Accountability in Healthcare

Healthcare Industry Accountability Beckham Company After having read your article entitled the accountability crisis in healthcare, one may have several observations and suggestions concerning both the content and conclusions contained within. First are the generalizations indicting the healthcare industry, (particularly the not-for-profits), in terms of the alleged fragmentation between the parts that make up the whole; namely, according to your text, physicians, hospitals and insurers. One may also take umbrage at examples you employ to ensure accountability.

While they appear on the surface to be worthy of merit, closer examinations reveal weaknesses in areas that may not be evident at first consideration. Finally, it appears that many of the examples cited as support for one point-of-view may support the opposing point-of-view equally as well. Let us examine the text more closely based on these issues. The major generalizations made in the text are as follows: Nobody is in control because they (the healthcare providers) operate independently of each other. (the different areas of healthcare provider) 2.

Everyone owns just a piece so no one feels responsible to the whole 3. Human beings and communities do not exist as fragments. Stating that nobody is in control because they operate independently is similar to stating that because the spark plugs operate independently of the carburetor the engine cannot run. One may counter with the opposing argument and assume that because "they" operate independently each is more likely to have distinct control and therefore contribute to the greater overall accountability of the whole.

According to Leatherman in her article, Measuring up: performance indicators for better healthcare, "one of the key problems is the sheer weight of new knowledge." Imagine if each "fragmented" area of healthcare were responsible for the whole of this knowledge and its accompanying regulatory requirements prior to the delivery of their particular segment of care. The task would cripple healthcare providers. Leatherman states, "Improving the performance of healthcare systems is becoming a priority in many countries as a result of economic pressure to optimize health spending ..

" This appears to be an important argument to support a view opposite of generalization number 2. Every holder of a piece has a vested stake in being part of the whole and must be involved to insure the value and continuity of the piece he holds. One may find generalization number 3 too broad to speak too without understanding the context from which it is derived. That context is not explained in the text of your paper, Mr.

Beckman, however one may offer that a poor mother on welfare whose child cannot receive a needed prosthetic because the item does not qualify under her plan is not a member of the same community as Mr. CEO, whose health coverage extends into the world of unlikely occurrence. That said one might move forward to address the examples used to support the above generalizations. They include the following: 1. The Athens story 2. The lack of laws and legal requirements concerning Medicare 3. Beth Israel 4. Quorum Health 5.

Space and time In the Athens example, the oath asks that the young men of the city leave the city better than they found it.

If there is, "no better notion of accountability" than this, then might one assume that any healthcare organization striving to achieve the betterment of community as a goal is meeting this aspect of accountability? Moreover, if so, then to whom are they demonstrating that accountability? Is it to themselves or to the community -- and to which community? With regard to the lack of laws governing Medicare, if one would take a brief walk into any nursing facility or hospital in their community and request a copy of the Health Department Survey they would understand the voluminous regulation that the healthcare provider must be in compliance with, to simply be paid.

(HCFA, 2003). There is no accountability issue in that respect. Healthcare facilities must comply or lose their licensing. Is this not an issue of accountability similar to the Quorum Health example? The example of Beth Israel used in your text, Mr. Beckman, suggests that the organization has empowered employees on every level of decision-making. One might ask how accountable an organization can be with such autonomy. This example also seems to contradict the "fragmentation" argument.

Can there be unity in autonomy? Quorum Health is cited as an example of accountability yet one must understand that this type of financial accountability is a contradiction to the requirement that the "community" understand and be a part of the whole. Quorum Health is insuring that its stockholders know that it is financially viable. That does not translate into measurable accountability in the community, with the exception of those interested in only the financial aspect of their healthcare provider.

The most curious argument used to illustrate accountability is that conveyed in the Oxford story. The college.