficulties they experience when communicating to each other about pain issues. Our analysis aims at providing evidenced-based guidelines that will provide a set of recommendations that can improve listening skills on the patient and the service provider.
While much has been done to encourage physicians to improve their listening skills, research indicates that listening, as well as provider-patient interactions can improve with adequate training and follow-up. As the number of studies increases, the results, effects and outcomes of patient-provider communication, there is still a much research to be done in the field.
Background
Questionnaires were designed and distributed over the internet. This environment allowed participants to freely and openly rate facial expressions as much as possible. Participants were well acquainted with internet and use of facial expressions in their day to day activities.
This equipped them with considerable knowledge of what was expected of them as many of the expressions such as anger, happiness, sadness, disgust, surprise, fear and pain in facial expressions related well with their personal experiences.
Literature Review
Analysis
The most frequent complaint among patients is pain. According to Baird et al (2008), an estimation of 30 million people in the United States are suffering from chronic pain. It can not be assumed that the most prevalent pain always occur naturally. Acquiring effective communication skills requires the employment of observation and application practice of communication expressions.
According to the US Bureau of the Census (1995), nearly 7% of the US population deals with chronic pain every year making it a high priority concern within the healthcare community. Evidence from the US Department of Commerce shows that pain associated problems costs billions of dollars in the healthcare industry.
It adds that related problems such as chronic pain management and how to effectively deal with pain and cost management to be also of concern. The same studies also evidences high occurrence of opiate dependence among the mentioned group.
Pain can be explained in different perspectives depending on individual experiences. Frischenschlager and Pucher (2002) provide that pain cannot be measured or quantified. Health care provider should in this case assess pain on individual perspectives. Therefore verbal and non-verbal description of their current health status depends solely on the patient.
This simply means that the overall communication context is influenced by the dynamic exchange of the service provider and patient interaction. However, this has never been the case. As Frischenschlager and Pucher (2002) state, “problems with the communication between doctor and patient are a frequent result (p.416).
Pain has often been defined as a warning sign indicating something wrong within the body. Pain is classified into two categories; acute and chronic pain. People in pain often undergo intense psychological experience. Acknowledging the importance of patients understanding how to respond to pain is important in communicating pain issues to the providers.
Issues associated with patient communication process are outside the scope of medical research. In this regard, Brannigan et al (2008) quotes, “pain should be looked at as a multi-dimensional affair and not just a one a warning sign” (p.12). Thus, being able to communicate effectively and knowing which messages to communicate are equally important.
Pain Theories
Frishenchlager and Pucher (2002) categorize pain theories into two groups; 1) the Frey theory and 2) the Goldscheider’s approach. Frey’s theory defines pain as special pain pathways that connect pain-specific nerve endings leading to the brain.
The Goldscheider’s approach states that nerve endings are not specific to any center of the brain and that pain can only be experienced when the level of pain reaches to an intense point that can not be tolerate leading a patient to expressing their discomfort.
Frishenchlager and Pucher (2002) links psychological factors such as distraction, relaxation, fear, depression, former pain experiences, family and cultural influences to be among factors that affect the way that people experience pain.
In their analysis, Frishenchlager and Pucher (2002) redefine pain as,”…………unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (p.419).Their definition gives equal weight to emotional and physical pain experience hence the rebirth of gateway theory that links emotions to physical pain, considered to be a breakthrough in theories of pain.
Effects of pain and patients’ inter-personal relationships are not only becoming important topics in research, the management of chronic and acute pain are also of paramount importance. In this regard, future research should take deeper studies in defining what chronic pain is and how it effects the population (Smith, 2008; GangHeong, 2000).
Pain is now being thought of as the Fifth Vital sign that offers way for physicians to assess overall health of an individual. Pain can be considered as chronic if the symptoms last up to three months. Walid et al (2008 argue that pronounced pain changes the behavior of an individual. They provide guidelines on how to determine levels of Chronic Pain as to include;
duration of illness;
number of treatments and consulted doctors;
psychological impairments such as depression, helplessness and loss of self-esteem;
social impairments such as social isolation, changes in the patient’s social role and position; and
Job-related impairments such as having to take days off because of being ill that can subsequently lead to dismissal.
Diagnostic classification of chronic pain
It presupposes:
A continuous, torturing pain, which;
Cannot be explained well by an organic damage; and
Psychosocial problems or emotional conflicts are recognizable and can be brought into direct connection with the pain the patient experiences.
Gromala and Shaw (2004) define chronic pain as pain that lasts from one month to a year. Their analysis records a statistic of 57 million people in North America with majority being the disabled people. To this we come to the conclusion that pain is indeed a difficult problem for both physicians and patients (Bennett et al, 2009).
McCosker (2004) defines pain an “inner experience and others cannot truly observe its effects or share in its suffering” (p.62). Frischenschlager and Pucher (2002) links withdrawal symptoms as part of the psychological challenges a person undergoes when experiencing chronic pain.
They add that when someone isolates themselves from the society to heal results to withdrawal making the pain more intense. When a person life revolves around their illness, pain becomes part of their life.
Facial Action Coding System
The Facial Action Coding System (FACS) dates back in to the mid 19th century (Piderit, 1858). The most influential theorist was Charles Dawn in which he argues in his book ‘The Express of Emotions in Man and Animals” that facial expression is universal and innate characteristics. He further added that facial expressions played a crucial role in the experience of emotion (Darwin (1896).
FACS is defined by Ekman (1984) as “changes in the facial musculature comprised a large portion of emotional state” (p.319). He argues that the expressions were based on a “theoretical study designed to measure specific facial muscle movements believed to be associated with emotional expression” (p.321).
Ekman and Friesen (1978) further distinguish between two different types of judgments to include message judgments that refer to specific behavior and those made about behavior. They argue that facial expressions such as anger or happiness can clearly be distinguished from pain expressions, while to accurately measure the assumptions of psychological state, inferences about that which is being measured is required.
Ekman and Friesen (1978) define pain scale as a measurement that “identifies specific responses to specific stimuli, natural unfolding of specific behavior over time….which segment is likely to produce the most expressive behavior” (p.322). The intensity of facial expressions are measured at four (1=low, 2=medium, 3=high and; 4=very high).
The low ratings often display mild expressions such as smile with slightly raised corner of the mouth and corners of the eye without displaying the teeth. Medium rating expresses moderate expressions. This is often displayed like half smiling and half laughing, with eyebrows slightly raised and lips apart, exposing teeth.
High rating emotions are displayed such cry or laugh, with an open mouth, raised eyebrows and cheeks. Very high rating, display intense expressions when crying or laughing and lips are completely apart, teeth showing and cheeks substantially raised.
Nonverbal Communication
There are many ways a healthcare provider can look beyond what their patients are saying to what their patient’s body is telling them. Cooper (1979) gives several suggestions for what a healthcare provider can do to read some nonverbal clues that will help them better understand their patient’s pain.
Cooper (1979) suggests that many people talk without looking at the eyes of the other person, especially physicians; and this can suggest that one is not listening at all. Some patients, especially those in pain, have trouble articulating their feelings. Some signs that Cooper (1979) gives for a healthcare provider to look out for:
Facial Clues
In fear and pain the eyes open wide with the lower lid tensed. The eyebrows rise in a straight line and the mouth opens with the lips tense and drawn back
In sadness the eyes look downward with the lower lid raised
Cooper (1979) continues on stating that a person’s attempt to control their facial expressions, their nonverbal behaviors, gives away the fact that they are in pain and not able to tell their physician everything.
Use of non-Verbal Communication
Clinical spectrum of typhoid is broad, ranging from diarrhea, which may be fatal in a shorter incubation period of 48 hours or longer periods of up to 3 months, with an abrupt offset of headache, diarrhea and vomiting. The symptoms are often as a result of loss of large volumes of isotonic fluid.
Simple Explanation
Not all people who get typhoid look equally sick. Some patients may portray minor symptoms, while others look very ill. While looking at a patient, healthcare provider should be able to identify these symptoms from facial expressions by distinguishes between judgmental facial expressions such as anger or happiness and those made about behavior.
In this regard, proper training of facial coding aligned with a dimensional model of emotions should be encouraged in health professional along with spending more time with their patients to distinguish between their facial features.
Some symptoms such as diarrhea may be omitted by a patient since many may regard it as routine and unnecessary to mention it to the heath provider which may lead to misdiagnosis and improper treatment regimes. Therefore purposeful nonverbal communication and asking thoughtful questions is more likely to improve the relationship between healthcare providers and the patients.
Use of nonverbal communication such as body gestures, positions and facial expressions to convey information requires full attention and minimal distraction from the service provider, as reciprocate of showing caring and empathy to the patient.
It is proven that verbal communication builds relationship and enable people stay together longer. A patient may also gain a lot of knowledge about themselves that may improve interpersonal relationships. Talking to the healthcare provider about your health concerns, how you feel about yourself and how you feel about life, helps a patient heal and accept their condition.
Self disclosure puts someone in a position to see who they really are and binds people together. In addition, every person has their own beliefs, and they are able to reconcile their disagreements with a person they feel close to. Someone may feel unaccepted, your feelings may be hurt and you may feel your relationship is threatened.
To this reason, people need to make their feelings known by revealing and exposing themselves. Often, people who can not express themselves or rather shy individuals experience great anxiety in trying to express themselves.
Conclusively, communication is a complex and challenging process but is still absolutely essential asset for communication and building relationships. One progressively move from being a stranger to being close friends with healthcare providers is essential in improving patient’s health.
People may often feel that disclosing to much information may turn people away. They also have the perception that disclosing premature information to early, their intentions may be misread as an invasion and some may see it as an attack.
Patients often relate their past experiences of telling people very sensitive issues may lead to unfavorable impressions. One patient explained that a person may use information disclosed to them against the individual and we often take risks by sharing personal information with healthcare providers since information shared in a healthcare setting can not be used against them or for blackmail purposes.
Therefore, while self disclosure can be useful in helping patients relieve stress, patients should be educated on the importance of disclosing all their health issues and concerns, how to express their pain using facial expressions and the ability of healthcare providers to keep this information confidential (Donabedian 1988; Mechanic, 1998).
In “Healthcare and Listening: A relationship for Caring” by Brannigan et al, (2008) begin with the statement that the “optimal relationship between healthcare provider and patient is one of trust” (p.168). The authors continue on to explain that this trust relationship cannot exist without effective communication between the doctor and the patient.
Research is also found to support that effective communication practices are key in patient compliance with medical regimens, patient satisfaction, as well as decreasing malpractice lawsuits is found (Morlion et al, 2008).
If the goal of healthcare is what Brannigan et al, 2008) states as one that “…. prevents illness and injury, and help patients and their families manage medical conditions through counseling, medicine and therapeutic interventions” (p.168). Patients must trust their healthcare providers with sensitive, possibly life-threatening or life altering, information.
It is physician’s responsibility to use limited time that they have with the patient to listen and guide the conversation to get to, potentially, the most important information so that a correct diagnosis can be made. Communication becomes the most important element in the patient/doctor relationship (Eggly and Tzelepis, 2001)
A providers’ nonverbal behavior may provide subtle yet powerful messages concerning their perceived efficacy of pain management (Frantsve and Kerns, 2007). They continue that patients may respond to such unintentional “demand characteristics” that physicians may show; especially those patients who are in pain.
The research points out that within the last few decades the relationship between patient and physician has evolved from a parental relationship into a partnership (Eggly and Telesis, 2001). To address this shift, national medical organizations such as the “Accreditation Council for Graduate Medical Education” has put an emphasis on training physicians in more effective communication.
Methodology
The design for the research study uses questionnaire posted over the internet to obtain raw data about listening skills facing young, middle and old aged patients and healthcare providers. Quantitative survey technique comprising of participant observation, and quantitative methods of randomly selecting participants were utilized because they were considered appropriate to the cultural and language differences that exists.
This research was designed in the quantitative genre of data collection as I believe this approach will allow us to obtain a more comprehensive understanding of health issues surrounding the selected group. Our research methodology of using questionnaire helped us gain better understanding on the complexities of social, economic and cultural factors impacting on them.
Quantitative approaches were believed to be appropriate as they are likely to yield more honest opinions in obtaining in-depth understanding of the meanings and events by obtaining raw data from participants. The participants were 108 comprising both male and female who ranged in age 18-60 years and were part of the large study of ability to recognize facial expressions.
Target Population
Target population consists of both male and female of ages 18 to 60. These samples group is aimed at educating the public, patients and healthcare providers (nurses, General practitioners and physiotherapists) dealing with patients with chronic pain on how to recognize facial expressions.
Participants were also selected with regards to; recent history of pain, structural deformity, thoracic pain, systematic unwell and constant progressive, non mechanical pain (chronic pain).
While the focus of this study was on adults alone, a participant of below 15 years was also included to obtain a holistic view of a Lay” person could do WELL in distinguishing facial expressions. The sampling techniques were randomized sampling (Polgar & Thomas, 2008), requesting participants to rate facial expressions and selecting samples to use in the study (Grove, 2007).
Instrument
Pain scale seems like the most appropriate instruments a physician could use to assess patient’s pain. It is performed by having patients rate their pain on a scale of 1(being no pain) to 10 (being of severe pain) as demonstrated in the graphic rating scale in Appendices A.
Pain Scales
Pain scale instrument is commonly used by Healthcare Providers to assess patient’s pain. Brannigan and his colleagues (2008) article on ‘Healthcare and Listening’ stated that “the optimal relationship between the healthcare provider and the patient is one of trust” (p.170). It can not be assumed that effective communication always occurs naturally.
Acquiring effective interpersonal relationship between the service provider and the patient requires observation practice and interpersonal listening skills. This responsibility lies heavily on the healthcare provider. Their primary attribute to providing effective care requires being emphatic listeners as a strategy to understand patient’s nonverbal communication and take the time to observe their communication patterns.
Common problems often experienced in providing effective communication to patients is lack of empathy and understanding of nonverbal signals and communication apprehension on the part of the patient (Bundy, 2001; McCroskey et al,1998).
Testing and Evaluation
First of all, pain face scale should be tested to check the ability of patients learn the basics of the program. For the testing, patients should be invited in the survey room where a healthcare provider explains theoretical material and track the way students accept the information from the pilot training program.
Then, patients will be proposed to fulfill the assignment established by the program creators to check how they understand the facial expressions. Once the practical assignment is completed, patients should be offered to look through other options of the program.
Finally, a healthcare provider should provide with other helpful ideas that might be helpful for patients when living at home. The evaluation of the results should be based on the validity and reliability verification.
Project Location And Duration
The project implementation will be conducted with the help of the hospital facilities for the project managers to accurately test and evaluate the effectiveness of the pain scale instrument. More importantly, as face scale deals with exclusive evaluation of facial expressions, it has the correct training that can work out a consistent plan of publishing program implementation.
The project results are planned to be delivered in three weeks, as the pain scale should be properly tested and evaluated. The operation will be defined into three stages. First, the department should study the main difficulties in handling pain scale that may appear among the patients dealing with this program.
Second, the project team should conduct a research in the field and define what listening skills and technologies will fit best. This stage will take the most of the time allocated for the scheme. Finally, it is necessary to conduct pilot implementation in order to eliminate all possible drawbacks of the program.
Data collection
Participants were required to read the questionnaire carefully and select the picture of the facial expression such as happiness, pain, disgust, fear, anger and sadness that best described the picture provided. Below is a sample of the data collected over the internet.
There are many different pain scales used; however, it is the general consensus that none of them are an adequate source of determining ones “true” pain level.
When pain levels are described to medical professionals they are usually assigned meaning by using verbal descriptors such as “excruciating, unbearable, etc.” At times doctors give examples and patients are asked to choose from those descriptors such as the McGill Pain Questionnaire.
While there are an abundance of appropriate words to describe pain they are not words we use. Therefore it is important that patients and physician’s come to a mutual understand and achieve shared meaning when communicating about pain (Faunce et al, 2006).
Although pain is the most common medical complaint most patients seeking treatment for pain are not chronic pain patients. Chronic pain patients develop a pain vocabulary that is influenced by medical specialist treatment and by exposure to repeated pain assessment measures (GangHeong, 2000).
When dealing with pain it is of vital importance that the provider and patient develop a “shared meaning” of pain descriptors since the medications that are given to deal with pain are very potent and therefore it is important to get a correct diagnosis and for the patient to have a good relationship with their health care provider (Roberts and Bucksey, 2007).
According to Butler and his colleagues (2009) both the VAS and VRS (in appendices) are based on the assumption that people have a “shared” meaning or understanding of pain and its descriptors.
The results of this study did not support this, as hypothesized participants were personalized in their use of pain descriptors and presumably in their understanding of the word as well. Butler et al, (2009) have shown that a valid assessment for pain cannot be developed if people in pain do not have a shared perception of the dimension.
Butler et al (2009) go on to state that caution should be used when relying on the use of word to convey pain intensity. Also words meant to describe only the most acute pain have little understanding when brought together with other pain assessments. When attempting to clarify pain levels in a medical setting more than just relying on VAS or VRS is needed.
Butler and his colleagues (2009)continues to addresses the idea that language and pain are interrelated and that pain can be better understood by the understanding of the language. Since patients and doctors use different descriptors for pain it is difficult to reconcile the descriptors.
Also, since the descriptors for the illness and pain given by the doctors are at times so grave the patient’s initial reaction is not a favorable one. Also it is found that since language descriptors for pain differ from person to person, it is difficult to assign a value to each descriptor.
It is understood that pain caries from person to person so the terminology differs from person to person (GangHeong, 2000; Darmohray et al, 2008; Beckett et al, 2009).
Pain face scales as well as other scales are still under scrutiny for their lack of patient interaction, the scale does not take into account the fact that pain is a very personable experience and must be treated as such (Crichton, 2001).
Future Research and the required Changes in Healthcare
According to Roberts and Bucksey (2007), there have been two significant social changes that have helped put emphasis on the importance of effective communication for healthcare providers:
The first came in 1999 when the Institute of Medicine announced that medical mistakes are not unusual or isolated, rather that they happen everywhere and often. Also they concluded that these mistakes were not minor but deadly.
They went on to say that the disclosed mistakes were only a small sampling handpicked to be given to the public, while the real bulk of the incidents were never disclosed to the general public. Healthcare providers were outrage to have to admit their mistakes and patients were fearful as safety became a national priority.
After panels were put together to as quoted by Brannigan et al, (2008) to “set standards, address safety issues, and review medical errors; it became apparent from the research conducted that poor communication and concealing mistakes were two significant factors that ultimately led to legal recourse” (p.170).
The second problem was the public’s loss of trust, high profile scandals by individuals or groups in power caused the public to be critical to those who were in a profession that was perceived as prestigious (Brannigan et al, 2008.)
In recent years various medical organizations (such as the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education) have begun to emphasize improved training and demonstration of competence in communication skills.
The nursing profession is also beginning to advocate good listening and communication as a quality needed to be a good nurse; skills which one must possess to demonstrate caring to a patient.
The idea that listening is important to be a well rounded medical professional is not a new concept but it is just being framed as a skill and an expectation of a skill that all medical professionals should have the basic concept of(Bundy, 2001; Bennett et al, 2009).
Brannigan et al,(2008) proceeds to say that methods to improve communication and effective listening on the part of the physician have been studied since the 70’s, however the early research focused mainly on the physician’s communication skills, medical skill training communication skills and how the physician performed in clinical encounters.
As studies become more recent they include the elements of empathy, time, trust, malpractice, and patient satisfaction.
The patient can benefit in positive ways from a healthcare provider who is an effective communicator such as the patient’s improvement in emotional health, functional status, and a change in physiological measures, particularly in patients with chronic conditions (Morlion et al, 2008).
Considering the risks involved for both the patient and the physician the importance of effective, thorough, and willing communication and listening goes beyond just a “courtesy” and on to an ethical obligation (Castro-Lopes et al, 2008).
Listening and the sensitivity associated with communication are required by both parties: from patients to provider and from provider to patient. This is an underdeveloped area of communication, according to McCroskey et al (1998), and needs to incorporate considerations of communication and listening is required.
Recommendations
Communication Apprehension and Healthcare
In some cases, lack of good communication relationship between the healthcare provider/patient relationships relies on the patient. The patient can experience what is called Communication Apprehension also known as “CA”. CA is “an individual’s level of fear or anxiety associated with either real or anticipated communication with another person or person’s” (McCroskey et al, 1998).
This is the definition that has been used to describe people who have “CA”, people who are anxious about real or upcoming communication situations. It is clear that this anxiety or “discomfort” caused by the “CA” can cause very real physical effects to the person suffering from the ‘disorder’ (McCroskey et al, 1998).
There are clear indicators if a person is “high CA”. A “High CA” when presented with a situation where they have to communicate will experience the fight or flight syndrome. These are the people that would rather die than speak in public.
These types of people may even have problems with their speech or they may use a high amount of vocal pauses (uum, ya know, ahhh). Others may have a negative perception of these people because of their lack of communication skills.
Because “more talk” is better in the United States, someone with High CA is likely to be considered as a less attractive socially and may seem less desirable to be around just because of their unwillingness to speak up. These kinds of self-crown perceptions tend to affect the patient/doctor relationships.
In some cases, people with high CA may still be apprehensive to speak up when in pain or in the presence of a Healthcare Providers (McCroskey et al, 1998). When the person is having trouble speaking up they can often leave out details that are important to a potential diagnosis or frustrate the physician leading to a breakdown in communication (Bundy, 2001).
McCroskey et al (1998) revealed that trait CA had a small relationship with patient question asking and information seeking. Sate CA had a strong relationship with patient question asking and information seeking. In the health care environment High CA’s are going to ask fewer questions, start fewer conversations, and avoid communicating with their physician whenever possible.
Because in other contexts High CA’s should have more state anxiety when communicating with someone of elevated status such as their physician five more research questions were formed to flesh out the patients fear of communicating with the doctor and the trait and state CA.
A patients fear or anxiety related to communicating with their physician is consistent with the theory that patient apprehension can seriously interfere with the physician/patient communicative relationship and be associated with negative outcomes for the patient.
There are many elements which factor into communicating with the physician, such as disconfirmation communication, language usage, controlling interaction, nonverbal communication, apprehension, trust, and willingness to discuss personal issues. Butler et al, (2009) found that “individuals, who are apprehensive about communicating with a particular person, do not normally initiate interactions with that person” (p.56).
So if you are uncomfortable with your doctor you would not initiate a conversation with him/her about an intimate problem (Eggly and Tzelepis, 2001).
The most effective way to treat chronic pain is through an ongoing, collaborative relationship with a primary care provider or pain specialist. According to Frantsve and Kerns (2007) giving providers communication training can lead to positive outcomes, including greater satisfaction ratings by individuals with chronic pain.
Most patients indicated that they believed that their relationships with providers were better when their providers spend more time with them, at least twenty minutes or more, and displayed a greater amount of interest in their life and issues (Darmohray et al, 2008).
McCroskey and his colleagues (1998) article on effective physician-patient communication identified four communication relationship to include; 1) engagement 2) empathy 3) education and 4) enlisting the patient in the doctor – patient relationship.
They mention communication skills required by doctors to include: 1) active listening 2) eliciting patients’ perspective on illness 3) decoding and responding to patient emotions 4) negotiating treatment plans more effectively
It is clear that communication is a necessity in a good doctor-patient relationship.
The process of communication requires encouraging two way dialogue and establishing partnership between two parties; the patient and the service provider-that creates an atmosphere of caring. This bridges the social gap between the provider and the patient, effectively uses verbal and non-verbal communication and creates a friendly atmosphere that allows a patient to tell his or her story and ask questions.
Pain face scales should be personalized in relation to patient’s educational level and their ability to express their pain and treatment instructions. This can first start by asking a patient to recall or to repeat instructions given to them. This is one way of ensuring effective communication by enabling patients understand their health conditions and available treatment options (Curtin, 1987; DiMatteo, 1994; Hal 1988; Ong, 1995).
The relationship between a patient and a client is one important way of ensuring healthcare providers communicate the outcomes of the patient’s illness. Important aspects to consider when determining communication inter-relationships are educational background, sex, age and ethnicity as earlier stated by McCroskey and his colleagues (1998).
Others factors such as ample time allocated to patient-provider personal contact and privacy should also be considered when identifying characteristics that can improve communication relationships between the two parties. Also, service providers should improve practices in their own settings by adopting behaviors and techniques that could result to increased patient knowledge and effective communication.
It is evidenced that establishing good relationship between healthcare provider and the patient creates an atmosphere of caring and bridges the gap between them. This means that facial expression should be personalized in accordance to the patient’s educational level and ability to understand the technical information.
In this regard, patients and health providers should be able to 1).establish and maintain rapport and trust (care), 2). Diagnose communication and problem solving skills to determine diagnosis and treatment (solve) and; 3).counseling and education (education) (Fallowfield, 1998; Kopp,1989; Levinson, 1995; Roter & Hall, 1991).
The following table provides examples of responsibilities required from both service providers and patients in exchanging factual communication.
Share facts
Share feelings
Service provider
Communicate clearly and accurately on diagnosis and help patient apply the treatment to their own life
Show care by understanding and respecting them
Patient’s responsibility
Clearly description health condition and ask questions where needed
Be honest by expressing expectations and concerns
Two-Way dialogue
Both speak and listen without interruption. Both ask questions, exchange information and express opinions to fully understand the other party. Both relationships should be regarded as partnerships in which both parties strive to maximize the results. The patient should also realize that both parties are responsible for the outcome and their cooperation is highly required.
Disclosing all required information from a patient to determine proper diagnosis and treatment is also of paramount. The service provider on the other hand should have the required skills that will enable him interpret and analyze information received effectively to explain the condition and treatment to the patient.
Bias and Confounding
The problems in collecting data over the internet were summarized as follows; communication issues in the around the world have not been adequately addressed, despite best efforts of number of researchers dedicated to the health and welfare issues of these people.
The quality of the data collected here can not serve as conclusive, this is because a relative small portion of the population was used, and the research used different definitions for pain. There was also a problem in assessing remote indigenous population, hence compromising the results of the study (Valance, 2001, p.1). Therefore, little data collected here can not be relied on for future research.
Since communication issues in respect of listening skills such as engagement, empathy, education and enlisting the patient in the doctor care are increasing at an alarming rate, Valance (2001) suggests that studying the problem more closely with the affected people of the relevant communities is likely to address the problem adequately.
Validity of the Research
This research conducted sought to answer the question, “Can pain faces be distinguished from other emotional expressions-such as happiness, disgust, fear, sadness, surprised and anger?” This research principle is founded on two principles;
Patients people have different cultural and language background—which required the researcher to develop models of inquiry
Any attempt to solve problems on middle-aged population will be done in partnership with the consent of the communities surrounding them.
Quantitative research methodology used in this research provided a better chance of identifying the nature of the problem because the sampling strategies are better suited in dealing with small samples.
It also equipped the researcher with considerable knowledge of the population to be studied contributing to the validity of the results. Internet questionnaire were well guided, informed and driven by personal experiences. Also, the time allocated before the study commenced helped the researcher gain more understanding of health problems facing the world at large.
To ensure the middle aged and the old population are able to have a say, equal opportunity in the research study and design was responsive to the needs of the population under study.
The need for ongoing health campaigns of the communication skills should be provided and extended to the community, schools and preschools. Health related promotional activities should be encouraged to minimize occurrence of pain complains.
Results
The systematic reviews were identified using the internet and survey monkey database. Pain scales used the grading was simple and easy to apply and showed a large degree of consistency between the grading of the patient that of the health provider, diagnosis and treatment.
Patients of ages 51 to 60 of Caucasian, Black/African American decent and Asian origins with average income mostly identified the same facial expression with regards to happiness, sadness, surprise, anger, disgust, disgust and pain. Also, participants of ages 28 to 30 with high income responded well to nonverbal communication signs compared to those of below 15 years.
A set of questions were drawn in English language to guide participants and to ensure consistent information was gathered. The iquestionnaire protocol covered the key information area (facial expressions), including opinions on intervention services of the same to uncover their thoughts, perceptions and feelings.
The questions were structured in a culturally sensitive manner, using their own language to obtain raw data from participants. In a research sought to measure the occurrence facial expressions on day to day activities, as a strategy to identigy the service gaps regarding health issues within the healthcare profession.
Conclusion
It is clear that understanding and further research in listening skills knowledge will assist in the communication of pain descriptors and putting at ease the patient in the treatment of pain. What is most needed is for all those involved in Healthcare to understand the listening process as well as having a basic understanding of how to read nonverbal signals.
Having this skills along with that of empathy, will empower the healthcare provider to offer a more complete treatment plan to those who they treat and will allow them to see those that are in pain more clearly.
This research has provided a set of principles that should be used in the training course to improve listening skills. The three process of communication; caring, diagnosis and problem solving and education of patient-provider provide attention to the most important aspects of healthcare.
These processes combined with proficiency in providing health services and appropriate diagnosis and treatment when effectively applied results to better outcomes for the two parties. Emphasizing listening skills, nonverbal aptitude, and empathy, is not a new attitude in the healthcare setting but as seen it is one that is still lacking emphasis.
It is proven that verbal communication builds relationship and enable people stay together longer and improves interpersonal relationships. Patients should be educated that by talking to healthcare providers about your health concerns, how they feel about yourself and how they feel about life, helps them heal and accept their condition. Self disclosure puts someone in a position to see who they really are.
Healthcare providers should on the other hand learn and understand each patient’s beliefs and cultures. As the objective of this paper strives to improve listening skills and the facial exercises, references used here will provide opportunities to accomplish these goals.
Healthcare providers have their own clinical language that requires use of technical words that enable them communicate to each other which may be complex when used with patients.
In some instances patients can also speak in their own dialects and slang, which makes it difficult for a health provider to comprehend. But with a little training a Healthcare Provider could be able to distinguish distinguishes between two different types of judgments; pain expressions and emotional expressions.
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The present paper is devoted to the comparison of the healthcare systems of Germany and the US. Both are federative countries that have states (provinces in Germany) with a certain level of autonomy (Mossialos et al., 2014). Naturally, their sizes are not comparable (80 million people in Germany versus 270 million people in the US), but they also have other similarities.
In particular, they are both developed, industrial G8 countries that are moving in a similar direction concerning healthcare (Ridic, Gleason, & Ridic, 2012, p. 117). As pointed out by Ridic et al. (2012), Germany has moved further, which implies that its experience is of particular interest to the US (p. 114). In this paper, an attempt at illustrating this opinion will be made, and several aspects of the healthcare systems of the two countries will be compared and contrasted to extract possible insights and lessons.
Healthcare System Overview
The current healthcare system of Germany is based on its historical predecessor, the expansion of the “mutual aid societies,” which had been operating since the beginning of the 19th century, by the country’s first counselor, Otto von Bismark (Ridic et al., 2012, p. 114). Health insurance is mandatory in Germany, and there are two options: public (statutory) health insurance (SHI) and private health insurance (PHI).
Those who do not earn over €4,462.50 cannot opt for private insurance. There are over 130 statutory and 43 private insurers in the market that compete for customers (Mossialos, Osborn, Anderson, & Wenzl, 2014; Ridic et al., 2012). The majority of decisions and regulative activities are carried out by healthcare and insurance providers’ associations. They also regulate prices, determining the maximums to avoid their uncontrollable growth (Busse & Blümel, 2014; Mossialos et al., 2014).
In the US, the major legislative change of the past years, the Patient Protection and Affordable Care Act of 2010 has resulted in a noticeable increase in the covered population (Lovett-Scott & Prather, 2014). Despite this, in 2014, over 50% of adults were using a form of private insurance (including employee-based), and over 13% of adults remained uninsured (Mossialos et al., 2014, p. 6).
The US healthcare insurance benefits vary in federal programs; also, the states can introduce specific plans and policies. APA’s goal is explicit: to provide affordable care to everyone, which implies national coverage. As a result, it can be concluded that the US is indeed moving towards the goal that Germany has already achieved, which implies that the former can get some lessons from the latter’s experience (Ridic et al., 2012).
In the US, the key federal bodies are the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services. There is less price regulation, and, as a result, the prices for healthcare in the US are noticeably higher than in other developed countries (Squires & Anderson, 2015).
Healthcare Spending
The US healthcare spending is almost notorious: it is the highest in the world if the per capita indicator is considered (Mossialos et al., 2014). The spending had decreased in the aftermaths of the recession of the year 200-2009 together with that in other countries all over the world (Squires & Anderson, 2015). However, in the US, the expenditures are expected to keep increasing in the next years to constitute 19.3% of the gross domestic product in 2023 (as compared to 17.2% in 2012) (McCarthy, 2014).
Apart from the high prices, the figure can be explained by the extensive use of modern technology in US healthcare (Ridic et al., 2012). Unfortunately, though, the immense spending does not result in corresponded improvement of life quality and span with few exceptions like cancer (Squires & Anderson, 2015, p. 2). This fact indicates that spending is ineffective.
Germany has an average healthcare spending when compared to other industrial countries; in 2014, it constituted 11% of the gross domestic product, which was comparable with those of France (which, as stated by Lovett-Scott and Prather (2014) has the most admired healthcare system in the world), Denmark, Japan, and Switzerland; it was lower than that of the US by 5% (Mossialos et al., 2014, p. 7).
Vulnerable Populations
In the US, Medicare and Medicaid are meant to provide insurance for the elderly, disabled, and poor. There are also miscellaneous systems of subsidies, cost-sharing discounts, and exemptions that are created through federal and state programs.
In Germany, the specific payment for a person is calculated while bearing in mind the income, age, and dependants; there is a limit for maximum costs (no more than 2% of a household income), and it is lower for the chronically ill (Mossialos, Osborn, Anderson, & Wenzl, 2014; Ridic et al., 2012) There are similar maximums for the US insurance, but they are measured in dollars, not household income percent, which is why they might be less effective (Mossialos et al., 2014, p. 6).
Mental Care
In Germany, mental care is also financed by SHI; it is typically carried out by mental health specialists, although some non-acute cases, especially in rural areas, are treated by physicians (Mossialos et al., 2014, p. 66). In the US, insurance plans to cover treatment, drugs, emergency care and may include other benefits for mental patients (Mossialos et al., 2014, p. 156). In both countries, mental care had been developing slower than that for psychical diseases, which is why there is still some work to be done to improve its integration.
Conclusion
In general, the health disparities, which are a global issue (Busse & Blümel, 2014; Lovett-Scott & Prather, 2014), are regarded as national healthcare issues and are actively addressed by the US and Germany (Mossialos et al., 2014). Apart from that, the areas of healthcare that are specifically concentrated on are also similar for the countries and include women’s health, disease management, lifestyle issues, and continuous quality improvement.
Emphasized Aspects of Healthcare
Women’s Health and Maternal Child Health
The issues of maternal and child health are included in the federal healthcare goals of both countries (Mossialos et al., 2014). However, the outcomes differ: for example, the maternal mortality ratio has been steadily but slowly decreasing in Germany in the past two decades, while in the US it has been slightly growing (Kassebaum et al., 2014, pp. 9, 11). Also, the decrease in the rate in Germany does not live up to the Millennium Development Goal of 75% reduction. It can be concluded that there is room for improvement in this respect in both countries.
Disease Management
In Germany, the Robert Koch Institute is the body that is in charge of infectious disease control (Mossialos et al., 2014, p. 69). There is a variety of Disease Management Programs that are deployed in Germany for particular diseases (for example, diabetes or HIV) (Busse & Blümel, 2014). These programs are approved and accredited, and then insurance companies can offer them to patients.
In the US, the CDC performs the function of the major disease management body (Mossialos et al., 2014). Among the initiatives that are aimed at disease management in the US are the Healthy People, which defines benchmarks for the improvement of various disease and other health indicators (for example, smoking) for a particular decade (Lovett-Scott & Prather, 2014).
Theory and Practice of Health Promotion
In Germany, the theory of health promotion employs the idea of care integration, healthcare technology used, quality management and clinical government, continuous education for healthcare staff, and specific guidelines for drug assessment and procedures evaluation (Mossialos et al., 2014). There is a system of 182 indicators that all the hospitals are supposed to report and publish. The Robert Koch Institute coordinates reporting, conducts surveys, and provides publicly available datasets on healthcare and health indicators.
In the US, the key health promotion bodies include the Agency for Healthcare Research and Quality (AHRQ) and the NIH. Besides, the Food and Drug Administration promotes health through its control over the quality of foods and various drugs and medical equipment. The US also adopts the ideas of quality management and care coordination and conducts comprehensive activities in research and implementation of quality improvement strategies through AHRQ, NIH, and the Institute of Medicine (a non-profit independent research organization). As for care coordination, it is being improved through the grand Accountable Care Organizations project, which presupposes the creation of networks of health care providers who are “accountable” for a particular population.
Concerning the practice and outcomes of the healthcare systems, it is impossible to define which of the two countries performs better. For example, the avoidable death rate is the lowest in Germany when compared to the majority of industrialized countries and the highest in the US.
However, some of the quality performance indicators (for example, breast cancer survival) were lower for Germany in 2014, and its immunization rate was low when compared to other industrialized countries (Mossialos et al., 2014, p. 8). It can be concluded that both countries have room for improvement concerning the quality of care, but in certain areas, their performance is exceptional.
Behavioral and Lifestyle Factors
Smoking and alcohol intake, unhealthy dietary choices and lack of exercise remain an issue for both countries since they are a preventable cause of diseases (Busse & Blümel, 2014; Lovett-Scott & Prather, 2014). Also, both countries include the promotion of a healthy lifestyle as a part of disease prevention measures (Busse & Blümel, 2014; Mossialos et al., 2014).
Their activities yield results: for example, the alcohol intake rates in the US and Germany are much lower than in Russia (Lovett-Scott & Prather, 2014, p. 257). However, the US has a serious obesity problem, which indicates lifestyle issues with its obesity rate being 30% (12% in Germany) (Lovett-Scott & Prather, 2014, p. 289).
Conclusions
From the analysis presented above, it is apparent that the US and Germany attempt to provide the population with healthcare in similar ways by paying the attention to similar aspects (maternal health, quality improvement, and so on) and deploying similar policies (for example, decentralization or the diversity insurance types).
Also, both countries demonstrate good performance in some areas and require improvement in others. However, the recent developments in the US healthcare legislation show that the country aims for national insurance. As a result, the experience of Germany that has already achieved this outcome is of particular interest for the US, especially since the two countries are similar in other aspects, in particular, economic and political. Possibly, by analyzing the example of the other country, the US will be able to avoid its mistakes and perform better in the areas where Germany requires improvement.
References
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Prophylaxis refers to therapeutic or community healthiness procedures carried out with the aim of putting off, as opposed to offering treatment or restoration to health of an existing condition (Community-Based Prophylaxis, 3). Prophylaxis is as well a means to curb an outbreak of infection, or reduce the signs of a person who has had exposure to an infection or germ.
Principal prophylaxis involves any procedure that is carried out to put a stop to infection prior to its occurrence. An appropriate illustration of this is having one’s teeth proficiently cleaned by a dental practitioner. This exercise goes a long way in putting to a stop bacterial plaque, tooth rot, and gum infection.
Resulting prophylaxis involves measures that help put a stop to contagion following contact with an infection, or to play down signs linked with a sickness or fitness state. For instance, if a medical practitioner gets infected with the HIV/AIDS virus, they will take an antiretroviral medication to assist them keep contraction of the ailment at bay.
Immunizations are an appropriate case in point of prophylaxis. Vaccinations are used to make certain that the receiver does not catch a given ailment, for that reason doing away with the likeliness of a requirement for therapy later in life.
On a broader extent, urgent situation preparedness is a further type of prophylaxis. In view of the fact that epidemics can come about in devastating circumstances, being geared up for such an occurrence reduces the requirement for ultimate cure.
Condoms are branded as prophylactics since they help put a stop to maternity and the transmission of sexually transmitted infections (STIs). Antibiotics are in given times utilized as prophylactics when the affected role has got contact to an ailment or germ such as anthrax, to minimize the signs or secondary effects from the contact.
Anticoagulants are administered to those persons who are ill with heart and blood vessel ailment(s). In most times these patients take a day after day prescribed amount of acetylsalicylic acid in the type of over the counter medications. These medications assist in thinning of blood and as a result lessens the danger of blood coalesces that leads to heart attack or stroke.
Every therapeutic field one can consider makes use of prophylaxes. Cosmetic general practitioners administer medications to their patients to assist keep at bay deep vein thrombosis (DVT). This is a possible danger with any superficial surgical procedure. Exposure to radioactive substance for cancer sufferers is regarded as prophylaxis.
Even the persons who carry out homeopathy and substitute medication have an assortment of types of prophylaxes that they utilize in providing treatment to sufferers (Community-Based Prophylaxis, 6). Prophylaxis can make reference to a far-reaching regime of medications and therapeutic measures, or it can be as straightforward as using an antibacterial mist on an injury to hasten curing and put a stop to contamination.
Mass prophylaxis
Mass prophylaxis refers to the capacity to save from harm the healthiness of the populace by means of administration and effective management of important interventions in reaction to a community health urgent situation in a bid to put off the buildup of infection amongst the persons who are uncovered or are potentially uncovered to community health dangers.
This ability takes account of the availing of suitable go through and keeping an eye on undesirable occurrences, not forgetting risk announcement subject matters to tackle the distresses of the community (Mass Antibiotic Dispensing). Mass prophylaxis can take place at the local, regional, state, or federal levels.
Is there a level where mass prophylaxis is more effective than the others?
The not long ago anthrax attacks in the United States and other assaults like 9/11 and destruction as a result of Hurricane Katrina and the corresponding measures serve as the best grounds on which to get answer(s) to this question. To face up such tests one has to be aware of performance necessities for a most important occurrence at the duty stage and make and uphold the abilities to carry out those duties.
What took place from the above mentioned cases showed that watchfulness for major occurrences has to engage all echelons of the administration (National Incident Management System). That means the local, regional, state and federal levels play equally significant roles in the undertaking. The private sector, non-governmental entities and the general public also need to chip in for success to be realized.
Effect
Proper medicine prophylaxis and immunization approaches are put into operation in a well-timed method in the lead to the commencement of an occurrence to put a stop to the progress of ailment in exposed persons. Community information approaches take account of proposals on detailed measures people can take to save from harm their relations, acquaintances and themselves.
Contribution by all levels to offer desired results
What is required in such an arrangement is a nation geared up with harmonized abilities to put a stop to, save from harm, act in response, and pull through from all dangers in a manner that steadies threat with the available resources and requirements. For this to be achieved, the course(s) of action has to come up with precedence to meet the needs at hand. To begin with area group effort has to be spread out in order to reach as many people as possible, if not all.
This needs to start at the local level. With such an arrangement in place it then becomes easy to put into operation the national incident administration scheme and the national reaction arrangement, among others. While this is taking place it needs to be ensured that information distribution and group efforts are made stronger (Hupert, 17).
With this then medicinal surge can be built up together with mass prophylaxis abilities. Once all the above has been done then the reinforcement of planning and population watchfulness abilities automatically falls into place. Achievement is delivered by suitable arrangements of scheduling, categorization, apparatus, instruction and workouts.
All the stakeholders have to be involved at all levels if the desired results are to be achieved. They have to be involved right from the start, that is, in drafting of the course of actions to be followed. Chipping in can be done through nationwide stakeholder forums, operational organizations and the private division.
Defining the Capabilities
The abilities are obtained from a hazard and operation scrutiny. The foremost step should be finding the response to the question ‘how prepared does the given entity need to be?’ This means there has to be the variety, capacity, enormity and difficulty of the situation to be tackled.
Operation breakdown has to be worked out in order to offer a general idea of all the significant roles connected to attainment of the desired outcome. It is there to make sure that awareness undertakings are centered on task accomplishment (Emergency Management Accreditation Program Standards).
The nationalized scheduling situations are there to serve as the ground for classifying roles that may be essential to effectively put a stop to, guard against, act in response to, and pull through a broad array of dangers and risks, also the abilities required to carry out the assignments.
From this it is clear that whoever is keen on isolating the federal and carry out the exercise at the local, regional, or state level is going to miss out on a very important matter. As a result there needs to be a collective assignment list where assignments that needs to be carried by various stakeholders as the administration, non-governmental, private and the public are catalogued.
For such an exercise to be successful, it has been shown that no single authority or organization should be anticipated to carry out each assignment identified and no two entities need matching height of abilities. This is further proof that all levels have to work hand in hand, that is, local, regional, state, and federal levels.
The reality of the matter as regards to federal priorities is that they are subject to be altered together with their sustaining plans. This occurs whenever there is a surfacing intimidating situation and struggle for limited resources. As a result, mass prophylaxis will suffer a setback if it were being carried out at the federal level minus involvement of the other levels.
Alteration of plans by one level will not bear negative consequences in a case where all levels are involved as one or more of the other levels will chip in to accommodate such changes. What’s more, divisions of roles to be worked out are normally decided on considering definite tasks, assignment, purposes, and the suitable echelon of abilities will rely upon risk and requirement when all the levels are involved.
One of the main roles of the federal entity is to make available a guide for establishment of a lead for coming up with a nationalized system of capabilities that will be at hand at the moment and place where required in order to put a stop to, guard against, act in response to and pull through major occurrences.
On the other hand, if such a duty were left to say the local level, then it would prove to be an uphill task to come up with the required results (Incident Communications Emergency Plan). However, when the state has come up with the guide and definitions for the entire task at hand, then lower levels can comfortably chip in. In addition, it will be a problem for the lower ranks to carry out their assignments if in the first place they are not adequately defined.
In this spirit, the federal level has to craft an objective abilities catalog(s). This is a reference draft that illustrates the abilities for attaining comprehensive watchfulness. It also steps in as a scheduling, evaluation and workout tool. The list has to fully cover the areas discussed below for satisfactory results to be attained.
Risk evaluation is the foremost of these items. The definition of risk takes account of recognition and categorization of dangers, their end results, and the populace’s susceptibilities.
With each of these being vital for abilities-based scheduling and national watchfulness, establishments of susceptibility are vital as they consist of not only contact and predisposition, but toughness. Hardiness is a major aspect as it refers to the populace’s dealing with capability to soak up occurrences, become accustomed to, act in response to and pull through its affects.
The next item is planning and is devised to set up and uphold the capacity to build up, bring up to date, and experiment strategies. What’s more, each item is normally full of both watchfulness and performance roles and procedures that back up the ability result and act as a lead for watchfulness scheduling.
The watchfulness assignments and procedures illustrate most important aspects or matters that should be taken in hand in strategies, events, and schemes, as well as administrations, interactions, and accords that need to be in place to get geared up to utilize the item. The performance assignments and procedures as well enlighten the scheduling procedure.
The next stage involves crafting of lines of attack to tackle the issue at hand and validation of the venture. Normally, the general structure presented by the instructions, priorities, and abilities serve up as a lead to improve mother nation defense policies and venture rationalizations at all echelons.
Evaluation of watchfulness is vital and needs to be carried out. A well researched catalog should be in a position to offer a ground for evaluating watchfulness to assist authorities and societies to prepare tactically, draw suitable plans that satisfy verified requirements, and assess the efficiency of ventures over time.
Emphasis should be laid on duty performance. Training agendas need to be adjusted as proper to make certain that they offer partakers with understanding, technique, and capabilities to carry out the most important duties defined by the list of activities to be worked out (DHS, Office for Domestic Preparedness). It is vital that these duties are worked out to an aptitude level adequate to attain the competence end result(s).
Assessment of abilities needs to be carried out through work outs. Such work outs offer a way to assess and authenticate watchfulness. For instance in the United States, the Homeland Security Exercise and Evaluation Program, popularly referred to as HSEEP is intended to egg on a universal exercise plan, carry out, and assessment line of attack crossways all echelons of the administration and private sector.
The duties of this body are intended and assessed to show capacity levels by means of evaluation of performance of decisive duties and attainment of results, as laid out by the list of tasks to be accomplished.
Hypotheses required for prophylaxis to be carried out successfully
For such an exercise to be worked out fruitfully, there are assumptions which all partakers and especially at the federal level need to bear in mind. The first is that the requirement for prophylaxis can come about at any moment with little or no notice at all.
What this basically means is that all the levels right through from the local, regional, state and federal have to be ready for such an eventuality(s). This means coordination between the various levels can be easily achieved to attain the desired result(s).
Giving out as much information as possible as relates to the matter at hand is very vital. This has to apply at all levels for effectiveness of the exercise. Again, this should take place at the off the record and unclassified stages crossways various authorities and among the civic and private sectors (Centers for Disease Control and Prevention).
The exercise has to engage solitary or several geographical regions. With this in mind then it again calls for collaboration between the various levels of society for effective outcome(s).
It is important for the partakers in such an undertaking to have it in mind that whatever is being carried out has may bear noteworthy global affect and/or may require considerable global data giving out, resource harmonization, and/or backing.
As the world is today there are some nations that are more advanced in one sector or another than others. As a result, if a nation is well endowed in knowledge and expertise in what some other nation requires, then the two have to work out a compromise on how to assist the one in need.
Carrying out of prophylaxis effectively can stretch the field of occurrence supervision to take into account putting a stop to, defense, reaction and resurgence.
The exercise also engages numerous, very much wide-ranging risks and dangers. As such all the partakers at all levels have to take precautionary measures to keep out of harm’s way. Carrying out prophylaxis may end up in several injured persons, losses, dislocated people, and loss of material goods, interference of regular living prop up structures, vital public amenities, and fundamental infrastructure. There might also be the occurrence of considerable harm to the surroundings.
The exercise may affect vital infrastructure crosswise sectors. It also has the capacity to overcome abilities of federal, state, regional and local administrations. The same may also apply to the private sector resource holders and operatives.
It is also noteworthy to assume that prophylaxis may be a magnet for an incursion of spur-of-the-moment unpaid helpers and provisions (Receiving, Distributing, and Dispensing Strategic National Stockpile Assets). The exercise may also call for short-notice positive feature harmonization and reaction. It may also call for long-drawn-out, continued event running actions.
Community preparedness and chipping in
It is now clear that all the administration levels in any given country or nations have a role to play in effective implementation of prophylaxis. The local community is also very important and efforts need to be geared to ensuring that all persons are wholly awake, educated, and trained on the way(s) in which to put a stop to, safeguard against, get ready for and react to all dangers.
As a result, it is vital for the whole populace to have a duty in individual awareness, trainings, and continuing volunteer curriculums and rush forward competence reaction. Detailed capacities for general awareness, together with understanding of all risks (scientific, ordinary, and rebel occurrences) and associated defensive procedure, techniques, and provisions should be able to be settled on by the locals by means of a joint procedure with urgent situation respondents.
Consequently, there needs to be a framework and a course of action for continuing group effort between government and nongovernmental resources at all echelons.
The outcome of this should be that volunteers and private sector contributions are slotted in policies and work outs, the populace is informed and skilled in the key assignment areas of awareness, and they take part in volunteer undertakings and offer capacity back up (Hupert, 25). Such preparedness will also ensure that private resources are administered efficiently in catastrophes and there is a provision in place to assess advancement.
Moving forward – improvements to any form of prophylaxis capabilities list
The capabilities list stands for a most important footstep toward being prepared and effective application of mass prophylaxis. In instances where values and guiding principles are real, they have to be used, although standards and guiding principles may not be real for a lot of these capabilities.
As a result, a good deal of the information in the capabilities catalog is to be founded on the best decision and know-how of the persons who took part in drafting it and those who analyzed and made comments on it.
The capabilities list is therefore a vital document that has to be devised so that it can be added to as time goes by as stakeholders gain knowledge form its function and relevance in the practical arena (Emergency Management Accreditation Program Standards). The most excellent way through attaining this is by utilizing it and making out and highlighting where it requires alteration.
For instance, one needs to find out whether there exist urgent tasks that have to be incorporated or improved. Whether there are standards to gauge performance, if these standards need adjustment such that they can fit in various situations or levels and whether there are enough resources t the given level and task at hand are some of the other questions partakers need to ask themselves.
Another important thing to find out is whether the goals and duty responsibility for drafting and holding up offer the set of connections of capabilities that will be offered at the time and place they will be required. Partakers have the duty to assist change anything that they see that will not work for their field.
Works Cited
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Community-Based Prophylaxis. “A Planning Guide for Public Health Preparedness.” Weill Medical College of Cornell University, Department of Public Health. (August 2004).
DHS, Office for Domestic Preparedness, Metropolitan Medical Response System (MMRS) program. (2006). Web.
Emergency Management Accreditation Program (EMAP) Standards. (September 2003). Web.
Hupert, Nathaniel. “Modeling the Public Health Response to Bioterrorism: Using Discrete Event Simulation to Design Antibiotic Distribution Centers, in a September-October 2002 supplement to Medical Decision Making (Med Decis Making 2002:22(Suppl): S17-S25).” (2002).
Incident Communications Emergency Plan. ICEP–2004. “U.S. Department of Homeland Security.” (2004).
Mass Antibiotic Dispensing: A Satellite Web Cast Primer. Centers for Disease Control and Prevention. (June 2004). Web.
Mass Antibiotic Dispensing-Managing Volunteer Staffing. Centers for Disease Control and Prevention. (December 2004). Web.