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173 Cards in this Set
- Front
- Back
the U.S. does not have a health system, instead we |
have hundreds of thousands of health care providers and insurers providing health services in an uncoordinated manner (both private and public)
leads to inefficient delivery of care and higher costs as well as inconsistent care due to fragmentation |
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why does the U.S. not have a health system |
1.) no systematic policy approach to health care delivery 2.) multiplicity of financial arrangements and payers 3.) large array of settings where medical care is provided 4.) organization developed organically over time - (1) U.S. cultural values, (2) political realities, (3) incremental legislation |
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National Health Expenditures per Capita
1960-2013 |
1960 - 5% 1970 - 7% 1980 - 8.9% 1990 - 12% 2000 - 13.4% 2010 - 17.4% 2013 - 17.4% |
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U.S. is higher than any other country in |
health expenditure per capita |
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the U.S. spends |
2.5 times more than any other country on health care, but don't have the highest life expectancy |
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Life expectancy in 2010 for U.S. |
78.7 years
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health care spending per person GDP |
$8,233
Canada is next, then Sweden, United Kingdom, Japan, Mexico |
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health care prices compared between U.S. and other countries |
angiogram, colonscopy, hip replacement, lipitor, MRI scan are all higher than Canada, Switzerland, Spain, New Zealand, and Netherlands |
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why is the U.S. healthcare so expensive |
1.) profit driven providers (move from non-profit to profit) 2.) pricing schemes and insurance 3.) misaligned financial systems leads to over utilization of testing, drugs, procedures, etc. 4.) acute care focused (instead of prevention) 5.) administrative costs - many layers of overhead due to our insurance/reimbursement mechanisms |
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distribution of National Health Expenditures by Type Service in 2010 in billions |
1.) hospital care - 31.4% 2.) physician/clinical services - 19.9% 3.) other health spending - 15.7% - admin costs 4.) other personal health care - 14.8% 5.) prescription drugs - 10% 6.) nursing care and retirement - 5.5% 7.) home health care - 2.7%
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most European and Asian countries have some kind of |
national health care system |
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3 common types of health care systems |
1.) publically financed, privately delivered national health care system (Canada) 2.) publically financed and delivered national health systems (Britain) 3.) socialized insurance system with mandatory contributions and private delivery (Germany) |
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Medicaid was enacted in |
1960s |
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type of health insurance design relates to key issues for patients: 7 |
1.) affordability 2.) differences in access by income level 3.) availability of services 4.) waiting list/wait times 5.) choice 6.) complexity of interacting with insurance system/paperwork 7.) patient satisfaction |
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iron triangle of health policy |
1.) access to care 2.) cost 3.) quality |
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access |
the ability to use or access needed, affordable convenient, acceptable, and effective personal health care services |
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key barriers to access: 4 |
1.) lack of health insurance 2.) inadequate health insurance 3.) insurance coverage limitations 4.) workforce issues |
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health care access - uninsured and underinsured key characteristics: 6 |
1.) poor 2.) low education 3.) non-native 4.) racial/ethnic minority 5.) location 6.) age |
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problems with being unisured: 4 |
1.) less access to care 2.) less timely care 3.) less likely to follow treatment 4.) recommendations due to cost
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underinsured |
do not have financial resources to cover the gap between what their insurance covers and their medical bills: high cost-sharing, co-payments, deductibles, premiums, reimbursement and visit caps, service exlusions |
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safety net providers serve many uninsured and underinsured such as |
1.) CHDs 2.) FQHCs 3.) public hospitals |
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barriers to health care among nonelderly adults by insurance status, 2013 |
1.) no usual source of care- u 53% for uninsured 2.) postponed seeking care due to cost 3.) went without needed care to cost 4.) could not afford prescription drug
all 4 ranked highest for uninsured, then Medicaid/public, last employer/private |
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uninsured rates among the nonelderly by state 2013 |
southern states, montana, wyoming, but not mississippi, and louisana, alaska= >16%
new york area, northeast, midwest = <12%
remainder = 12-16% |
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most people in U.S. obtain health insurance through |
their employer |
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health insurance acts as an |
intermediary between patients and providers |
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an estimated 93% will be insured once the |
ACA is implemented
22 million insured through state/federal health insurance exhanges
16 million newly insured in Medicaid or CHP |
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coverage changes among the nonelderly 2000-2013 |
uninsured and underinsured = gone from 16.8- 12% to 17-23% from 2000 to 2013
private = from 71% to 61% from 2000 to 2013 |
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U.S. spends more per person on health care but often ranks poorly on |
health care measures |
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IOM - Err is Human: Building a Safer Health System |
10,000s of Americans die each year as a result of preventable mistakes in their care, the report lays out a compreshensive strategy by which government, health providers, industry, and consumers can reduce errors |
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key causes of errors affecting patient safety: 4 |
1.) medication errors 2.) infection control 3.) injuries from falls 4.) injuries from procedures |
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IOM outlines 6 areas for improvement |
1.) safety 2.) effectiveness 3.) patient centered care 4.) timeliness of care 5.) efficiency of delivery of care 6.) equitable provision of care |
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quality issues in the delivery of care stem from the |
complexity of the U.S. healthcare system due to its decentralized and fragmented nature - difficult to provide coordinated, patient-focused care and leads to: variation in services, inefficiencies, and overuse, underuse, and misuse of services |
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10 Essential Public Health Services Roles of local and state public health agencies |
Assessment:
1.) monitor health 2.) diagnose and investigate
Policy Development:
3.) inform, educate, and empower 4.) mobilize community partnerships 5.) develop policies
Assurance:
6.) enforce laws 7.) link to/provide care 8.) assure competent workforce 9.) evaluate
System Management:
10.) research
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what are the roles of federal public health agencies: 5 |
provides national oversight, policy, and funding for:
1.) disease control and prevention 2.) research 3.) consumer safety and protection 4.) provides resources to care for vulnerable populations (MH/SA, HIV, Disabled, etc.) 5.) emergency response
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key federal health agencies of the department of health and human services |
1.) Centers for Disease Control and Prevention (CDC) - roles/authority: lead agency for prevention, health data, epidemic investigation, public health measures aimed at disease control and prevention; ex: of structures/activities: CDC Epidemiology Intelligence Service (EIS) functions domestically and internationally at the request of goverments 2.) National Institutes of Health (NIH) - roles/authority: lead research agency, also funds training programs and communication of health infor to professional community and the public; ex: of structures/activities: 17 institutes in all - the largest being the National Cancer Institute, NIH is the world's largest biomedical research enterprise with extramural research grants throughout the world |
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key federal health agencies of the department of health and human services - continued |
3.) Food and Drug Administration (FDA) - roles/authority - consumer protection agency with authority for safety of foods and safety and efficacy of drugs, vaccines and other medical and public health interventions; ex: of structures/activities - division responsible for food safety, medical devices, drug efficacy and safety pre and post approval 4.) Health Resources and Services Administration (HRSA) - roles and authority: seeks to ensure equitable access to comprehensive quality health care; ex: of structures/activities: funds community health centers, HIV/AIDS services, scholarships for health professional students |
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what are the roles of global public health organizations and agencies? |
provides international oversight, policy, and funding for:
1.) disease control and prevention 2.) coordination of response to major disease outbreaks and natural disasters 3.) tracks population health across countries |
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global public health organizations: |
1.) World Health Organization (WHO) - structure/governance: United Nations organizations, seven regional semi-independent components, e.g. Pan American Health organization covers North and South America; roles - policy development, e.g. tobacco treaty, epidemic control policies, coordination of services, e.g. SARS control, vaccine development, data collection and standardization, e.g. measures of health care quality, measures of health status; limitations - limited ability to enforce global recommendations, limited funding and complex international administration |
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global public health organizations: |
2.) International Organizations with focused agenda, Bilateral governmental aid organizations; structure/governance: UNICEF, UNAIDS, USAID, many other developed countries have their own organizations; roles: focus on childhood vaccinations, focus on AIDS, often focused on specific countries and specific types of programs, such as the US focus on HIV/AIDS, and maternal and child health; limitations: limited agendas and limited financing, may be tied to domestic politics and global economic, political, or miliatry agendas |
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how can public health agencies and the community they serve work together? 4 |
1.) strategic planning - prioritize health issues and populations and identify resources for addressing them (MAPP) 2.) pooling resources to address needs 3.) coordinating service delivery 4.) educating the community (prevention campaigns) |
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local public health system examples: |
police, EMS, community centers, churches, civic groups, doctors, hospitals, philanthropist, fire, mass transit, corrections, environmental health, economic development, elected officials, parks, nursing homes, employers, tribal health, mental health, drug treatment, schools, MCOs, home health |
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The Anatomy of Health Care in the US by Moses et al (JAMA) |
provides trends in health care spending and utilization and looks at drivers that impacts these trends |
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management |
1.) interdisciplinary compilation of concepts that is integral to all human enterprise including public health 2.) necessary to assure the goals of public health programs are met 3.) it is an integral component of the social contract between employers and employees
concepts derived from sociology, psychology, economics, statistics, and finance
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health policy and management is one of the |
core competencies areas for public health |
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how health professionals learn to manage |
1.) as an add-on to their public health training and not as an integral part of their training 2.) on the job 3.) some never have any training |
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management |
is the operational glue that keeps all the components of public health working together to meet the vision and mission of public health |
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most employees have not had formal training in |
management and pick up what is needed through work |
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management, organization, and culture are inextricably linked to organizational effectiveness, therefore |
managers are often judged by their organizations performance |
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organizational philosophy |
the value of an organization can also be called this |
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high-performing organizations have |
a values system that furthers the organizations goals, an organization in which all staff understand the desired values and incoporate them into their work lives will achieve its goals more effectively |
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ethics audits |
are an important tool managers can use to biopsy the organizations value system
consists of:
1.) staff surveys 2.) obervations of staff and patient interaction 3.) reviews of staff recruitment 4.) training |
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audits |
provide understanding of cultures |
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management or managing has 4 main elements: |
1.) a process comprised of interrelated social and technical functions and activities 2.) that accomplishes organizational objectives 3.) achieves these objectives through use of people and other resources 4.) which occurs in a formal organizational setting |
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senior management establishes |
organizational objectives, which have the clearest and most direct effect |
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managers at all levels shape |
.organizational values and cultures |
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managers can be described by |
functions performed, skills used, roles played, and competencies to succeed |
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management skills: 3 |
1.) technical - abilities of managers to use the methods, processes, and techniques of managing - decrease as managers become more senior 2.) human/interprsonal - cooperating with others, understanding them, and motivating and leading them in the workplace - important at all levels 3.) conceptual skills - are the mental ability to see how various factors in a given situation fit together and interact - increases as managers become senior |
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management roles: 6 |
1.) interpersonal - figurehead, leader, and liason 2.) informational - monitor, disseminator, and spokesperson- inside and outside organization 3.) decisional - entrepreneur, resource allocator, and negotiator - most important tool of manager 4.) designer - organizing work functions for maximum effectiveness - also important 5.) strategist - focus on how to adapt their organizational domains to external challenges and opportunities 6.) leader - the leader role is affected by how well the roles of designer and strategist are performed, more difficult because of dynamics in health field |
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management functions and decision making: 5 |
1.) planning - establishes objectives, first step in managing, occurs when planning new program or make changes 2.) organizing - develops tools and resources needed to achieve plan 3.) staffing - retaining human resources that are effective 4.) directing - depends on the ability to lead, motivate, and communicate with staff 5.) controlling - regulating activities in accordance to plan; has four steps: 1.) setting standards, 2.) measuring performance, 3.) comparing actual with expected results, 4.) making corrections as plan is implemented |
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5 management functions of planning, organizing, controlling, directing, and staffing are connected by |
decision making |
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problem solving steps: 7 |
1.) problem identification, or recognizing the prescence of a problem (including gathering and evaluating info) and stating the problem - one of many functions of manager 2.) making assumptions, which uses logic to extend what is known 3.) developing tentative alternative solutions and selecting those to be considered in depth 4.) evaluating alternative solutions by applying decision criteria 5.) selecting the alternative that best fits the criteria 6.) implement the solution 7.) evaluate the results of implementing solution |
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fact |
defined as an acutality, certainity, reality, or truth, obtaining facts is necessarily constrained by time and resources |
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hearsay and rumor may have elements of |
truth, this makes them important to the extent that they suggest potential problems that warrant further investigation, in themselves hearsay and rumor are never the basis for action or decision making |
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persons who make assertions should be asked how the assertions are supported by |
facts |
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leadership |
functions of an organization such as the public health department are organized into areas of common interest, expertise, and public health priorities |
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leaders or managers must have the ability to |
tailor communication and relationship building based on the interest of the individuals and key stakeholders within these functional groups, its all about relationships |
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primal leadership |
these individuals have a natural way with communication (born leaders) |
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taught leadership |
an art, not a science - most successful leaders lead through negotiations |
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building leadership skills: 6 |
1.) assess the environment for collaboration 2.) create clarity through visioning and mobilizing, shared values 3.) build trust among constituents 4.) share power and influence - developing synergy and communication 5.) develop people through mentoring and coaching 6.) self reflection |
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leadership practices inventory (LPI): 5 |
1.) model the way - finding a way to clarify personal values and set examples by aligning actions and shared values 2.) inspire a shared vision - imagining possibilities for the future and enlisting others in the common vision by appealing to shared goals and objectives 3.) challenge the process - seeking innovative ways to change, grow, and improve through risk-taking and experimentation 4.) enable other to act - fostering collaboration and promoting goals and trust among individuals and organization - uplifting others through shared power 5.) encourage the heart - recognizing contributions and showing appreciation for excellence by celebrating values and victories to create a spirit of community |
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relationship management |
public health leaders and managers must work with individuals from many different types of organizations
while the organizations may differ in their business structure, mission, and goals - they are all staffed by people
different behaviors are necessary to effectively manage the relationships with the various types of individuals, not one size fits all |
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relationship management |
1.) governing boards: need clear line of responsiblity so the governing board does not become a micromanaging group, recognizing the political nature, may have aligned or competing ideas of how the organizations should be led and manged, managing these relationships takes inpiring a shared vision, has responsibility for evaluating the performance of the leader: through experience, open communication, staying true to mission or organization; in this state, local public health departments dont have local government boards, but do in others; all non-profit public health organizations do have government boards
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relationship management |
2.) senior managers - have their own goals - advancement, retirement, maintaining the status quo, etc, share the path for success through development and implementation of a roadmap, key to managing relationships with senior management is to keeping them involved and participating in the process, be honest and upfront about the challenges and benefits of completing certain tasks and must provide the necessary resources, all five LPI behaviors are essential in this setting to manage relationships with senior mangement |
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relationship management |
3.) front-line employees - face the public on a daily basis and feel the immediate reaction of implemented programs, need to know that leaders and managers are with them, understand the job they do, and are sympathetic to the challenges they face, enable others to act and model the way are two behaviors that can help front line workers better relate to the leader and/or manager |
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Relationship Management |
7) Consumers: |
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Relationship Management |
8) Community Leaders/Other Organizations |
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Importance of Teams in Public Health: 2 |
1.) Limited resources |
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Outstanding teams Focus on: |
. accomplishing a particular goal |
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Types of Groups and Teams: 2 |
•Informal Groups:
•Have boundaries |
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Relationship Management: 5 |
1.) governing boards 2.) senior managers 3.) front-line employees 4.) Consumers 5.) Community Leaders/Other Organizations |
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Team Characteristics: 5 |
•Composition – size and expertise |
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Improving Team Effectiveness |
Leadership:
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Improving Team Effectiveness |
Group learning:
Team development:
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Improving Team Effectiveness |
Strategies:
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Improving Team Effectiveness |
Organizational culture:
External environment:
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Principles of Organization Design: 5 |
•Organization design is never static. |
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Organization Design |
Signals for redesign:
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THE FIVE BASIC PART OF THE ORGANIZATION: 5 |
1.) Strategic apex 2.) middle line 3.) operating core 4.) technostructure 5.) support staff |
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Forms of Organization Design: 5 |
•Functional |
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Factors Influencing the Choice of Organizational Form: 6 |
•Mission |
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Governing Board |
Three broad classes of boards:
•Specific roles:
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Managing Your Relationship with the Governing Board |
•Important elements that are part of this relationship and include:
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Ethics |
can be defined as the standards of conduct and morality |
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Law |
is a system of principles and rules for human conduct that arises from a society’s value system, is recognized by society, and enforced by public authority |
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Public health employees must see their value system--their ethic--as a |
special charge and responsibility to those they serve |
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In most cases, the law is the minimum |
performance expected in society. Professions demand that their members not only obey the law, but hold them to a higher standard of conduct. |
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Law & Ethics |
Shows the succession of events that results in the public scrutiny of an organization’s decisions, and a judgment whether they are legal, ethical, or both
codification manifestation coprorate decisions decisions exposed to public scrutiny decisions determined to be legal/illegal and ethical/unethical |
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Organizational Philosophy and Values |
•Personal ethics is a result of values imparted from family and friends; religious training; self-study, education, life experience and introspection; and professional codes of ethics. |
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Linking Theory and Action |
Four principles should guide decisions in public health. These principles should be reflected in the organization’s philosophy and culture, as well as in the manager’s personal ethic:
•Respect for persons
These principles should be reflected in all of the policies, procedures, and rules used by the organization. |
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12 Principles of the Ethical Practice of Public Health |
1. Public health should address principally the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes. |
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12 Principles of the Ethical Practice of Public Health cont… |
4. Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all. |
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12 Principles of the Ethical Practice of Public Health cont… |
7. Public health institutions should act in a timely manner on the information they have within the resources and the mandate given to them by the public. |
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12 Principles of the Ethical Practice of Public Health cont… |
10. Public health institutions should protect the confidentiality of information that can bring harm to an individual or community if made public. Exceptions must be justified on the basis of the high likelihood of significant harm to the individual or others. |
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Conflict of Interest |
•Conflicts of interest arise when someone has two sets of duties or obligations (differing interests) and meeting one set makes it impossible to meet the other. |
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Patient Consent |
•Consent is obtained after benefits, risks, and alternatives to the services to be rendered have been explained.
•Voluntary - Consent must be given freely, without coercion or other interference with the decision.
•Obtaining consent for clinical decisions that is voluntary, competent, and informed is the legal responsibility of health care practitioners |
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Consent & Public Health Practitioners |
•Must have patient’s informed consent to be treated by someone in a public health agency. |
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Preventing and Solving Ethical Problems |
•Ethics committees can provide consultation on a number of issues that arise in clinical programs. They can also:
•serve as a repository of expertise |
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Leadership |
Leadership
•The focus of leadership is on other individuals or groups |
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Leadership Roles and Power |
5 forms of power commonly used by leaders to influence others:
•Legitimate – this form of power comes from one’s official position in the organization.
•These five forms of power are complementary and should be part of the skill set of every leader. |
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Leadership Styles |
Three primary leadership styles:
•Authoritative style is used when leaders tell their employees what they want done and how they want it accomplished, without getting the advice of their followers |
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Evidence Based Leadership |
Kouzes and Posner found 5 similar patterns of behavior when leaders were at their best:
•Model the Way: Leaders create standards of excellence and then set an example for others to follow |
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Alternative Leadership Perspectives: Transformational Leadership |
•It has four components:
•Charisma or idealized influence
•Being charismatic involves possessing a dynamic, energetic and commanding presence. |
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Alternative Leadership Perspectives: Servant Leadership |
•There are a number of important attributes of servant leaders and they include:
•Listening receptively to what others have to say |
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Public Health Funding Sources |
•There are four major sources of funding local health departments: local taxes, state grants, federal grants, and fees for service. |
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Public Health Funding |
•Public Health agencies lack of adequate funding to support ongoing services, and have inflexible sources of funds. |
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Funding Priorities |
•Federal funding of public health is determined by Congress who provides states with categorical funding (immunizations, emergency preparedness etc.) |
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Health Economics |
•Economics involves the utilization and management of scarce resources |
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Measures of Health Status |
Life expectancy measures used in economic analysis:
•QALY: Quality-adjusted life years calculates life expectancy adjusted for quality of life, where quality of life is measured on a scale from 1 (full health) to 0 (dead). |
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Economic Analysis |
•Can be used to determine the burden of a disease or cost effectiveness of a treatment.
•The prevalence of the disease in a population |
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Economic Analysis |
•Economic evaluations must take into consideration the difference between efficacy and effectiveness.
•Efficacy is the maximum possible benefit, often achieved with controlled trials |
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Methods of Economic Analysis |
Cost-benefit analysis (CBA):
•The objective of cost-benefit analysis is to maximize net benefits (benefits minus costs in monetary terms).
Cost-effectiveness analysis (CEA):
•Similar approach by calculating the monetary value of the intervention costs. The difference is that cost-effectiveness considers the effects produced by an intervention, which are not measured in monetary terms (lives saved, illnesses prevented or years of life gained). |
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Examples |
•CBA:
•Immunizations save $8.50 in direct medical costs for every $1 spent
•CEA:
•Colon cancer screening $20,000 per 1 QALY saved |
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The gains and losses of providing public health programs |
.apply not only to the people who are receiving the services but to the population as a whole (allocation of scarce resources).
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Diverse Base of Funding Sources |
•Health service organizations must be attentive and open to all possible funding sources outside of their usual business revenues (fees for services).
•Robert Wood Johnson Foundation |
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Revenue Types
With revenue that is considered philanthropy, there are three general categories: |
1.Restricted Revenue: support specific projects and programs (usually has a defined budget) |
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Fundraising Basics |
•Financially successful organizations create varied, unique philanthropy road maps that include both short and long term goals. |
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Federal and State Agency Contracts and Grants |
•Largest source of revenue for public health organizations
•There are important distinctions between a grant and a contract
•Grants usually have broader expectations, no legal ramifications if project not accomplished (may be paybacks or blacklisted for future grants)
• Competitive process
•“Request for proposals” outlines all of the information required in proposal. |
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Foundations |
•Play important philanthropic role in supporting non-profit organizations
•Private Foundation: An organization created from designated funds from which the income is distributed annually as grants to not-for-profit organizations, groups and/or individuals.
•Foundations tends to want to build relationships with their grantees - initially make small steps until the organization “proves” itself |
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Individual Donors |
•Greatest source of philanthropy in the United States
In order from most effective to least effective:
personal - face to face personal letter on personal stationary personal telephone call personalized letter direct mail phon-a-thon - impersonal special event door to door media advertising |
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Fundraising Staffing |
•All members of an organization play a part in fundraising - every staff member understands how they help promote a culture of philanthropy within their broad community (spokesperson for the organization) |
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Fundraising Ethics |
•Need to be vigilant about how to engage with fundraising prospects and donors:
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Strategic Project Management |
•Organizations that have successful fundraising programs tie fundraising strategy to the organization’s strategic plan, mission and vision.
1.What are we trying to accomplish and why?
•Also help the organization and the donor better understand possible partnerships available to help execute the organization’s vision and plans |
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Setting Organizational Strategy |
•To build your fundraising infrastructure and to set fundraising dollar targets, health services managers must consider several interrelated areas:
•Staffing: fundraising budget allocation (employees or contracted services) |
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Long-term Process |
•Not a quick fix to an organization’s financial difficulties. |
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Strategic Thinking |
Strategic thinkers:
•Acknowledge the reality of change |
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Strategic Planning |
•Provides a sequential, step-by-step process for creating a strategy |
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Environmental Assessment |
•External Environmental Analysis - examines the external forces impacting an organization including demographic, economic/fiscal, and political factors and trends
•Environmental scanning - systematically scanning for changes in your environment – political, technical, economic, societal etc.
•Used to formulate the opportunities and threats faced by an organization |
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Environmental Assessment |
•Internal Environmental Analysis and Value Creation
•Identifying internal strengths and weaknesses
•Value- services valued by the community?
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SWOT Analysis |
•Strengths: characteristics of the business that give it an advantage over others. - internal and helpful |
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Strategic Choice |
•Strategies need be aligned with your Mission, Vision and Values
•Relate to attributes critical to your mission
•Strategic Alternatives
•Growth strategies |
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Strategic Plan Implementation |
•Assign tasks and timeframes |
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Strategy and Organizational Culture |
•Implicit, invisible, intrinsic, and informal consciousness of the organization |
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Change Management |
•Four attributes that specifically determine the outcome of any change process:
•Duration – the length of time needed until a change process is completed |
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Marketing |
•Marketing is another tool used in strategic management. |
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Marketing Strategies |
•Build relationships with local media - provide them with information about new programs or initiatives, trends or public health threats. |
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U.S. Demographic Trends |
•The percent speaking a language other than English at home went from 17.9 percent in 2000 to 19.7 percent in 2007, while continuing upward to 20.8 percent in 2011. |
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U.S. Demographic Trends |
•In addition to English and Spanish, there were six languages in 2011 spoken at home by at least 1 million people:
•Chinese (2.9 million) |
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What is Culture? |
•Culture - integrated patterns of learned beliefs and behaviors that is shared among groups and includes thoughts, styles of communicating, ways of interacting, views on roles and relationships, values, practices, and customs. |
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Culture and Language |
Culture and language may influence: |
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Cultural Competency |
Definition: Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. |
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Need for CLC Services |
There are ethical and practical reasons why providing culturally and linguistically appropriate services in health and health care is necessary, including the following:
1.To respond to current and projected demographic changes in the United States. |
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National Policy |
•In 2001, DHHS‐OMH (Office of Minority Health) released the National Standards on Culturally and Linguistically Appropriate Services (CLAS) to emphasize the need for a health system‐level response to language access. |
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National CLAS Standards |
Principle Standard: Provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs. |
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Governance, Leadership and Workforce |
• Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices and allocated resources. |
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Communication and Language Assistance |
•Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services. |
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Engagement, Continuous Improvement and Accountability |
•Establish culturally and linguistically appropriate goals, policies and management accountability, and infuse them throughout the organization. |
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Linking the Pieces |
1.) cultural competence 2.) linguistic competence 3.) community engagement 4.) patient and family centered care 5.) health literacy 6.) partnerships between patients & health professionals
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Individual Awareness |
•One’s perceptions of other cultures are influenced by one’s own world view |
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BELIEF Model |
The BELIEF model is based upon several of the interviewing instruments and is intended for use by clinical personnel.
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Workplace Diversity Defined |
•Nondiscrimination in the workplace on basis of race, ethnicity, primary language spoken, religion, disability, sex, or age. |
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Health and Healthcare Disparities |
•The overall health of the Americans has improved over the past few decades, but not all Americans have benefited by these improvements. |
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Racial and Ethnic Workforce Diversity |
•The IOM stresses the evidentiary basis for health workforce diversity: |
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Diversity in the Public Health Workplace |
•Three core functions characterize the public health enterprise: assessment; assurance; and policy development. |
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The Legal Basis of Workforce Diversity |
•The laws that govern non-discrimination in the workplace are complex and are broadly summarized as follows: |
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Categories of Non-Discrimination Laws: Legally Protected Populations |
•Federal civil rights laws prohibit workplace discrimination: |
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Civil Rights Act of 1964 |
•Federally protected under Title VI of the Civil Right Act of 1964 |
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Laws compelling diversity as a condition of federal funding |
•Beyond federal civil rights laws, various federal programs that provide funding may contain specific conditions that create diversity obligations. |
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Managing for Workplace Diversity |
•“Corporate compliance” – oversees employment practices, contractual obligations and legal obligations. |
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Four Diversity-centric Business Strategies |
•Think broadly about diversity - not just what is required by law |
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mission
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statement of organization's purpose or reason for being |
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vision |
seeks to describe what the organization wishes to become and its hope for the future |
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values |
the core principles that organizations and the people within them stand for and that serve to make the organization unique |
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strategic goals |
the mission, vision, and values of an organization provide the focus and direction for the choice of strategic goals |