What Influences Healthcare Policy at National Levels

Structure and Process in Health Care Organizations and Health Care Policy

Introduction

The structure and process in health care organizations is inherently tied to health care policy, the aim of which is always to provide the best quality care to patients that is possible. For that aim, the structure of health care organizations, their inherent processes, and the overarching health care policies all serve important parts in determining the outcome of the patient experience. They impact accessibility and affordability of care; they affect the efficiency of care delivery. This paper examines the interrelatedness of these elements—structure, process, and policy—to show how they act to serve the patient.

Structure of Health Care Organizations

From primary care clinics to specialized hospitalizations and rehab centers, structure determines operations. Even field hospitals rely upon a set structure in the care of patients. No matter whether it is an emergency situation or setting, or one in which care is determined months in advance, structure is essential. Structure is how everyone knows role and responsibility, and typically a hierarchy of roles is established within that structure, and operational systems are implemented.

Thus, at the top of most structures one finds the administrative level, where executives and board members make decisions about the business and corporate strategy for the organization (Luciano et al., 2020). This is where direction and policies are determined. Below this level, one finds management and department heads of staff; the next level down consists of clinical staff members, such as physicians, nurses, and techs. At every level, for every role, there are formulated and defined responsibilities, jurisdictions, and expectations. This is all established and communicated to maintain order and functionality within and throughout the organization as a whole.

Operational systems are set up for patient registration, medical record keeping, billing, and other administrative tasks. These systems need to be efficiently organized and operated so as to keep services functional and so as to provide patients with satisfaction on the administrative side of care provision. These operations are also essential in assisting the organization with maintenance of its own financial stability.

Overall, the structure of a health care organization is not static and it will change in accordance with the business plan, strategy, and goals of the organization. It will change based on the needs of the patient population, advancements in medical technology (such as the adoption of telehealth services), and changes in health care policies (such as regulations regarding scope of practice laws for Advanced Practice Registered Nurses). Nonetheless, a well-structured organization can adapt to these changes, and continue to provide services and quality care to all patients.

Processes in Health Care Organizations

Processes in health care refer to the series of actions taken to provide care to patients (Teisberg et al., 2020). These processes include patient intake, diagnosis, treatment, discharge, and follow-up. Everything that happens from the moment the patient presents to the conclusion of the follow-up counts as part of this process. The first stage of the process, therefore, is where patients are registered, their medical histories are taken, and initial assessments are made. Based on the initial assessment, further tests might be conducted, a diagnosis made, and subsequent treatment plan developed and implemented. Once treatment is complete, patients are discharged with instructions for home care, prescriptions for medications may be given, and follow-up appointments set.

Processes need to be efficient for the sake of patient safety and patient satisfaction (Gavurova et al., 2020). If there are hiccups at any point in the process, from reception to discharge and follow-up, the patient may feel ignored, a negative impression may be formed of the organization itself, required treatment could be delayed, and patient health could suffer. In simple terms, for example, a streamlined patient intake process can reduce wait times, and an effective discharge process can reduce hospital readmissions. The inverse can also be true, and that is what processes should strive to avoid.

Efficiency, timeliness, regard for safety of the patient, regard for the morale and stamina of staff (so as to avoid nurse burnout and any nursing errors that could result from it), and proper oversight are all essential aspects of process support in healthcare. Evidence-based guidelines and protocols should be implemented so that the care provided meets the highest industry standards. For example, a standardized treatment pathway for patients with chronic conditions like diabetes or hypertension would be part of a structured process that all patients dealing with this particular health issue would receive, and the approach would be in line with the latest medical research and guidelines (Saunders et al., 2019).

Health Care Policy

Health care policy is a broad term, but generally speaking it encompasses the decisions, guidelines, plans, and actions designed to support healthcare workers in achieving specific health care goals (World Health Organization, 2021). These policies can be formulated at the local, state, or national level and can cover a range of issues. They may be developed international or within one’s own organization. Typically, however, they focus on issues such as accessibility of care, quality of care, and cost of care. Due to legislation, regulation, political factors, and economic factors, policies can be divisive, confusing, unwarranted, and problematic (see, for instance, the way some still disallow APRNs from practicing to the full scope of their training and education—in spite of recommendations from the Institute of Medicine urging regulators to permit these nurses to practice to their full scope). Scope of practice restrictions are determined at the policy level according to input from various parties, lobbyists, and activists—and it can be a challenge to have helpful policy implemented and unhelpful policy overturned (Cuccovia et al., 2022). This is a challenge for all stakeholders.

Oftentimes, politicians and advocacy workers will focus on policies that can help stakeholders improve healthcare. For example, policies that determine who can access health care, under what conditions, and at what cost, are often the focus of different groups. Due to various inputs from insurance lobbyists and other corporate lobbyists, these policies can be hampered and left in limbo for many years.

However, other policies look at the standards and regulations to which health care providers must adhere in order to make sure that patients are receiving the best possible care. These policies can set down terms for providing preventive care in order to receive reimbursements from the government, for instance, as was the case with the Affordable Care Act. Still, policy implementation is one thing and policy enforcement quite another. Just because a policy is passed into law does not mean it will be well-regulated. Too many policies and too little regulation can actually do more harm than good in the healthcare sector, as it allows bad actors to assume that no one is watching and that they can get away with unethical activity. This is one reason the opioid crisis bloomed out of untenable over-prescription as a result of pharmaceutical companies giving kick-backs to physicians.

Furthermore, decisions related to health care financing, including insurance coverage, government subsidies, and patient out-of-pocket expenses, are sometimes set in policies like the Affordable Care Act. But as one administration moves out of power and another moves in, policies can change or be caught in a perpetual state of overhaul so that healthcare organizations are constantly in a state of reaction to whatever new update or change in a policy has been made. This can draw on healthcare organizations’ resources and lead to serious capital crunches, which is one reason so much consolidation has occurred in the healthcare space in recent years: it is simply impossible for many smaller organizations to exist in the face of so much regulatory change and pressure as they do not have the resources to keep up.