Resolving a Complex Patient Complaint (huc3)

HCA 3305, Health Unit Coordination 1

Course Learning Outcomes for Unit III Upon completion of this unit, students should be able to:

3. Distinguish between the roles of health care team members. 3.1 Describe the different professions that comprise a health care team. 3.2 Determine what qualifies an occupation as professional. 3.3 Differentiate between the different departments within a hospital and services provided to

patients. 3.4 Explain the importance of teams and team building in health care. 3.5 Examine the contribution of telemedicine to present-day health care. 3.6 Explore the importance of hospital case management in terms of progression of care, hospital

discharge, and preventing readmissions.

Course/Unit Learning Outcomes

Learning Activity

3.2, 3.4, 3.5, 3.6

Unit Lesson Chapter 10 (2 sections) Chapter 23 Article: “Telemedicine in the United States: An Introduction for Students and

Residents” Article: “Hospital Case Management and Progression of Care” Unit III Assessment

3.1, 3.3 Unit Lesson Unit III Assessment

Required Unit Resources Chapter 10: When the Employees Are Professionals—Read the following sections:

• Nonhealth Professionals in Health Care • The Essential Team Approach

Chapter 23: Teams, Team Building, and Teamwork In order to access the following resources, click the links below. Hyder, M. A., & Razzak, J. (2020). Telemedicine in the United States: An introduction for students and

residents. Journal of Medical Internet Research, 22(11), Article e20839. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690251/

Daniels, S., & Frater, J. (2011, August). Hospital case management and progression of care. Healthcare

Financial Management, 65(8), 108–113. https://link.gale.com/apps/doc/A269921337/AONE?u=oran95108&sid=bookmark- AONE&xid=b7a18b7b

Unit Lesson The health care team and a health care system are comprised of many different roles and departments working together collaboratively to care for patients. Understanding the function of each different role and department is vital to health unit coordination because each team member and department has a unique set

UNIT III STUDY GUIDE Health Care Roles and System Departments

HCA 3305, Health Unit Coordination 2

UNIT x STUDY GUIDE Title

of skills and training or a distinctive purpose in the patient’s care. As a leader, one must understand the intricate functioning of all to run their unit smoothly. Telemedicine is rapidly expanding in contemporary health care, becoming a necessity for the health care system. As such, understanding telemedicine, its role, and its limitations is also necessary for the health care leader.

Health Care Roles

In beginning to explain various health care roles, one will quickly establish that some roles require formal college education and/or licensure, while others do not. Further, some disciplines are considered professional, while others are not. Therefore, exploring what is considered a professional is a useful place to begin. McConnell (2019) indicates some important legal characteristics of a professional include advanced knowledge, creative latitude, engagement in the education of others, and work that requires reasoning and decision-making at least 80% of the time. Typically, but not always, professional roles are salaried, and overtime is not paid. In addition to work duties, professionals typically possess an academic degree and/or licensure/registry, do work that is considered technical or advanced, and may be involved formally or informally in training others (McConnell, 2019). Providers Usually, care and treatment are orchestrated and overseen by physicians. Physicians can either be MDs, which means they graduated from a medical doctor program, or DOs, who graduate from an osteopathic medicine program (MedlinePlus, n.d.). There are several key differences between the MD and DO programs, but primarily, the DO program is considered more holistic, more focused on preventative care (“MD vs. DO,” 2021). Each type of program is 4 years in length after completing 4 years of undergraduate study, and each culminates in licensure. If a physician chooses to continue their formal education, they may specialize in many different types of medical practice through a residency and board certification. Some examples include but are not limited to anesthesiology, cardiology (care of the heart), dermatology (care of the skin), gastroenterology (care of the digestive tract), surgery, infectious disease, nephrology (care of the kidneys), neurology (care of the brain and nervous system), oncology (cancer), ophthalmology (care of the eye), pulmonology (care of the lung), urology (care of the urinary tract) (MedlinePlus, n.d.). Midlevel providers are increasing in prevalence and provide a broad array of services to patients, typically in collaboration with or under the supervision of a physician. Examples include nurse practitioners (NPs), who are graduate-prepared nurses; physician assistants (PAs); certified nurse midwives (CNMs), who are graduate-prepared nurses who specialize in prenatal care and labor and delivery; and certified registered nurse anesthetists (CRNAs), who are graduate-prepared nurses who have advanced training in the field of anesthesia (MedlinePlus, n.d.). Nursing Nurses are either registered nurses (RNs) or licensed practical nurses (LPNs), and nursing support is provided by certified nursing assistants (CNAs). RNs, LPNs, and CNAs can work in a wide variety of care settings, such as hospitals, clinics, camps, schools, surgery centers, nursing homes and rehab centers, and serve many different types of patients. RN and LPN training varies in length and type of program, but both disciplines are required to pass board examination to obtain licensure. RN programs can be diploma programs run through hospitals that do not result in a college degree, associate degrees, or bachelor’s degrees. There are more than 100 different nursing specializations, including but not limited to camp nurse, cardiac catherization lab nurse, clinical nurse specialist, community health nurse, corrections nurse, diabetes educator, dialysis nurse, emergency nurse, flight nurse, geriatrics nurse, hospice nurse, informatics nurse, legal nurse consultant, med-surg nurse, neonatal intensive care nurse, nurse executive, occupational health nurse, parish nurse, pediatric nurse, psychiatric nurse, rehabilitation nurse, sexual assault nurse examiner, and travel nurse (Guide to Nursing, 2022). Non-Nursing Professional Roles Non-nursing roles that are typically considered professional roles include respiratory therapists, rehab specialists, social workers, psychologists, dietitians, and pharmacists. Respiratory therapists (RTs) provide care to patients targeted at improving their respiratory function when suffering from a wide variety of disorders such as asthma, emphysema, and chronic obstructive pulmonary disease (Nursing OnPoint, n.d.). The entry-

HCA 3305, Health Unit Coordination 3

UNIT x STUDY GUIDE Title

level degree is an associate degree. Some of an RTs’ duties include assessing pulmonary functions, drawing arterial blood gases, giving nebulizer treatments, providing oxygen via a multitude of mechanisms, and taking care of patients on ventilators. Rehabilitation specialists include physical therapists (PTs), occupational therapists (OTs), and speech- language pathologists (SLPs). The entry-level degrees for these professions used to be a master’s degree but there is a shift toward the doctoral degree for entry into these professions (Nursing OnPoint, n.d.). Rehabilitation specialists also work in a variety of clinical settings, including hospitals, nursing homes, rehab centers, outpatient clinics, and even patients’ homes. In general, rehab specialists focus on restoring physical function, movement, and management of pain. Specifically, PTs typically focus on the lower extremities and ambulation, while OTs focus on the upper extremities, fine motor skills, and activities of daily living. SLPs’ major focuses are speech and swallowing (Nursing OnPoint, n.d.). A social worker’s entry-level degree is a bachelor’s degree, although many go on to pursue a master’s degree or even doctoral-level study. Social workers also work in a variety of settings, including hospitals, mental health facilities, clinics, schools, research, shelters, physician practices, the criminal justice system, and patients’ homes. In these settings, social workers assist patients with very complex needs such as discharge planning, food and medication security, mental illness, substance abuse, shelter needs, and issues surrounding abuse and neglect. Further, Proctor (2017) indicates social workers’ interventions focus primarily on behavioral, cognitive, or emotional well-being such that symptoms are lessened, function is improved, or well-being is attained. There are psychology degrees at the associate, baccalaureate, and master’s degree level, but psychologists typically have either a PhD or a doctorate in psychology (PsyD) degree (Cherry, 2021). Psychologists participate in the assessment, diagnosis, treatment, and prevention of mental illness, substance abuse, and other behavioral health issues (Wahass, 2005). Wahass indicates there are several subspecialties in psychology, including clinical psychology, medical psychology, clinical neuropsychology, counseling psychology, rehabilitation psychology, pediatric psychology, and community psychology. Registered dietitians (RDs) hold at least a bachelor’s degree, but in 2024, the entry level degree for an RD is increasing to a master’s degree (NutritionEd.org, 2021). Additionally, to become registered, one must complete 1,200 hours of clinical work and successfully pass the national certification examination. Dietitians work in hospitals, clinics, nursing homes, public health, or research domains. Dietitians are involved in planning and educating the specific diets for patients experiencing such concerns as diabetes, malnutrition, or eating disorders. The four main specialties for an RD include clinical dietitian, food service management dietitian, community dietitian, or research dietitian (NutritionEd.org, 2021). Pharmacists have a doctoral-level entry degree requirement and must pass two exams to become licensed (U.S. Bureau of Labor Statistics, 2021). Pharmacists are responsible for dispensing medications to patients and provide education as well as expertise to prescribing providers. Pharmacists work in hospital pharmacies and other health care facilities, stores, or research entities. Non-Nursing Support Roles Non-nursing roles that are typically considered supportive in nature include home health aides, medical assistants, and phlebotomists. Home health aides (HHAs) typically are only required to have a high school diploma but most of them complete a training program typically offered at community colleges and vocational centers. Usually, HHAs provide care to patients in their homes under the direction of an RN. The type of care they provide ranges from personal care, day-to-day home duties, taking patients to a doctor’s office or other appointments, and supervising the management of recommended drugs for the patients (Goettel, 2022). Medical assistants (MAs) work under the direct supervision of a physician, most often in a physician’s outpatient office. According to Fraher et al. (2021), there were almost 674,000 MAs practicing in this country in 2018. The educational requirement for MAs is loose, in that some have a vocational certificate, some have a 2- or 4-year degree, and others just received on-the-job training. There is also high variability in the job description and duties of an MA, but most provide direct patient care in the office setting, educate patients, document and scribe for physicians, draw blood, and administer vaccines (Fraher et al., 2021).

HCA 3305, Health Unit Coordination 4

UNIT x STUDY GUIDE Title

Phlebotomists are charged with drawing patients’ blood. Phlebotomy training programs require a high school diploma or GED and are typically just a few weeks in duration and can be taken at hospitals, vocational centers, and community colleges (Vocational Training HQ, 2022). There is a certification available, but it is not always required to gain employment. Phlebotomists typically work in hospitals, clinical laboratories, doctor’s offices, nursing homes, blood donation centers, public health agencies, or research entities.

Hospital Departments Hospitals and health systems are comprised of many different departments that can be subdivided into clinical and nonclinical departments. Included in clinical departments are the inpatient wards such as the emergency department, intensive care unit, and all the different nursing units where patients can be admitted such as cardiology, neurology, oncology, labor and delivery, pediatrics, and medical-surgical units (Hansen, 2019). Most all hospitals have a surgery department that has preoperative areas where patients are readied for surgery, operating suites, and a post-anesthesia care unit where patients are cared for immediately after surgery. Other clinical areas are considered ancillary departments such as pharmacy, rehabilitation, radiology, and the laboratory. Nonclinical departments include dietary, housekeeping, transport, medical records, and administration (Hansen, 2019). Some other nonclinical departments worth discussing include case management, risk management and quality, and the departments involved with the revenue cycle. These departments provide vital services necessary to patients, reimbursement, and/or regulatory compliance. The case management department is typically comprised of RN case managers, social workers, and case management assistants. Case management is involved with patients in terms of care coordination, progression of care, utilization review, and discharge planning. Daniels and Frater (2011) indicate that the case management department serves to assist with the patient flow through the continuum and combat the fragmentation of care that exists in most hospitals and communities. By bridging the gap between the hospital and the outpatient world, case management assists patients and physicians by directing the treatment plan towards ultimate discharge, identifying barriers to safe discharge, advocating for patients and families, and assisting with many types of transitions of care.

Risk management and quality departments have a myriad of responsibilities in a hospital. Risk managers identify risks, investigate issues, manage patient complaints, perform compliance reporting, educate physicians and staff, and serve as the bridge between the hospital and regulatory bodies as well as legal entities (“What Is Risk,” 2018). Further, the eight areas involved in an overall risk management program should include operations, clinical and patient safety, strategic, financial, human capital, legal and regulatory, technological, and environmental and infrastructure-based hazard mitigation. Working in collaboration with risk management, the quality department is usually staffed by RNs who focus on ensuring evidence-based care is ordered and given to patients (Hukari, 2015). The quality department completes a myriad of regular audits and provides a substantial amount of education to physicians and nurses. The hospital revenue cycle includes every step in the process of a hospital being reimbursed for care provided to patients. Specifically, it starts with the patient presenting to the hospital and ends when the hospital is fully paid for all services rendered. The seven steps in the process include pre-registration, registration and insurance verification, charge capture, claim submission, remittance processing, insurance follow-up, and patient collections (Carney, 2021).

Hospital departments include patient access, an insurance team, verification team, utilization review department, billing, accounts receivable, coding, auditing, denials and appeals, and patient collections.

HCA 3305, Health Unit Coordination 5

UNIT x STUDY GUIDE Title

Teams and Team Building

As you can see, many disciplines and departments interact to provide care to patients. As such, it is imperative that new health care leaders understand the value of working on a team, team building, and team leading. According to McConnell (2019), teams in health care are either comprised of people from different departments and disciplines or a departmental team made up of individuals from the same unit with the same leader. Developing and managing teams requires finesse. Some key rules to keep in mind are to never allow teams of employees to work on responsibilities related to wages or working conditions as these topics should be solely reserved for management. Never force employees to be a part of a team. Do not allow teams to only focus on complaints. And always provide teams with clear guidelines and objectives. McConnell (2019) emphasizes the benefits gained from team building, including increased efficiency and excellence, improved morale, and a better overall work environment. The stages of building a team include formation, disequilibrium, role definition, maturity, and maintenance.

It is important to note that some teams never progress past the disequilibrium stage. Doing so requires skill and leadership, as well as a people-centered focus (McConnell, 2019). Finally, McConnell indicates that the

HCA 3305, Health Unit Coordination 6

UNIT x STUDY GUIDE Title

most vital aspect to determine whether a team is successful or not is the leadership style of the department or team’s leader.

Telemedicine

Arguably, the future of health care almost certainly includes telemedicine. Hyder and Razzak (2020) define telemedicine as health care that is given or provided from a distance. For example, telemedicine now allows patients to connect with nurses or providers via phone or video chat. Physicians can even evaluate patients through video software designed to allow comprehensive assessment of patients. While telemedicine has existed somewhat sluggishly over the last few decades, the COVID-19 pandemic caused a surge in its existence. Specifically, Hyder and Razzak indicate that at least 76% of all hospitals use telemedicine in some way to care for their patients. Telemedicine platforms are used in the care and treatment of stroke patients, within radiology departments, and in the field of psychiatry. Outside of the hospital, telemedicine is also used by patients to connect with their providers from home. Recently, both commercial and government payers have adjusted their contracts to allow for a greater use and reimbursement of telemedicine services. Key concerns and limitations of telemedicine are noteworthy. There are privacy and data concerns. Moreover, it is even more challenging to ensure quality of care in the telemedicine environment compared to care for patients in the hospital or office setting. There are access concerns, especially for older patients who may not understand how to use the technologies associated with telemedicine. Also, there is a loss of non-verbal cues between patients and providers. Lastly, there are physician-licensing challenges that can hinder telemedicine given that each states require a separate license for physicians.

Conclusion

The preceding lesson focuses on the primary roles and disciplines found in the health care industry. Understanding these roles is important for a new health leader who will be challenged to work with many different people to achieve common goals. It is also essential to understand key departments within a hospital to be able to assist one’s own unit as well as attempt to assist patients in navigating the system. Given the wide variety of people with which a health care leader will interact, understanding key concepts related to leading and working in teams as well as team building is crucial. Finally, some experts argue that telemedicine is at the heart of the future of health care. Understanding this technology, as well as the barriers, is vital for a health care leader.

References Carney, K. (2021, July 13). The seven steps of revenue cycle for a healthcare practice. Nashville Medical

News. https://www.lbmc.com/blog/revenue-cycle-health care-practice/ Cherry, K. (2021, July 27). 5 types of psychology degrees. Verywell Mind.

https://www.verywellmind.com/psychology-degrees-2795151 Daniels, S., & Frater, J. (2011, August). Hospital case management and progression of care. Journal of the

Healthcare Financial Management Association, 65(8), 108–113. https://www.researchgate.net/publication/51595042_Hospital_case_management_and_progression_ of_care

Fraher, E. P., Cummings, A., & Neutze, D. (2021, February). The evolving role of medical assistants in

primary care practice: Divergent and concordant perspectives from MAs and family physicians. Medical Care Research and Review, 78(1 Suppl.), 7S–17S. https://doi.org/10.1177%2F1077558720966148

Goettel, D. (2022, May 7). What does a home health aide do? PracticalAdultInsights.

https://www.practicaladultinsights.com/what-does-a-home-health-aide-do.htm Guide to nursing specializations and concentrations. (2022, January 20). NurseJournal.

https://nursejournal.org/resources/nursing-specialties-guide/

HCA 3305, Health Unit Coordination 7

UNIT x STUDY GUIDE Title

Hansen, A. (2019, November 7). The importance of different departments in a hospital. Gilbert Hospital. https://www.gilberter.com/2019/11/07/departments-in-a-hospital/

Hukari, D. (2015, January 27). What does the quality management department do at the hospital?

MyMotherLode. https://www.mymotherlode.com/news/health-articles/does-quality-management- department-hospital

Hyder, M. A., & Razzak, J. (2020). Telemedicine in the United States: An introduction for students and

residents. Journal of Medical Internet Research, 22(11), Article e20839. http://dx.doi.org/10.2196/20839

McConnell, C. R. (2019). The effective health care supervisor (9th ed.). Jones & Bartlett Learning.

MD vs. DO: Which is better and what are the major differences? (2021, November 4). BeMo.

https://bemoacademicconsulting.com/blog/do-versus-md MedlinePlus. (n.d.). Types of health care providers. National Library of Medicine.

https://medlineplus.gov/ency/article/001933.htm Nursing OnPoint. (n.d.). Non-nursing healthcare professions. https://nursingonpoint.com/education/nursing-

degrees-guides-to-practice/advanced-degree-comparisons/ NutritionEd.org. (2021). What is a dietitian? https://www.nutritioned.org/what-is-a-dietitian/ Proctor, E. (2017, Fall). The pursuit of quality for social work practice: Three generations and counting.

Journal of the Society for Social Work and Research, 8(3), 335–353. https://doi.org/10.1086/693431 U.S. Bureau of Labor Statistics. (2021). Pharmacists. In Occupational Outlook Handbook.

https://www.bls.gov/ooh/health care/pharmacists.htm Vocational Training HQ. (2022). How to become a phlebotomist: The definitive guide.

https://www.vocationaltraininghq.com/how-to-become/phlebotomist/#Education Wahass, S. H. (2005, May–August). The role of psychologists in health care delivery. Journal of Family &

Community Medicine, 12(2), 63–70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410123/ What is risk management in healthcare? (2018, April 25). New England Journal of Medicine Catalyst.

https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0197