Analysis of Operations in Healthcare Organizations

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Hospital Healthcare Operation Systems

Healthcare operations refer to specific administrative, legal, financial, as well as quality improvement actions of a covered entity, which are crucial in running its business in support of the core roles of treatment and payment (Linda, 2012 p. 488). A hospital conducts quality assessment and perfection activities, improves health or reduces costs in healthcare by activities that are population-based and case management as well as case coordination. A hospital also reviews the competence of its healthcare workers and evaluates the performance of the provider and health plan (Mosadeghrad, 2014 p.210). It facilitates auditing and legal services and medical review. In addition, a hospital conducts planning and cost-management analyses that is related to operating and managing the hospital to ensure business planning as well as development. Also, a hospital operation system involves general administrative actions and business management, which include activities similar to complying and implementing the Privacy Rule together with additional Administrative Simplification Rules, solving of internal grievances, customer service, and creating health information that is de-identified (Linda, 2012 p. 490).

A hospital care giver uses protected patient health information to give appropriate healthcare to the patient and may also check with other healthcare givers concerning the patients treatment. According to Linda (2012), a hospital primary care provider may provide a copy a patients medical record to a given specialist who requires the information to treat the patient. A hospital may also provide healthcare instructions for a patient to a nursing home where the patient has been transferred to. In addition, a hospital discloses protected health plan coverage information of a patient to a certain covered entity such as an ambulance that brought the patient to the hospital, a laboratory or pharmacy in order to facilitate billing for the provided services (Mosadeghrad, 2014 p.216). Furthermore, a hospital discloses such protected patient information to another covered entity that has or had a health plan relationship with the patient in question. Similarly, a hospital discloses healthcare information to another covered entity which takes part in mutual healthcare operations belonging to the organized healthcare arrangement (Linda, 2012 p. 492).

However, a hospital must come up with policies and procedures, which limit its requests for and disclosures of protected patient information for hospital operations and payment reasonably to the minimum necessary (Linda, 2012 p. 494). A hospital may voluntarily decide to get the consent from a patient to make use of and disclose information about the patient for the purpose of treatment, payment, as well as healthcare operations. Lastly, the hospital operational system is consistent with the covered notice of privacy practices entity (Mosadeghrad, 2014 p.220).

Custom and Standard Care

A hospital involves a blend of custom and standard care elements whereby healthcare givers usually give both simultaneously in attempt to combine these two types of service processes, despite the literature from operations management advocating the separation of custom and standard care elements. Standard care is applied in clearly understood clinical conditions, which possess evidence-based solutions that are clear. In contrast, custom care deals with not clearly understood problems, or atypical or totally novel conditions or unusual response of a clearly-understood problem after standard interventions (Riadh, 2010 p. 505). At each particular time, the hospital care giver decides on the choice of the operating strategy based on the nature of the needs of the patient as well as medical knowledge state.

According to Corbett (2016), a hospital, while applying standard care makes use of evidence-based medicine through a systematic manner in ensuring patients obtain high quality-care. Standardization of the hospitals bests practices serves as an important section in giving effective, affordable as well as, safe care. This has many benefits that include and not limited to: consistent outcomes, reduced waste, labor savings, and enhanced efficiency, reduced costs, and enhanced patient safety.

In contrary to one-size-fits-all strategy in treating patients, custom care in hospitals allows care givers to know their patients in details and treat each patient in a unique manner. This improves the experience the patient and increases the engagement of the patient. Such personalization motivates patients in the hospital in becoming active participants throughout their health journey (Corbett, 2016).

Both standard care and custom care are not mutually exclusive. They work together in ensuring improved quality. In a hospital setting, standard care enhances custom care by getting rid of unnecessary work for care givers and providing them additional time to spend with their patients. It also gets rid of unnecessary expenses as well as complications arising from failure to adhere to best practices. Also, custom care in a hospital can switch to standard care upon iterative process bringing up a clear understanding of the healthcare condition that is underlying (Riadh, 2010 p. 505). Hospital care givers make decisions in treatment based on their exclusive personal clinical experiences. As such, standardization complements care giver experience and lowers the chances of guesswork. It therefore serves as the foundation on which hospital care givers personalize patient care (Corbett, 2016).

Conceptual framework involving a blend of these two models in a hospital requires that limits are set on the standardization process. It also requires critical determination of justifiable clinical autonomy. Lastly, it requires provision of a rational root for a radical split from traditional work outline involving moving away from clinical activities that are generic to more specialized and focused work in a hospital (Riadh, 2010 p. 506).

Public Reporting

Public reporting (PR) refers to the system of availing data concerning healthcare structure, process, or even outcome available publicly or accessible to a diverse audience without any charges or at a supposed cost. PR enables comparison of data among providers or to a performance data report on that is regional or even national whereby there are acknowledged standards or best practices (Campanella, 2016).

Internally, hospitals report their performance to groups including and not limited to senior management, boards of directors, clinical teams, as well as board committees. They choose and monitor outcomes with high measurability. However, at times, this approach fails to give the highest valuable information on performance or lead to accountability via cross-system comparisons. They ally decision-making with internal objectives as well as the external performance expectations. With a crucial set of indicators accounted across all hospitals enhances and upholds benchmarking with the capability of driving performance in specific domains (Kraetschmer et al., 2014 p.36).

Externally, according to Kraetschmer et al., (2014), specific measures in a hospital ought to be reported to a diverse of bodies that include and not limited to: Ontario Ministry of Health and Long-Term Care (MOHLTC), Health Quality Ontario (HQO), Cancer Care Ontario (CCO), Local Health Integration Networks (LHINs), and the Canadian Institute for Health Information (CIHI) (p.44). However, these measures fail to be fully aligned during most of the times.

PR impacts positively on both hospital operations and performance. PR has increasingly become common amidst healthcare systems globally. Makers of decisions and policies have become further interested in getting information concerning quality performance, hence PR has been projected as a mechanism that avails further transparency as well as accountability of hospital care givers. Usually, healthcare users inform themselves on the healthcare system quality prior to choosing a certain provider. As such, hospitals with high performance are rewarded by being selected while those with low performance are avoided. This stimulates improvement of performance (Campanella, 2016).

PR improves hospital care quality through the selection pathway whereby the hospital care givers are concerned about their market share. This is as a result of health seekers selecting better performers, which motivates care givers to advance quality so as to attract more health seekers. PR also improves quality of care in a hospital through the change pathway in which identification of quality deficits serves as sufficient in stimulation of professional motivation of hospital care givers and improvement of organizations. In addition, PR improves quality of care in a hospital through the reputation pathway whose basis is on the premise that hospital care givers that perform poorly, following identification via PR, suffer reputational damage. Such further motivates improvement in quality of hospital care so as to protect or enhance their reputation. Clinical outcomes data PR serves as a great tool that enhances the transparency in a hospital set up, as it facilitates patients in making informed choices on their healthcare, since the health seekers are aware of their right to awareness on the quality of care, which one is highly possible to get from hospital care givers (Campanella, 2016).





Campanella Paolo, Vukovic Vladimir, Paolo Parente, Adela Sulejmani, Ricciardi Walter, and Specchia Lucia Maria, 2016. The Impact of Public Reporting on Clinical Outcomes: a Systematic Review and Meta-Analysis. BMC Health Services Research 16(296).

Corbett E. D., (2016). Standardized Care vs. Personalization: Can They Coexist? Health Catalyst. Retrieved from

Kraetschmer Nancy, Jass Janak, Woodman Cheryl, Koo Irene, Kromm K. Seija, and Deber B. Raisa, 2014. Hospitals Internal Accountability. Healthcare Policy 10(SP): 36-44

Linda V. Green, (2012) OM Forum. The Vital Role of Operations Analysis in Improving Healthcare Delivery. Manufacturing & Service Operations Management 14(4): 488-494

Mosadeghrad Mohammad Ali, 2014. Factors affecting Medical Service Quality. Iranian Journal of Public Health 43(2): 210-220

Riadh T. Abed, (2010). Custom and Standard Care: Implications for the Future Role of Doctors in Mental Health. The Psychiatrist 34: 505-506


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