One of the major challenges facing healthcare administration is the problem of diversified care. The modern world and all the technological improvements that are found in medicine mean that levels of care are better than ever, but this is not without challenges for administrators. An increasing number of specializations in medicine, for example, mean that administrators must prepare for an increasing number of units and specialists, which in turn leads to problems with funding and human resources. There are also issues associated with the fact that patients are generally more aware of technological advances in medicine, and may be more vocal about the type of treatment that they are seeking. Specializing also means that traditional hospitals are increasingly competing with smaller units that offer these specialized treatments and care options, which also provides a challenge to hospital administrators attempting to financially improve their organization (Deravaj et al., 2013).
Recommendations in Health Care
Improving a wider variety of services
Helping connect people with the best services for their needs
General Problem Statement
The aim of this proposed capstone is to assess the impact of specialized care and diversification in medicine on hospital administration. It will focus on the changes in healthcare over the last decade, to highlight the importance of providing specialized care and liaising with a variety of different staff members with different skills to provide well-rounded care to patients. It has been suggested that this diversification of care has a financial impact on organizations in a number of ways (Deravaj et al., 2013). The financial impacts of hiring well-qualified, specialist staff will be investigated, as well as the impact of smaller competing organizations that offer one or two treatment options that hospitals generally cannot (Mosser & Begun, 2014). The purpose of the research is investigate the problem of the diversification of healthcare options and the impact that this has on hospital administration in particular.
Specific Problem Statement
The research will focus on the ways in which hospital administration can help to avoid these problems. It is important to assess the process in which administration teams can recognize the needs of the community with respect to diversified healthcare, and then apply them to their own organization. To do this, a review of the current literature about the processes with which administrators have attempted to solve the problem will be conducted. It is expected that this will give insight into the best ways of approaching the problem, which will in turn highlight how best to ensure that the organization changes with the changing technology. It is expected that there will be many different approaches to dealing with the diversification of healthcare, and the merits and demerits of each of these approaches will be considered with reference to a theoretical framework for making change in the healthcare organization. The problem here is understanding the best way that healthcare administrators can deal with the changes in the delivery of healthcare services.
Purpose Statement
The purpose of this research is to highlight the challenges of diversification in healthcare and to understand the different approaches to dealing with the issue.
Research Questions
What are the different challenges that are facing healthcare administrators with respect to the changing nature of care?
Are administrators under pressure to provide more services? If so, how has this affected the organization?
What are the different approaches to providing diversified healthcare, and what are the most effective?
Literature Review
As noted above, there are a number of different challenges facing organizations that provide health care, but one of the biggest challenges is keeping up with new technologies and approaches that require a diversification in the services offered. Multidisciplinarity is an element that can positively affect a health care provider in that it improves team outcomes, and often teams are staffed so that they can provide this multidisciplinary approach (Fay, Borrill, Amir, Howard & West, 2006). One of the challenges here, of course, is ensuring that these teams run smoothly and all of the bases are covered when considering the needs of the patients. It was found that team innovation is highly correlated with this type of multidisciplinary teams, and this can contribute to positive patient outcomes (Fay et al., 2006). This suggests that understanding multidisciplinary approaches is an integral part of creating an outstanding health care organization, and that focus on diversification is one of the best ways in which to achieve this goal.
The purpose of this literature review is to assess the current state of the literature on health care diversification and what it means for health care providers and organizations that are looking to implement a more multidisciplinary approach. It will focus on some of the benefits of diversification in health care, as well as some of the approaches that have been used by other organizations to diversify the teams that they employ and the services that they provide to patients. It will also focus on understanding why this diversification is important in terms of meeting patient needs and competing in the health care marketplace. It will become clear that, whilst there is no general consensus on the best approach, there is a strong foundation of research that supports diversification in health care.
The Management of Diversification
Meads, Wild, Griffiths, Iwami & Moore (2006) focused on a purposive sample of 16 countries to assess the developments in health care that can provide challenges to organizations. It was found that organizations that had a lower rate of resistance to modernizing policies were more likely to have successful implementation of diversification programs, and that this translated into more positive patient outcomes. It was also noted that organizations that had mechanisms for multiple funding opportunities as well as diversification in the treatments and services offered were more likely to be successful (Meads et al., 2006). The effectiveness of management in implementing these changes was one of the key drivers for success, and is something to be considered when assessing whether to offer a diversification in services.
Noordegraaf (2011) highlighted the importance of understanding the challenges that the professionals themselves face when entering a health care organization. There is a challenge arising from the implementation of new technologies that stems from a need to offer multi-professional acts, and this in turn puts strain on organizational management. Salge & Vera (2009) also highlighted this problem, but in a large-scale empirical study of the English National Health Service found that innovativeness on the part of the hospital offers a solution to issues facing patients. The idea here is that offering multiple services is challenging both for those that work in the organization but also to management, but can offer a huge number of benefits to the hospitals and organizations themselves. It is a key driver for change that offering a wider range of services means more economic benefits for the institution, but also increases organizational performance.
Delivery systems must also focus on the changing needs of the patient and the increase in medical technologies that means that more specialists are required in the organization. Lega (2007) noted that integrated delivery systems are the dominant organizational form in the health care sector, and that these are necessary for meeting the organizational needs of the hospital or other institution. Lega (2007) also noted that there was a serious issue in that there are design issues with these integrated delivery systems that have not been assessed to any great extent in the literature, and this may be one of the reasons why these systems are difficult to implement. The challenge here is ensuring that the organization is prepared for making changes related to diversification of services, and ensures that integrated delivery services are working to make it easier for multidisciplinary teams to communicate with each other and provide the services they need. As with any issue in organizational systems, Lega (2007) notes that communication is one of the central important concepts to consider when implementing an integrated delivery system within the organization, and can improve the flow between different services to benefit patients. More research needs to be done on how to ensure that this happens.
Approaches to Multidisciplinary Diversification
There are a number of different approaches to health care that can be used to understand the issue and highlight the needs of the patients in terms of delivery. McCrae (2011) highlights that nursing theory can be important in the use of multidisciplinary systems that meet the diversification needs of the organization. These nursing theories can be applied because many of them encompass the need to be holistic in health care, providing a wide variety of care options and large multidisciplinary teams. In a sense, these approaches are useful as they are designed for the diversification of health and related issues as they provide a framework for understanding the needs of patients. McCrae (2011) notes that these models can be developed to be applicable to the health care organization as a whole to make the change to a multidisciplinary, communicative team that incorporates all health technologies easier and faster.
Sultz & Young (2006) note that the United States is a unique health care system in that patients are generally aware of what they want and are able to choose their provider. This, of course, presents a challenge to the health care organization as they need to be appealing to patients to ensure that revenues stay high, and it does not necessarily logically follow that because their hospital was chosen for surgery it will be chosen for physiotherapy, for example. This means that the diversification of health care within the organization needs to mirror the general competitiveness of the market, and each of the departments and staff members needs to be competing both with other large-scale organizations and individual providers. The model that is suggested her is one that incorporates communication between providers and patients, makes the delivery of health care between departments smooth, and one that focuses on ensuring that each department of the hospital or organization is competitive with all options in the area. Taking this three-pronged approach ensures that all bases are covered in terms of the diversification of healthcare and provision of multidisciplinary care.
Baldwin & Baldwin (2007) propose a model for learning and service that focuses on interdisciplinary education and health team training. This model focuses on improving the staff members that are already within the organization, rather than expanding to meet diversification needs. This means that the staff members are able to provide a wider range of services within existing teams, rather than hiring from outside. This is a good approach because it improves team relationships, but also because it meets the education needs of staff members. Allowing staff members to explore their interests in terms of education and health care provision is also one way of improving their job satisfaction (), suggesting that this model covers a number of issues that might face health care organizations when planning for the diversification of delivery options.
Challenges for Diversification in Health Care
One group of patients that stands to gain from the diversification of health care teams is those with chronic disease. Patients with chronic disease often require multidisciplinary care over long periods of time, making them important in terms of the financial success of the organization (). Harris & Zwar (2007) note that one of the biggest challenges in terms of diversification is that there is a lack of physical infrastructure that supports the diversification of the workforce, making these patients a challenge for the organization and reducing the standard of care that they are receiving. Ayres et al (2006) notes that comprehensive health care in terms of those living with HIV/AIDS is one of the areas in which diversification can provide the most benefits to patients, but that organizations are not generally equipped to meet all these needs in house. The challenge is first asserting the needs of the patients and understanding what services need to be provided, then identifying the equipment and personnel required to meet these needs. This requires a large-scale analysis of the organization.
The next challenge is assessing whether it is most appropriate (financially and logically) to provide these services in-house, or whether it is more appropriate to delegate services (Saami et al., 2008). Whilst it is more beneficial in some cases for an organization to offer the “whole package”, this may not be logical or even possible in some cases. The biggest challenge is ensuring that the right amount of work is delegated to outside organizations whilst still remaining competitive with these organizations and larger ones that can and do provide a consistent, in-house set of services for dealing with chronic patients and/or those with complex needs (). It may be appropriate, for example, to provide all of the services needed for a diabetes patient in-house but hire an independent contractor to deal with glaucoma, still using the hospital equipment but to reduce the load on other optometrists (). This challenge is one that requires significant amount of analysis on the part of the organization and there is no set model which is ideal for making these plans and assessments. This will be the focus of the current research.
Mental health care is one of the fastest moving areas of health care, and there is a definite need for organizations to meet the diversification needs of these patients. Robiner (2006) notes that there has been a diversification in the types of health care professional required for treatment, as well as in the nature of mental illness itself. This is a significant challenge to organizations that do not have the internal structure required to support these patients. Children’s mental health care is a particularly complex area of provision, with significant case complexity and long wait list (Reid & Brown, 2008). Again, the challenge here is that organizations need to ensure that the care is being given to these patients whilst still ensuring the security of the organization from a financial and logical perspective. This will be discussed at length during the current research.
Addressing System Needs
Garrido, Gerhardus, Rottingen & Busse (2010) suggest that health technology assessment can be used to help organizations address the health care needs and improve the system. These technologies can be used to incorporate new technologies, including the diversification of the products available and contextualizing the issues facing the organization. By using technology, predictions can be made about the future needs of the patients and put it in the context of the needs of the organization and what it can logistically provide. These technologies can be used as a model to help prepare the organization for change and to ensure that the transition to a higher level of diversified care is smooth and does not adversely affect either the patients or staff members. Health technology assessment can also be used to predict the economic benefits and disadvantages to taking on new technologies within the organization, by putting into context the number of patients that can be helped, potential income, and the cost of providing these services.
Dubois, Singh, & Jiwani (2008) note that there is a major human resource challenge in diversified care. This means that there may not be enough staff who are able to meet the needs of the patients and provide the levels of care required. In this sense, the human resources issue must be addressed first when assessing the potential diversification of the organization, and this should be a key focus of organizational management who are attempting to address the issue. Novella (2010) suggest that mental health care is, again, one of the biggest challenges facing organizations who want to diversify their provisions, and that it is human resources that provides the biggest challenge. Mental health care requires a large number of personnel with different specialties and skills, and this needs to be incorporated into a large and diversified workforce. Again, there is a need to focus on the personnel rather than the actual services or equipment.
Garrido, Gerhardus, Rottingen & Busse (2010) suggest that health technology assessment can be used to help organizations address the health care needs and improve the system. These technologies can be used to incorporate new technologies, including the diversification of the products available and contextualizing the issues facing the organization. By using technology, predictions can be made about the future needs of the patients and put it in the context of the needs of the organization and what it can logistically provide. These technologies can be used as a model to help prepare the organization for change and to ensure that the transition to a higher level of diversified care is smooth and does not adversely affect either the patients or staff members. Health technology assessment can also be used to predict the economic benefits and disadvantages to taking on new technologies within the organization, by putting into context the number of patients that can be helped, potential income, and the cost of providing these services.
Dubois, Singh, & Jiwani (2008) note that there is a major human resource challenge in diversified care. This means that there may not be enough staff who are able to meet the needs of the patients and provide the levels of care required. In this sense, the human resources issue must be addressed first when assessing the potential diversification of the organization, and this should be a key focus of organizational management who are attempting to address the issue. Novella (2010) suggest that mental health care is, again, one of the biggest challenges facing organizations who want to diversify their provisions, and that it is human resources that provides the biggest challenge. Mental health care requires a large number of personnel with different specialties and skills, and this needs to be incorporated into a large and diversified workforce. Again, there is a need to focus on the personnel rather than the actual services or equipment.
Options in Diversified Care
One group of patients that stands to gain from the diversification of health care teams is those with chronic disease. Patients with chronic disease often require multidisciplinary care over long periods of time, making them important in terms of the financial success of the organization (). Harris & Zwar (2007) note that one of the biggest challenges in terms of diversification is that there is a lack of physical infrastructure that supports the diversification of the workforce, making these patients a challenge for the organization and reducing the standard of care that they are receiving. Ayres et al (2006) notes that comprehensive health care in terms of those living with HIV/AIDS is one of the areas in which diversification can provide the most benefits to patients, but that organizations are not generally equipped to meet all these needs in house. The challenge is first asserting the needs of the patients and understanding what services need to be provided, then identifying the equipment and personnel required to meet these needs. This requires a large-scale analysis of the organization.
The next challenge is assessing whether it is most appropriate (financially and logically) to provide these services in-house, or whether it is more appropriate to delegate services (Saami et al., 2008). Whilst it is more beneficial in some cases for an organization to offer the “whole package”, this may not be logical or even possible in some cases. The biggest challenge is ensuring that the right amount of work is delegated to outside organizations whilst still remaining competitive with these organizations and larger ones that can and do provide a consistent, in-house set of services for dealing with chronic patients and/or those with complex needs (). It may be appropriate, for example, to provide all of the services needed for a diabetes patient in-house but hire an independent contractor to deal with glaucoma, still using the hospital equipment but to reduce the load on other optometrists (). This challenge is one that requires significant amount of analysis on the part of the organization and there is no set model which is ideal for making these plans and assessments. This will be the focus of the current research.
Mental health care is one of the fastest moving areas of health care, and there is a definite need for organizations to meet the diversification needs of these patients. Robiner (2006) notes that there has been a diversification in the types of health care professional required for treatment, as well as in the nature of mental illness itself. This is a significant challenge to organizations that do not have the internal structure required to support these patients. Children’s mental health care is a particularly complex area of provision, with significant case complexity and long wait list (Reid & Brown, 2008). Again, the challenge here is that organizations need to ensure that the care is being given to these patients whilst still ensuring the security of the organization from a financial and logical perspective. This will be discussed at length during the current research.
Summary
Overall, there is a clear need to provide health care administrators with a template to follow when implementing services that involve the diversification of staff and/or technologies. The evidence from this literature review highlights this need, as there is no clear implementation protocol that can be used to allow for the diversification of health care nor for the implementation of multidisciplinary teams. There are two main areas where health care providers need to focus. Mental health care requires the involvement of several different professionals and these professionals need to be working together well to provide the full range of services. In chronic health care, there is also a need to provide a variety of different services to meet the needs of the customer to remain competitive in the market. Overall, the evidence shows that there are clearly issues with providing this type of diversified care but that the provision of this type of care allows for better organizations in general. It also has the potential to make staff members happier and to have more education in their field. More research is needed to assess the best way of implementing and approaching diversified health care.
References
Devaraj, S., Ow, T. T., & Kohli, R. (2013). Examining the impact of information technology and patient flow on healthcare performance: A Theory of Swift and Even Flow (TSEF) perspective. Journal of Operations Management, 31(4), 181–192.
Mosser, G., & Begun, J. W. (2014). Understanding teamwork in health care. McGraw-Hill. Retrieved from http://www.accp.com/bookstore/product.aspx?pc=LA_01UTHC
Ayres, J. R. de C. M., Paiva, V., França Jr, I., Gravato, N., Lacerda, R., Della Negra, M., others. (2006). Vulnerability, human rights, and comprehensive health care needs of young people living with HIV/AIDS. American Journal of Public Health, 96(6), 1001–1006.
Baldwin Jr, D. C., & Baldwin, M. A. (2007). Interdisciplinary education and health team training: A model for learning and service. Journal of Interprofessional Care, 21(sup1), 52–69.
Dubois, C.-A., Singh, D., & Jiwani, I. (2008). The human resource challenge in chronic care. Caring for People with Chronic Conditions: A Health System Perspective, 143–171.
Fay, D., Borrill, C., Amir, Z., Haward, R., & West, M. A. (2006). Getting the most out of multidisciplinary teams: A multi-sample study of team innovation in health care. Journal of Occupational and Organizational Psychology, 79(4), 553–567. http://doi.org/10.1348/096317905X72128
Harris, M. F., & Zwar, N. A. (2007). Care of patients with chronic disease: the challenge for general practice. Medical Journal of Australia, 187(2), 104.
Lega, F. (2007). Organisational design for health integrated delivery systems: Theory and practice. Health Policy, 81(2–3), 258–279. http://doi.org/10.1016/j.healthpol.2006.06.006
McCrae, N. (2012). Whither Nursing Models? The value of nursing theory in the context of evidence-based practice and multidisciplinary health care. Journal of Advanced Nursing, 68(1), 222–229. http://doi.org/10.1111/j.1365-2648.2011.05821.x
Meads, G., Wild, A., Griffiths, F., Iwami, M., & Moore, P. (2006). The management of new primary care organizations: an international perspective. Health Services Management Research, 19(3), 166–173. http://doi.org/10.1258/095148406777888125
Noordegraaf, M. (2011). Risky Business: How Professionals and Professional Fields (Must) Deal with Organizational Issues. Organization Studies, 32(10), 1349–1371. http://doi.org/10.1177/0170840611416748
Novella, E. J. (2010). Mental health care in the aftermath of deinstitutionalization: a retrospective and prospective view. Health Care Analysis, 18(3), 222–238.
Reid, G. J., & Brown, J. B. (2008). Money, case complexity, and wait lists: Perspectives on problems and solutions at children’s mental health centers in Ontario. The Journal of Behavioral Health Services & Research, 35(3), 334–346.
Robiner, W. N. (2006). The mental health professions: Workforce supply and demand, issues, and challenges. Clinical Psychology Review, 26(5), 600–625.
Saarni, S. I., Hofmann, B., Lampe, K., Lühmann, D., Mäkelä, M., Velasco-Garrido, M., & Autti-Rämö, I. (2008). Ethical analysis to improve decision-making on health technologies. Bulletin of the World Health Organization, 86(8), 617–623.
Salge, T. O., & Vera, A. (2009). Hospital innovativeness and organizational performance: Evidence from English public acute care. Health Care Management Review, 34(1), 54–67. http://doi.org/10.1097/01.HMR.0000342978.84307.80
Sultz, H. A., & Young, K. M. (2006). Health care USA: Understanding its organization and delivery. Jones & Bartlett Learning. Retrieved from https://books.google.ca/books?hl=en&lr=&id=3edcd3cNUL0C&oi=fnd&pg=PR7&dq=models+diversification+multidisciplinary+health+care+organization&ots=l8bCqgdObF&sig=_rr2lX33AjlC1qVMqpx-IBzY6ow
