Internal & External Forces The author of this report is asked to answer to a number of questions relating to the forces that exert themselves on a nursing or other medical organization, the source of the forces and what effect they can have on outcomes and decision-making in a medical organization. There will be total major internal forces, two major external sources and an overall assessment of the impacts these forces can and will have on things like strategic decisions, financial solvency and so on. While most external and internal forces are not terribly impactful on future outcomes and decisions relating to medical organizations, there are some major ones like the recent Affordable Care Act and recessions that can have a major and/or detrimental impact on the organization's outcomes and its people.

Analysis

As suggested by the parameters of the assignment, one major external force relating to medical care and medical organizations are legal regulations and laws. One perfect example of this is the Patient Protection and Affordable Care Act (PPACA), also often referred to as ObamaCare. There has been some good news regarding the PPACA. One example would be that the overall number of uninsured people is trending downwards (Britt, 2014). However, the PPACA has also manifested in a lot of public opposition to the law even four years after it was passed in 2010 and other problems such as major issues with the Healthcare.gov website and many delays in mandates and regulations relating to the law. Changes in the law including a lift on the cap on overall lifetime benefits as well as minimum standards for all newly issued policies going forward has also created a loss of wiggle room with medical providers and locations. The impact of the law is something that happens in many forms and functions at the state and federal levels.

Another major external force, also as noted before, are when economic recessions strike the country. This particular external force manifests itself in a number of ways including people not being able to afford even necessary medical care as well as people being more apt to put off medical care due to not being able to afford insurance and/or copays or even other things that are considered life necessities. This pattern of spending (or lack thereof) can negatively affect the bottom line of medical organizations because people in need of healthcare cannot (ethically or legally) be turned away just because they are unable to pay. Of course, procedures that are voluntary and/or cosmetic in nature are different but anything related to life and death or quality of life (in general) has to be paid for on some level regardless of the ability or inability to pay of the patient who needs care. However, even medical locations that are not required to offer some/all pay on a compulsory/ethical/legal basis are going to sail smoothly during rougher economic times. After all, people are more apt to get a nose job if they have a lot of free spending cash and they will be less apt to do so, all else equal, if money is a bit lacking.

To somewhat lump the two external force types above together, the plans and direction of a medical organization can take a major turn if/when external conditions like economic patterns, spending patterns and legal intervention/law passage come to pass and thus affect, by matter of necessity or even matter of direct law, and the organization must react. For example, it was standard practice for years to make people wait for coverage of preexisting conditions but that was strictly disallowed in the snap of a finger when the ObamaCare legislation was paid (Healthcare.gov, 2014). Along the same notion, economic conditions went from fairly good to awful in the span of a year from January 2007 to December 2007 and then it went even further south from there and the national economy is still digging out of that hole in many ways.

As for internal forces, one major internal force that can guide a firm in a good way or a bad way is buy-in (or lack thereof) in changes that are coming or are in progress at a firm. Of course, if the front-line employees of a firm are not on board with the changes that are currently happening or that are to come, the chances of the change or changes in question going off without major negative consequences and/or outcomes is fairly low. The only sure...

A related but different example of internal forces helping or hurting the outcomes of a firm are morale changes within the firm. The thing about employee morale is that changes or events that cause morale shirts within a firm are not always within the immediate control (if any control at all) of the firm. For example, examples that are not really in control of the firm would be recession/industry problems, workplace shootings or the death of a coworker.
However, a lot of factors and events that cause shifts in morale are entirely preventable and creatable but this must be done with great care. Often times, there are situations where doing something that is "good for business" is not always going to go over well with the employees. For example, if healthcare costs are soaring a lot higher and a major way to combat this is to raise the premiums paid by the employees, that may make business sense but would obviously run afoul of many to most of the employees who will have to pay the higher premiums. On the other hand, some firms make it a point to pay performance or Christmas bonuses as a means to incentivize and reward performance. They do this not because of "business need" or because they are legally bound to do so, but because they want to retain and reward good workers and motivate those that do not perform as well. Compensation is just one thing that can raise the ire or favor of many of employees and sometimes perceptions can hurt employee morale and the health of the firm worse than any facts. The medical field is no different as it relates to employee morale and compensation (among other things) because of things common to the medical field like burnout, too much work hours and/or overtime, emotional wear and tear due to being around death and suffering a lot and so on.

As was already started to be mentioned earlier in this report, the forces that come from external and internal sources have an effect on the decisions, outcomes, perceptions and decisions made within a firm. There is not a preconceived way and function to all businesses and the medical field proves this pattern to be the case. For example, some medical offices and firms pay bonuses while some do not. Some react very quickly to possible/known legal changes while others wait until the last minute. Of course, the main reason for making (or not making) changes is to remain competitive and stay within the overall general strategy and desired outcomes of a firm, medical or otherwise.

Some strategic decisions are purely discretionary and are based on the market positioning, geographical location and so forth of a firm. In other cases, changes and trends are based on necessity, compliance and so forth. Even so, many firms get innovative and take daring steps to get the results that they are after. The medical field has paved the way in this regard in the form of discounted health insurance rates for engaging in healthy behaviors and/or staying away from bad behaviors. Common ways that employees can bring down their rates are avoiding smoking and having a healthy BMI (Abelson, 2011). However, other firms have shunned this and charge the same rate for everyone regardless of age, health and so forth. The point is that many firms react quite differently to the same circumstance and not everyone follows the trends and the crowds.

However, this freedom to take one path over the other can have both very good effects as well as very bad effects. For example, if a medical firm makes a blunder and does not have the facility space for the services it expects and needs to provide, this can cause loss of revenue and/or a general ability to serve clients and patients at the proper level. On the other hand, sometimes space gets wasted and overhead becomes entirely too high for a medical firm and this can cause to a loss in profit or even a loss of the business. However, the aforementioned morale issues and overall perceptions of the medical firm, even from within the firm itself, can swing the momentum and direction of a firm greatly if it is deemed that the firm is being unethical, that the firm pays its employees too little or skimps on benefits and so on. An offshoot effect of the Great…