“The U.S. health care system is complex. It involves a whole host of professionals and institutions including, but not limited to, hospitals and clinics, physicians and allied health care professionals, pharmaceutical companies and insurance companies,” says Michael W. Posey, Ph.D., who is professor and chair of the Healthcare Management and Healthcare Information Systems Management majors at Franklin University.
Smart Business learned from Posey about why it is important to have a holistic understanding of the health care enterprise.
What is the current structure of the health care system?
Currently, a person primarily accesses the health care system through physicians who work mostly in practices or for clinics or hospitals. These services are rendered on-site at a hospital or clinic on an in- or out-patient basis. Once a patient is in the system, payment for services is primarily paid through insurance or through programs such as Medicare and Medicaid.
For people with insurance, there is usually some form of co-pay or portion of the bill that the patient must pay. People without insurance either pay out of their pockets or their care is absorbed through a variety of sources, including the hospital.
Today’s health care services require the latest technology and the most up-to-date knowledge. This has caused our health care system to rely on technology and interdependency at an unprecedented rate. Medical imaging systems, billing and accounting systems, patient care systems, and a whole host of other devices and technological tools used in today’s health care settings need to be constantly managed and updated in order for modern health care enterprises to work efficiently.
How do many medical professionals perceive their role in the enterprise?
The nature of health care and the reality of its practice make it easy for health care professionals to focus on their particular role and forget how they and their patients fit into the whole. For instance, X-ray technicians may focus on taking the X-rays of patients. They may develop the film, send it to the physicians and be done with it. However, that image is only a small part of the patients’ entire care.
Also, nurses may be focused on caring for patients on their floor. But these nurses may be unaware of the multitude of systems within the enterprise, both personnel and technological, which help them to provide quality care on their floor.
How should members of health care systems perceive their place in the system?
As more systems are tied together and more areas are merged, health care workers must have a broader view of the health care enterprise. Instead of the old view of health care consisting of individual areas and/or components, health care workers need to have a 360-degree view of the system to provide the best care.
Health care professionals with areas of technical expertise, such as physicians, nurses, and billing and coding specialists, are and always will be extremely vital to the enterprise. However, to advance and excel, health care workers not only need their specialty area of expertise, but also need a broad view of the entire health care system and how it all interrelates. A basic knowledge of areas such as management, law, insurance, policy, finance and contemporary health care issues, can help provide an enterprisewide view.
How can medical professionals learn how their specialty areas relate to the overall system?
There are several ways that medical professionals can obtain this knowledge. The easiest way is to ask others questions and observe others within their organization. By observing, health care workers can get a good sense of how the whole system works and an understanding of their place within that whole. Also, health care workers may be able to receive cross training in allied areas to develop a better understanding of the health care enterprise.
In my estimation, the best way for health care workers to learn these concepts is through formal training in the form of a degree in a field that specializes in teaching from a health-care-specific perspective. For example, a health care worker with an associate’s degree in radiology tech could get a bachelor’s degree in health care management. This would give him both the technical skill and the broader knowledge necessary to move upward within the enterprise. Someone who has a bachelor’s degree or even an M.D. may want to get an MBA to give her the knowledge base to effectively manage her own practice or an area within a health care enterprise.
Combining technical expertise with a formal degree in health care management will enable the health care worker to be at the forefront of today’s complex health care system and provide the patient with the best care possible.
MICHAEL W. POSEY, Ph.D., is a professor and chair of the Healthcare Management and Healthcare Information Systems Management majors at Franklin University. Reach him at firstname.lastname@example.org.