Academic journal article Frontiers of Health Services Management

Regulations, Rules, and Laws: Leading through the Changes

Academic journal article Frontiers of Health Services Management

Regulations, Rules, and Laws: Leading through the Changes

Article excerpt

Today's healthcare leaders must make sure their organizations evolve to keep pace in a radically changing environment. They must understand the ramifications of myriad changes and, just as important, the regulations and laws that address those changes.

Consider advances in technology, for example. Electronic health records, telemedicine, and other aspects of modern care delivery require us to consider Health Insurance Portability and Accountability Act (HIPAA) privacy issues as well as the evolving rules and regulations that dictate how care is delivered. And although smartphones may bring great potential for caregiving, they also can be conduits for sensitive patient information (e.g., via text messages between nurses and physicians regarding a patient's care). Texting can be highly efficient, but it is fraught with landmines in terms of potential HIPAA violations-for example, if a text message is accidentally sent to an unauthorized recipient or when nonsecured phones are used. The only way to face these issues is to be armed with an appropriate understanding of the regulations, rules, and laws that address these potential problem areas. Moreover, a dedicated and vigilant leadership team must be in place not only to stay on top of ongoing changes but also to communicate and teach the rest of the organization how to best navigate these treacherous waters.

The two feature articles in this issue of Frontiers of Health Services Management bring interesting perspectives to the daily challenges of today's healthcare environment. It is no longer enough that we deliver topnotch, safe care-that is expected by today's knowledgeable consumers. Rather, we must differentiate ourselves. One way to do that is by measuring our outcomes and benchmarking ourselves against best practices. But we must also understand and put into place policies and plans that conform to laws and regulations such as HIPAA, the Patient Safety and Quality Improvement Act, and the various requirements of the Centers for Medicare & Medicaid Services, to name just a few.

The "Village" Approach

As Simon points out in her feature article, silo thinking is a major obstacle for healthcare organizations in addressing regulatory and compliance matters. In my experience, it takes the entire village to deliver seamless care throughout an organization. Having worked in healthcare for more than 30 years, I have seen the value of working as a team rather than as separate but equal departments. By taking the "village" approach, an organization can minimize the number of times policies, regulations, and laws are missed or ignored. When such incidents do happen, there typically is no intent-except in the case of a False Claims Act (FCA) violation when a person or organization knowingly acts fraudulently. If an organization is siloed, a reasonably prudent person could presume that something did (or did not) get filed that would trigger an FCA suit.

The following is a typical example: A patient comes in to the emergency department (ED) during the day shift. He is checked in, labs are drawn, and an X-ray or MRI is taken. By the time the results are back and the examination is complete, a new team of doctors and nurses has taken over. They determine that the patient needs to be admitted, so they take him upstairs to see the hospitalist. Simon touches on this scenario in her article when she visualizes healthcare as a spider's web and describes the complexity of how it is woven together to create the whole. Given this analogy, and understanding the complexity of healthcare and all the regulations and rules that are involved in a typical series of handoffs in care, a fully engaged and skilled team is needed to guide the organization.

This ED snapshot shows how one patient entering a hospital can be exposed to multiple departments and healthcare professionals. This is where "it takes a village." Imagine the level of patient experience when all departments and healthcare professionals, including any ancillary team members, display a perfect sense of ownership and passion for ensuring a seamless transition for the patient throughout the hospital stay! …

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