1. The U.S. Healthcare System Hospitals: The Cornerstone of the American Medical System

2. Nurses Typifies the concern of healthcare: “nursing is concerned with human response to health problems” Historic factors that shaped nursing as a career:  Occupation to support physicians  Emergence of hospitals as community institutions  Acceptable female occupations, primarily white females  Linked to religious orders

3. Understanding the Nursing Shortage Changes in occupational opportunities for women since 1970s Majority of RNs are 50+ years of age or married with children at home Low salaries – pay compression Burnout Lack of clinical career ladder Active vs. Inactive – about 1/3 of nurses not working fulltime

4. Origins in the U.S. Origins in almshouses and pesthouses. First voluntary or community-owned hospitals  Influenced by European trained physicians.  Preceded church or state  Most supported by community contributions and philanthropy. Became the physician’s workshop

5. Forces Affecting Development of hospitals Advances in medical science increased efficacy and safety Technological sophistication required centralized setting. Professional nursing resulted in more humane treatment Advances in medical education Health insurance industry grew Hill-Burton Act Expanded hospitals around the country

6. 21sth Century Hospital Have become comprehensive community health centers Hospitals transforming - from inpatient to ambulatory services Have become large “industrial” forces with large finances and workforces Some more recent trends in Vegas to mobilizing main workforce – nurses – towards union labor force

7. Impact of Hospital on Worker Desirable Traits High Prestige/status Professionals want to be part of the “team”; recruitment and retention are eased Prestige, status, and miracles justify high costs and salaries Gives large voice and influence to managers and staff Undesirable Traits Pressure is on the managers to perform Workers are in the spotlight - even minor problems get publicity Public expects more than they may be able to deliver Cost reduction pressures will cause many of these workers to fail

8. Impact of Hospital on Consumer Desirable Aware of new treatments and technology and where to receive them Is confident the hospital will assist in recovering health Knows where to go for emergency services Undesirable High overhead and standby costs result in high costs Hospital is expected to do more than it can actually do Bureaucracy dehumanizes and causes structure responses Technology is imperative, but often leads to unnecessary testing

9. Types of Hospitals Private  For-profit  Non-profit or not-for-profit Public  Local (locally funded, public, to serve the poor)  State (typically mental health facilities)  Federal (typically military and VA)

10. The Organized Delivery System Organized Delivery System – a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and the health status of the population served.

11. Organized Delivery System Developed using direct ownership or alliances and/or contracts. Social and organizational mechanisms for improving community health and well-being Today, 50% of all community hospitals are members of systems. Consolidation of hospitals  Acquisition of one entity by another;  The merger of two or more entities to create a new organization;  Or the formation of loosely structured alliances and networks.

12. The Vertically Integrated System A broad range of facilities and services A group or network of primary care physicians Specialists Mechanisms for coordinating or integrating care Health promotion services Information systems Integrated strategic planning, resource allocation and assessment of system performance Unified marketing and contracting Integration of financing and delivery through common ownership or contractual relationships.

13. How Health Service Organizations are Structured Governing Board  Functions and duties  For-profit vs. Non-profit CEO and Executive Management  CEO  Management Team (CFO, COO, CNO, CIO) Professional Staff Organization

14. The Hospital Triad Hospital HSO Governing Board Profession Staff Organization Executive Management