Code Blue Health Science Edition Four The Board Chapter 2
Topics Covered in Chapter 2 • The beginning chapters of Code Blue focus on some of the administrative issues facing a community hospital. • Medical and technical issues will be addressed in more detail in subsequent chapters.
Topics Covered in Chapter 2 Since most health occupations students are looking for careers outside of administration, some wonder why it is important to understand the business side of hospitals and other healthcare organizations.
Why Study Administration? Nurses, doctors, respiratory therapists, and so on do not operate in a vacuum. It is necessary to work with and relate not only to other departments, but also to the administration of the hospital.
Why Study Administration? Many students may become department supervisors and must, therefore, work with administration in preparing budgets, hiring and firing employees, and in managing the department.
Why Study Administration? Some students may eventually move into administration as the hospital administrator or assistant hospital administrator.
Why Study Administration? Since the mid 1960’s, hospitals have increasinglybeen managed by administrators with backgrounds in business, rather than patient care. While this has made hospitals more cost effective, this increased efficiency may have come at a cost.
Why Study Administration? The health care industry is currently undergoing a major redesign. If the healthcare industry is to regain its focus on quality, compassion, and accessibility, clinical personnel must assume a greater role in the planning and implementation of the new programs that will be needed to meet the healthcare demands of today.
The Characters • Edward Wycoff—chairman of the finance committee • What kind of person is Edward Wycoff? • Dr. Ashton Amos—Newly elected president of the medical staff • What kind of a person is Dr. Amos?
Board of Trustees • The highest governing body in the hospital • Functions: • Hires and fires the hospital administrator • Approves the annual hospital budget • Approves the annual strategic plan • Appoints doctors to the medical staff • Approves physician privileges (procedures physicians are allowed to perform)
Executive Committee • Conducts business on behalf of the board between board meetings • Membership: • Chairman of the Board of Trustees • Hospital Administrator • President of the Medical Staff • Chairman of the Finance Committee
Finance Committee • Advises the board on financial matters • The budget • The accounting system • Financial reports • Edward Wycoff is chairman of the finance committee
Medical Staff • Consists of all physicians who practice medicine in the hospital • Dr. Ashton Amos has been elected president of the medical staff. • He represents the interests of the medical staff to the administrator and the board of trustees.
Hospital Departments • Hospitals are grouped into departments. • Examples include: surgery, administration, nursing, radiology, laboratory, housekeeping, finance, etc.
Department Heads • The supervisor of a department in a hospital is referred to as a department head. • Department heads report directly to the hospital administrator, or,in the case of larger hospitals, to an assistant administrator.
Other Terminology • Attending Physician: The physician who is in charge of a patient admitted to the hospital.
Other Terms Used in Chapter 2 • Prospective Reimbursement: This is an important principle that we will discuss in some detail later in the book. • It has dramatically changed the way that medicine is practiced in the United States. • It is also one of the reasons Brannan Community Hospital is in financial trouble. • For the time being, that is all we need to know about the topic.
Other Terms Used in Chapter 2 • Dietary Department: The department that plans and delivers meals to hospital patients. • Chief Dietician: The head of the dietary department. • Dietician: An individual trained in the practical application of diet in the treatment of hospital patients.
Career Opportunity • There are good career opportunities for those interested in hospital dietetics. • A number of universities offer degrees for hospital dieticians.
Other Terms Used in Chapter 2 • Double Bypass: An operation where two veins or internal mammary arteries are grafted between the aorta and a coronary artery branch to shunt blood beyond an obstruction.
Other Terms Used in Chapter 2 • Coronary Care Unit (CCU): The medical unit where patients with coronary (heart) diseases are treated and housed.
Other Terms Used in Chapter 2 • Critical Condition: The most serious classification of patient illness.
Other Terms Used in Chapter 2 • Emergency Call: Physicians at some hospitals are required to provide coverage of the emergency room. • These hospitals do not have full-time emergency physicians. • When a patient presents himself (or herself) at the emergency center, the doctor is called to the emergency center.
Other Terms Used in Chapter 2 • Life Flight: InCode Blue, a helicopter that transports patients from an accident to a hospital, or from a hospital to a more specialized hospital.
Other Terms Used in Chapter 2 • Managed Care: A philosophy and system of reducing healthcare costs. • MBA: Acronym for Masters of Business Administration – a general master’s degree in business. • Medicare: A Federal program to pay for healthcare costs of certain groups, including those 65 years of age or older. • Payer: The individual or organization that pays the healthcare bill. Insurance companies, Medicare and Medicaid are payers.
Other Terms Used in Chapter 2 • President of the medical staff: An individual elected by the medical staff to represent them to administration and the board.
Other Terms Used in Chapter 2 • Rounds: InCode Blue,a morning visit by a physician to his or her patients within the hospital. The term originated at Johns Hopkins Hospital, where all patient wings radiated off a central, circular hall.
Other Terms Used in Chapter 2 • Transportation Aide: An individual who is responsible for transporting food, supplies, and/or patients throughout the hospital.
Power and Politics • In this chapter, we learn the reaction of the board to the death of the hospital administrator. • We also are introduced to power and politics in the hospital. Financial problems facing the board are also briefly discussed.
Power and Politics • Selecting a new administrator may be a difficult task. • The board of trustees has at least the following five options:
Option 1 • Select an administrator who has been formally trained by an accredited program in healthcare administration and has prior experience in hospital management. • If the board of trustees of Brannan Community Hospital selects this alternative, they will not be able to fill the job immediately, since most experienced hospital administrators must provide several weeks notice to their current employer.
Option 2 • Select someone who has business experience, but no hospital experience, perhaps a local businessman or businesswoman. • The problem with this alternative is that the issues involved in running a hospital are very different from those involved in running a retail, manufacturing, or construction firm. By the time the new administrator learns the rules, the game may be over.
Option 3 • Choose someone from within the hospital to succeed the old administrator. This individual would have the advantage of understanding the problems of the hospital. • Department heads don’t always make the best hospital administrators, however. Many come from technical backgrounds and are inadequately trained in administration or finance.
Option 4 • Recruit a local physician to fill the job. • A non-competitive salary and a lack of business training are the major problems of this alternative.
Option 5 • Select an interim administrator to guide the hospital through the current crisis and provide the board of trustees time to find a permanent replacement. • The advantage of this alternative is that the hospital will have someone immediately to address the financial problems the hospital is having. • The disadvantage is that the interim administrator might not be as qualified as a permanent replacement, and the hospital staff will have to adjust to two administrators (the interim administrator and the interim’s replacement).
Discussion Question 1 What are the advantages and disadvantages of selecting an interim administrator to run Brannan Community Hospital?
Discussion Question 2 • Why did Edward Wycoff summon Dr. Ashton Amos to discuss the appointment of a new administrator prior to the board meeting? • What does Wycoff want from Amos? • Why did Dr. Amos agree to Wycoff’s proposal?