Healthcare operation activities are diverse but they revolve around patients’ needs and how to achieve their care expectations. The first activity is quality assessment and improvement of the services offered as well as the evaluation of care outcomes with the purpose of developing frameworks of operations or clinical guidelines. The operational activity defines healthcare scope of service in the delivery of health care to people as requested by other practitioners in practice based on identified needs (Code of Federal Regulations, 2017). The operations of healthcare also revolve around reviewing the qualifications, skills, and experience of practitioners while focusing on performance, which provides the baseline for carrying out training programs and supervisions. Operational activities in healthcare could also include the management of healthcare insurance contracts such as underwriting, renewing, replacing, creating, and enrolling in line with the needs, requests, and preferences of the patients. The other essential activity is arranging for medical reviews to determine the existing cases of fraud, abuse, and misuses while paying attention to the level of compliance and other legal services. Generally, this crucial role entails the auditing process (Code of Federal Regulations, 2017). The providers are mandated with the responsibility of delivering the products or services and making reports and diagnoses to the specified individual or as requested by another care provider. Additionally, healthcare operation activities include the aspect of business management and other administrative requirements, which is the basis for effective service delivery and smooth running of the health facilities (Code of Federal Regulations, 2017). Business planning and development is another essential operational activity in healthcare. The activity incorporates the management of costs, strategic planning of administrative activities, and expenditures including policy-related implementations.
Role of Healthcare Manager or Administrator
Healthcare managers and administrators are tasked with responsibilities majorly associated with coordination, organization, supervision, and oversight of essential operational activities in an assigned care facility. The first role is the management of activities outlined in different implementation and compliance frameworks or guidelines (Code of Federal Regulations, 2017). Additionally, it is the role of the administrators or healthcare managers to ensure that customer service quality is standard and acceptable. The healthcare administrators are also in charge of workers by ensuring that there is limited workplace conflict. In case of grievances, the administrators are responsible for resolution interventions and setting mechanisms to prevent reoccurrences of such instances in the care facility (Thompson, 2007). In addition, the administrator or manager of a healthcare facility is expected to ensure that sales, consolidation, transfer, and merger endeavors are undertaken effectively and do not interfere with the smooth operation of the facility whenever such strategies are part of the change process (Code of Federal Regulations, 2017). Moreover, it is the responsibility of the administrators to ensure that there is a systematic collection, storage, and use of information in the facility. Such a role equally involves guaranteeing the security of patient data (Ginter, Swayne, & Duncan, 2002). The managers are also entitled to finance-related mandates and fundraising initiatives for the entities they are in charge of as long as it is within the defined administrative scope.
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Governance Function Areas for Board Oversight of Patient Care Quality
The following is a list of the seven essential governance function areas identified by board members as depicted in the study by Prybil, Bardach, and Fardo (2014).
Ensuring the existence of comprehensive audit and compliance mechanisms
Management of executive compensation
Controlling and coordinating finance and investments programs
Outlining and reviewing mechanisms for improving patient care quality and development
Fostering board education and development initiatives
In charge of systematic strategic and planning programs
Supporting and approving community benefit interventions
References
Code of Federal Regulations. (2017). Title 45: Public Welfare: Definitions . Available at: https://www.govinfo.gov/content/pkg/CFR-2017-title45-vol1/xml/CFR-2017-title45-vol1-sec164-501.xm l
Ginter, P. M., Swayne, L. E., & Duncan, W. J. (2002). Strategic management of healthcare organizations . Malden, MA, Blackwell.
Prybil, L. D., Bardach, D. R., & Fardo, D. W. (2014). Board oversight of patient care quality in large nonprofit health systems. American Journal of Medical Quality , 29(1); 39 – 43.
Thompson, J. M. (2007). Health services administration . Sudbury, MA: Jones & Bartlett.
