Interview: Practitioner Interview

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Organization is a small to medium-sized private doctor's office, with three senior partners and a staff of twelve. All the senior physicians are general and family practitioners. The mission of the organization is to provide the best quality of care to all patients, and its vision is to provide a safe and enjoyable environment with which to receive medical care and attention. Wait times in the office are minimized by a skillful method of scheduling patients, which is overseen by the Senior Administrator. I interviewed the Senior Administrator, who will be called Darleen Samson for the purpose of this report.

Role Within Organization

Darlene Samson is a Registered Nurse who served as hospital administrator for a large local hospital. When the pressures of the job became too much, Samson left even if it meant taking a pay cut. Samson told me that managing the hospital is a stressful position involving politics as well as skill. In a smaller office environment like the one she is in now, Samson finds that everyone works together to achieve mutually beneficial goals.

As the senior administrator, Samson is in charge of patient and staff coordination. She also takes care of orders and supplies for the office and meets with pharmaceutical and equipment company sales representatives. Her contact with patients is minimal, although as a Registered Nurse she is occasionally called upon to aid staff during emergency situations or times when the office is understaffed. Samson maintains databases and records for the office's finances, and reports regularly to the office accountant. In addition to these duties, Samson also coordinates patient outreach, marketing, and human resources.

Samson oversees a staff of nine nurses with varying areas of specialization. In addition to the nursing staff, Samson also works with the physicians assistants and office receptionists. Samson denies that the organization has a hierarchical organizational structure, especially when compared with the hospital. However, she does describe her role within the organization as being subordinate to the physicians. The physicians are the owners and technically her bosses, but they leave almost all of the administrative duties up to Samson. Rarely do any of the physicians interfere with her work because they are busy taking care of patients. Therefore, Samson serves in a valuable role within the organization and the physicians treat her as an equal.

The office receptionist serves in a dual role as Samson's personal assistant. Otherwise, the administrative department of this small organization only consists of Samson's role. She is involved in strategic planning, which involves occasional staff meetings. All employees are encouraged to attend the meetings, because the owners want all staff to be aware of and involved in the health of the office. Part of the organization's vision is to create a positive workplace environment, and one in which all employees feel valuable.

Description of Function

Long-range planning is one of the most important functions of the senior administrator position. When Samson was hired, she was told that the office was floundering and losing patients to other clinics. Part of her job entailed patient recruitment and retention. To achieve this goal, Samson was also entrusted with a marketing role.

In addition to patient recruitment, retention, and management, Samson spearheaded an ambitious outreach project. The project consisted of three components: prevention, networking, and maintenance. Understanding that cost is one of the most prohibitive barrier to achieving patient outcomes and healthcare goals, Samson devised ways to minimize the costs associated with each of these components. Therefore, she acquired low-cost public outreach posters related to specific diseases and displayed them prominently in the waiting room. The posters were not selected randomly. Instead, Samson researched the patient database and discovered which diseases the office's patients were most at risk for and displayed those. Heart disease and diabetes were among the greatest concerns. Samson also understood that the patient database represented a diverse social and socio-economic spectrum. She selected posters that represented persons from various ethnic backgrounds. It was also important to include flyers and other take-home materials so that patients could learn more in the comfort of their own home. Another aspect of Samson's prevention project was to donate one of the office's old computer terminals to the waiting room. The terminal was set up specifically so that patients could access information related to their conditions and complaints -- linking them with outpatient services. Patients who did not have a computer at home were encouraged to use the office terminal on appointment days in order to learn more about medical conditions and how to prevent them.

Similarly, Samson employed technology to coordinate patient networking. She established patient groups, both virtual and real. The virtual groups could be accessed via the waiting room terminal but also remotely by the patient. Patients could also register for the outreach groups in the office, learning about meeting dates and times either at the waiting room terminal or on their own. Groups included those that addressed lifestyle changes for obese patients and special groups for children. Samson used email to contact patients, and only sent emails that pertained to the patient's needs.

Finally, Samson knew that health was linked to maintenance as well as prevention. Samson encouraged the senior physicians to agree to one free follow-up meeting with each patient. This encouraged patients to attend the meeting and also ensured that healthcare objectives were being met. The attention to patient care increased dramatically and within three or four months, the office had acquired more new patients than they had in the entire year prior.

Professional Standards

1. Critical Thinking

Samson's position as senior administrator involves a high degree of critical thinking, especially in regards to long-range planning. Her patient outreach project was built on Samson's ability to think critically about what the organization needed to do to reach its goals, and also how to go about implementing new tactics.

2. Reflective Thinking and Self-Evaluation

One of Samson's tasks in her prior role as hospital administrator was to perform regular performance evaluations on nurses. At the time, she felt it would be helpful to require self-evaluations as well. The self-evaluations helped Samson clarify issues, and she found the tactic so helpful that she applied it to her current role with the private office. Now, Samson completes a reflective log at least once a week. The log is recorded on her personal database and is available for the senior physicians to read.

3. Ethics and Sustainable Futures

Samson has struggled with this area as a healthcare administrator. She admits that the hospital was more difficult to manage in terms of ethics and sustainability but even in the small office, changes in operations were needed. For one, Samson minimized paperwork and reduced paper waste creation by over fifty percent. Digitalizing patient files enabled Samson to achieve this goal, with only minimal investment in employee training and technology. Second, Samson met with the doctors about ethics and responsibilities to patients. Confidentiality issues were not a problem, but disclosure issues were an issue with one of the senior doctors. Samson discovered a disturbing number of prescriptions being written for drugs that were not necessary to achieve patient outcomes. She has taken an aggressive approach to minimizing the impact of pharmaceutical sales on doctor prescriptions. Because of the ethical infringements she noticed when first accepting the position as administrator, Samson published a new code of ethics for the organization. In a staff meeting, all employees were encouraged to raise questions and signed the document collectively.

4. Information Literacy

When Samson first became the Senior Administrator for the organization, she found a lack of coordination among nurses and between nurses and physicians. She initiated a series of measures that increased information literacy by standardizing and digitalizing information. The need for increased patient information literacy was even more important. Samson acquired public service announcements and published her own data sheets about diseases. Each patient received a follow-up care guide that they could use at home, as well as a list of Web sites and resources. Patient information literacy was also improved via the implementation of the patient groups initiative, in which patients could meet with other people who had similar conditions or complaints. Outreach services was a top priority for Samson, who integrated information literacy with patient outcomes.

5. Computer Literacy

Samson helped the office upgrade its it system. The improvement of the office's it was projected to cut costs over the long run, even if initial expenditures were greater than two of the senior partners wanted to invest. Already the cost savings goals have been met, two years after the upgrades were implemented. Samson has ensured that all nursing staff and the physicians are connected via PDAs, and all patient data is digitalized. A waiting room terminal also helps to improve patient computer literacy. Samson provides a list of reputable Web sites for medical information to prevent patients from using Wiki or untrustworthy sources.

6. Diversity

As Senior Administrator, Samson understands the need for diversity awareness in creating a positive workplace… [END OF PREVIEW]

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