introduction to us health care caring for special populations

Introduction to US Health CareIntroduction to US Health Care

Caring for Special Caring for Special PopulationsPopulations

Mental DiseaseMental Disease

““psychological, biological, chemical, neurological, and behavioral psychological, biological, chemical, neurological, and behavioral disorders that impair cognitive, affective, and social functioning”disorders that impair cognitive, affective, and social functioning”

•Depression, anxiety, and phobias

•Psychosis, schizophrenia, and major depression

•OCD and other behavior problems

•Mental retardation

•Deterioration of brain function

•Substance abuse

Mental Health FacilitiesMental Health Facilities

State and county State and county mental hospitalsmental hospitals

Private psychiatric Private psychiatric hospitalshospitals

Short-term general Short-term general hospitalshospitals

Department of Department of Veterans Affairs Veterans Affairs facilitiesfacilities

Residential treatment Residential treatment facilitiesfacilities

OtherOther

Caring for the Mentally IllCaring for the Mentally Ill

AmbulatoryAmbulatory InpatientInpatientPCP officesPCP officesPsychiatrists’ officesPsychiatrists’ officesMental health centersMental health centersDay care programs, etc.Day care programs, etc.

Psychiatric unitsPsychiatric unitsMental hospitalsMental hospitalsSpecial purpose hospitalsSpecial purpose hospitals

27%

17%3%19%

18%

14% 2%

Private Insurance

Out-of-Pocket

Other Private

Medicaid

State and LocalGov't

Medicare

Federal

Funding Mental Health ServicesFunding Mental Health Services

Legal IssuesLegal Issues

Commitment LawsCommitment Laws Voluntary commitmentVoluntary commitment Involuntary commitmentInvoluntary commitment

Discriminatory Discriminatory Insurance PracticesInsurance Practices

The Americans with The Americans with Disabilities ActDisabilities Act

Homeless PopulationHomeless Population

More vulnerable to various More vulnerable to various diseasesdiseases

Certain illnesses are Certain illnesses are associated with povertyassociated with poverty

More difficult to follow More difficult to follow through with treatmentthrough with treatment

Challenges in Providing CareChallenges in Providing Care

Lack of insuranceLack of insurance Lack transportationLack transportation FearFear Complexities due to avoidance of careComplexities due to avoidance of care Not a priorityNot a priority MisdiagnosisMisdiagnosis

Veterans Health IssuesVeterans Health Issues

Rehabilitation servicesRehabilitation services Mental health issuesMental health issues Toxic agent exposure servicesToxic agent exposure services

Veterans Millennium Health Care and Benefits

Act

Immigrant Health CareImmigrant Health Care

Language barriersLanguage barriers Poorer country of origin health carePoorer country of origin health care Cultural variablesCultural variables

Duty to Treat

Caring for Special PopulationsCaring for Special Populations

People with AIDS and HIVPeople with AIDS and HIV

Victims of ViolenceVictims of Violence

Specialists vs. generalists

Obstacles to treatment

Planning-Controlling CyclePlanning-Controlling Cycle

Measure achievement of plan(Control)

Adjust expectationsor

Take other actions

Plan

Controlling Against Inappropriate BehaviorsControlling Against Inappropriate Behaviors

Establishing policies and safeguards Establishing policies and safeguards forfor Inappropriate use of company computersInappropriate use of company computers Misuse of company equipmentMisuse of company equipment Theft of company resourcesTheft of company resources Inappropriate interactions between staffInappropriate interactions between staff Establishing equipment maintenance Establishing equipment maintenance

schedulesschedules Policies—a control mechanismPolicies—a control mechanism

Types of Control SystemsTypes of Control Systems

Anticipatory (preventive)Anticipatory (preventive) Preventive maintenance schedulesPreventive maintenance schedules Back-up systemsBack-up systems

Concurrent (in process)Concurrent (in process) Monitoring equipmentMonitoring equipment AlarmsAlarms

Feedback (reactive/corrective)Feedback (reactive/corrective) Performance scorecard/dashboardPerformance scorecard/dashboard Exit interviewsExit interviews

Control System RequirementsControl System Requirements

Controls should:Controls should: Be understandableBe understandable Register deviations quickly and in a Register deviations quickly and in a

timely fashiontimely fashion Be appropriate, adequate, and Be appropriate, adequate, and

economicaleconomical Be somewhat flexibleBe somewhat flexible Indicate where corrective action should Indicate where corrective action should

be appliedbe applied

Story Time-Plan & ControlStory Time-Plan & Control

What goals in the medical office What goals in the medical office should you use the plan and control should you use the plan and control process to have the goals become process to have the goals become reality?reality?

Statistical Tools for Quality ImprovementStatistical Tools for Quality Improvement

Purpose of MeasurementPurpose of Measurement

Performance measurement meets multiple Performance measurement meets multiple internal and external needs.internal and external needs.

Three fundamental purposes of Three fundamental purposes of performance measurement:performance measurement: Assessment of current performanceAssessment of current performance Demonstration and verification of performance Demonstration and verification of performance

improvementimprovement Control of performanceControl of performance

Statistical Tools for Quality Statistical Tools for Quality

Improvement ImprovementBenefits of Effective Performance Benefits of Effective Performance

MeasurementMeasurement

Provides factual evidence of performanceProvides factual evidence of performance Promotes ongoing organization self-evaluation Promotes ongoing organization self-evaluation

and improvementand improvement Illustrates improvementIllustrates improvement Facilitates cost-benefit analysisFacilitates cost-benefit analysis Helps meet external requirements or demands for Helps meet external requirements or demands for

performance evaluationperformance evaluation

Statistical Tools for Quality Statistical Tools for Quality ImprovementImprovement

Benefits of Effective Performance Benefits of Effective Performance Measurement (cont.)Measurement (cont.)

May facilitate the establishment of long-term May facilitate the establishment of long-term relationships with various external stakeholdersrelationships with various external stakeholders

May differentiate the organization from May differentiate the organization from competitorscompetitors

May contribute to the awarding of business May contribute to the awarding of business contractscontracts

Fosters organizational survivalFosters organizational survival


Framework for MeasurementFramework for Measurement

A cohesive performance improvement A cohesive performance improvement program comprises three elements:program comprises three elements:

1.1. Performance improvement processPerformance improvement process: : carefully chosen, values-based, systemic, carefully chosen, values-based, systemic, organization-wide approachorganization-wide approach


Framework for Measurement (cont.)Framework for Measurement (cont.)

2.2. Performance improvement planPerformance improvement plan: a : a detailed strategy consisting of:detailed strategy consisting of:

Identified and prioritized opportunities for Identified and prioritized opportunities for quality improvementquality improvement

Adequate staffingAdequate staffing Expected time framesExpected time frames Necessary financial/material resourcesNecessary financial/material resources


Framework for Measurement (cont.)Framework for Measurement (cont.)

3.3. Performance improvement projectsPerformance improvement projects: diverse, : diverse, individual, focused initiatives that hospitals individual, focused initiatives that hospitals implement to achieve clearly defined, measurable implement to achieve clearly defined, measurable improvementsimprovements

Other components that support successful Other components that support successful implementation of performance improvement programs:implementation of performance improvement programs:• Leadership commitmentLeadership commitment• Staff understanding and participationStaff understanding and participation• Establishment of partnerships with key stakeholdersEstablishment of partnerships with key stakeholders


Framework for Measurement (cont.)Framework for Measurement (cont.) Establishment of a performance improvement Establishment of a performance improvement

oversight entityoversight entity Selection/use of performance improvement Selection/use of performance improvement

methodologymethodology Development of protocolsDevelopment of protocols Identification and response to performance Identification and response to performance

resource needsresource needs Recognition of successes and effortsRecognition of successes and efforts Continuous assessment of effectivenessContinuous assessment of effectiveness

Story Time-ExplainingStory Time-Explaining

How are going to explain the plan How are going to explain the plan and train the employees to do their and train the employees to do their part in the process improvement part in the process improvement initiatives?initiatives?


Critical Performance Measure CharacteristicsCritical Performance Measure Characteristics RelevantRelevant ReliableReliable ValidValid Cost effectiveCost effective Under the control of the providerUnder the control of the provider Precisely defined and specifiedPrecisely defined and specified InterpretableInterpretable Risk adjusted or stratifiedRisk adjusted or stratified


Statistical Process Control (SPC)Statistical Process Control (SPC)

Method of using data to track processes Method of using data to track processes to improve the quality of products and to improve the quality of products and services; uses simple statistical tools to services; uses simple statistical tools to explain any process that generates explain any process that generates products or servicesproducts or services

Requires a change in thinking from error Requires a change in thinking from error detection to error prevention (i.e., doing detection to error prevention (i.e., doing it right the first time)it right the first time)


Figure 7..1

Process

Product or Service

Data

SPC

Process Intervention

Process

Product or Service

Data

SPC

Process Intervention

Etc.

How a process that generates a product or service alsogenerates data that can be analyzed using statistical process control tools and used to improve the process


Elements of a Control ChartElements of a Control Chart

A control chart is a line graph with a A control chart is a line graph with a centerline that represents the overall centerline that represents the overall process average (or mean). It shows process average (or mean). It shows the flow of a process over time and is the flow of a process over time and is a dynamic presentation of data. The a dynamic presentation of data. The measure of the process being measure of the process being monitored appears on the vertical monitored appears on the vertical axis.axis.


Example of a Control ChartExample of a Control Chart

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR AP

R

MAY JU

N

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR AP

R

MAY JU

N

0

0.05

0.1

0.15

0.2

0.25

PROP

ORTI

ON

1998 1999

+3

-3

2000

P = 0.096

C - s e c t i o n R a t e


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Months

0

0.1

0.2

0.3

0.4

0.5

Prop

ortio

n

+3

Mean

Test 1: >3 Sigma

Test 3: Run of 8 Same Side

Test 2: Downward Trend of 6

-3

123456

123

45678

A trend is defined as six consecutive data points incrementally increasing or decreasing.


Comparison Chart AnalysisComparison Chart Analysis

Objective: to evaluate whether an individual Objective: to evaluate whether an individual healthcare organization’s performance is different healthcare organization’s performance is different from the expected level derived from other from the expected level derived from other organizations’ dataorganizations’ data

Inter-organizationalInter-organizational Cross-sectional analysisCross-sectional analysis OutlierOutlier: when an organization’s performance level : when an organization’s performance level

is, statistically speaking, significantly different is, statistically speaking, significantly different from the expected levelfrom the expected level


There are a number of ways to use There are a number of ways to use data for improvement purposes, all of data for improvement purposes, all of which involve comparison.which involve comparison.


Data can be used to compare:Data can be used to compare: An organization’s performance against An organization’s performance against

itself over timeitself over time The performance of one organization to The performance of one organization to

the performance of a group of the performance of a group of organizations collecting data on the organizations collecting data on the same measures in the same waysame measures in the same way

An organization’s performance against An organization’s performance against established benchmarks or guidelinesestablished benchmarks or guidelines

Story Time-ChartsStory Time-Charts

How will you determine which How will you determine which processes in the medical office processes in the medical office should be under statistical process should be under statistical process control?control?

StandardsStandards

Criteria against which subsequent Criteria against which subsequent performance or results can be judgedperformance or results can be judged

Also known as performance metricsAlso known as performance metrics State what should be doneState what should be done

Derived from organizational goals and Derived from organizational goals and objectivesobjectives

Expressed in numerical termsExpressed in numerical terms

Establishing StandardsEstablishing Standards

May be developed by looking at May be developed by looking at others (benchmarking)others (benchmarking)

Can be broad or narrowCan be broad or narrow Should be responsibility-linked, Should be responsibility-linked,

customer-focused, balanced, timely, customer-focused, balanced, timely, credible, comparable, and simplecredible, comparable, and simple

Tangible StandardsTangible Standards

Most commonly are physical Most commonly are physical standards that pertain to the standards that pertain to the operation of a departmentoperation of a department

Define:Define: The amount of x within y time, or The amount of x within y time, or For the cost of x the amount of y will be For the cost of x the amount of y will be

produced, orproduced, or The content of x will be present in y The content of x will be present in y

quantityquantity Are quantitative and qualitativeAre quantitative and qualitative

Intangible StandardsIntangible Standards

Criteria is not as preciseCriteria is not as precise Quality of careQuality of care Reputation of medical staffReputation of medical staff

Can use tools such as surveysCan use tools such as surveys Employee satisfactionEmployee satisfaction Patient satisfactionPatient satisfaction National surveys on “best doctors”National surveys on “best doctors”

Tools to Establish StandardsTools to Establish Standards

Time and Motion StudiesTime and Motion Studies Work-measurement techniqueWork-measurement technique FlowchartsFlowcharts Defining the best methodDefining the best method

Time LaddersTime Ladders How much time doing whatHow much time doing what Down/idle/non-productive timeDown/idle/non-productive time

Tools to Establish StandardsTools to Establish Standards

Work SamplingWork Sampling Direct observationDirect observation

Working/Not workingWorking/Not working

Strategic StandardsStrategic Standards

Need to concentrate on standards Need to concentrate on standards that best reflect the goals and that best reflect the goals and whether they are being metwhether they are being met

Consider timelinessConsider timeliness Consider economy (to monitor)Consider economy (to monitor)

If it costs (in time or actual outlay of If it costs (in time or actual outlay of funds) too much to monitor, then it’s not funds) too much to monitor, then it’s not a good standarda good standard

Consider economics (budget Consider economics (budget compliance)compliance)

Effectiveness of StandardsEffectiveness of Standards

Standards must be communicatedStandards must be communicated Staff must understand expectationsStaff must understand expectations Must be tied to individual’s Must be tied to individual’s

responsibilities/dutiesresponsibilities/duties Strategies must be monitoredStrategies must be monitored

ObservedObserved MeasuredMeasured

Expect some deviation—define what is acceptableExpect some deviation—define what is acceptable ReportedReported Acted onActed on

Taking ActionTaking Action

Critically assessCritically assess Analyze reasons for deviationAnalyze reasons for deviation Investigate reasons to gain further Investigate reasons to gain further

detailsdetails Establish corrective actions for each Establish corrective actions for each

variationvariation Benchmark with others to see if Benchmark with others to see if

there is a “better way”there is a “better way” Involve existing staff—brainstormInvolve existing staff—brainstorm

Story Time-Taking ActionStory Time-Taking Action

How would you do each of these things:How would you do each of these things: Critically assessCritically assess Analyze reasons for deviationAnalyze reasons for deviation Investigate reasons to gain further detailsInvestigate reasons to gain further details Establish corrective actions for each Establish corrective actions for each

variationvariation Benchmark with others to see if there is a Benchmark with others to see if there is a

“better way”“better way” Involve existing staff—brainstormInvolve existing staff—brainstorm

Budgetary and Other Budgetary and Other Control TechniquesControl Techniques

Seminar 8Seminar 8

ObjectivesObjectives

Define the approaches, types, and Define the approaches, types, and purposes of budgetspurposes of budgets

Outline the role of the supervisor in Outline the role of the supervisor in preparing the budgetpreparing the budget

Compare and contrast different Compare and contrast different budget modelsbudget models

Review the function of budgets in Review the function of budgets in cost containmentcost containment

BudgetBudget

A written planA written plan Expressed in figures and numerical Expressed in figures and numerical

termsterms Projects revenue and expense for a Projects revenue and expense for a

specified timespecified time Sets the financial standards to be Sets the financial standards to be

met by the organizationmet by the organization

Planning or Controlling?Planning or Controlling?

Creating the budget is a planning Creating the budget is a planning functionfunction

Managing the budget is a control Managing the budget is a control functionfunction

Budgeting FundamentalsBudgeting Fundamentals

Master (or Comprehensive) Budget—Master (or Comprehensive) Budget—When all of the institution’s operations When all of the institution’s operations are covered by budgets and all are covered by budgets and all departments are consolidated into an departments are consolidated into an overall budgetoverall budget

Budgetary Control—Use of budgets to Budgetary Control—Use of budgets to control the department’s daily control the department’s daily operations; involves evaluating results operations; involves evaluating results and taking corrective action as needed.and taking corrective action as needed.

Budgeting FundamentalsBudgeting Fundamentals

Budgets are tools for managementBudgets are tools for management Budgets should be developed in such Budgets should be developed in such

a way as to provide flexibilitya way as to provide flexibility May be required to reduce or expand May be required to reduce or expand

beyond what was budgetedbeyond what was budgeted

Budgeting DrawbacksBudgeting Drawbacks

Are time consumingAre time consuming Are an expense to createAre an expense to create May inappropriately monitor May inappropriately monitor

management performance in management performance in monetary terms onlymonetary terms only

Basis of BudgetBasis of Budget

NumericalNumerical MonetaryMonetary Nom-Monetary Numerical TermsNom-Monetary Numerical Terms

Labor hoursLabor hours Hours per adjusted patient dayHours per adjusted patient day Quantity of servicesQuantity of services Number of employeesNumber of employees

Most cover 1 yearMost cover 1 year Submitted 3 to 4 months prior to start of Submitted 3 to 4 months prior to start of

new yearnew year May be broken down into smaller periods May be broken down into smaller periods

(quarters) for periodic budgeting(quarters) for periodic budgeting

ParticipationParticipation

All levels of managementAll levels of management Input from first-line staff about capital Input from first-line staff about capital

items and suppliesitems and supplies Finance/budget departmentFinance/budget department CEOCEO Board of trustees/directorsBoard of trustees/directors

Budget committeeBudget committee

Budget ApproachesBudget Approaches

Rolling Budget: As one month or one Rolling Budget: As one month or one quarter is completed, another month quarter is completed, another month or quarter is added to the end of the or quarter is added to the end of the current budgetcurrent budget

Flexible Budget: A budget that is Flexible Budget: A budget that is prepared for different levels of prepared for different levels of activity (usually three levels—activity (usually three levels—predicted, above predictions, below predicted, above predictions, below predictions)predictions)

Budget ApproachesBudget Approaches

Historical/Conventional/Traditional Historical/Conventional/Traditional Budgeting—Basing the future budget Budgeting—Basing the future budget on expenditures that occurred this on expenditures that occurred this year by adjusting expenses by an year by adjusting expenses by an inflation factorinflation factor

Incremental Budgeting—Assumes a Incremental Budgeting—Assumes a base budget and assesses year-to-base budget and assesses year-to-year change in the total amounts year change in the total amounts above the base above the base

Budgeting ApproachesBudgeting Approaches

Zero-Based Budgeting—The new Zero-Based Budgeting—The new budget ignores the prior budget; budget ignores the prior budget; start with zero and incrementally start with zero and incrementally build the budget based on the build the budget based on the department’s activities and department’s activities and demands.demands. Seven stepsSeven steps Assessing options to accomplish the Assessing options to accomplish the

work of the departmentwork of the department

Preparing the BudgetPreparing the Budget

Requires timeRequires time Requires collection of information Requires collection of information

about the services, functions, or about the services, functions, or activities of the department and new activities of the department and new endeavorsendeavors

Assesses the economic climate to Assesses the economic climate to determine if implementing a new determine if implementing a new endeavor is appropriateendeavor is appropriate

Preparing the BudgetPreparing the Budget

After the budget is approvedAfter the budget is approved Summarize reasons for variancesSummarize reasons for variances Summarize status of new activitiesSummarize status of new activities Prepare monthly or quarterly updatesPrepare monthly or quarterly updates

Other Budget ConsiderationsOther Budget Considerations

Budget Director: Individual who Budget Director: Individual who coordinates the budget activities for coordinates the budget activities for the organizationthe organization

Budget Committee: May be an Budget Committee: May be an administrative or board committee to administrative or board committee to evaluate the consolidated budget evaluate the consolidated budget compared to strategic planscompared to strategic plans May have a Capital Budget May have a Capital Budget

SubcommitteeSubcommittee

Other Budget ConsiderationsOther Budget Considerations

Cost AllocationCost Allocation Costs associated with the department Costs associated with the department

are allocated to the departmentare allocated to the department Cost of benefits for those employed in the Cost of benefits for those employed in the

departmentdepartment Depreciation on the assets used by the Depreciation on the assets used by the

departmentdepartment Proportionate share of utilities for the Proportionate share of utilities for the

departmentdepartment

Story Time-EnforcementStory Time-Enforcement

If you find at the end of the year the If you find at the end of the year the medical office is way over budget medical office is way over budget what would you do about it?what would you do about it?

Handling GrievancesHandling Grievances

Seminar 8Seminar 8


Define the term grievanceDefine the term grievance Differentiate between the roles of the Differentiate between the roles of the

shop steward and the supervisor in shop steward and the supervisor in responding to a grievanceresponding to a grievance

Review the process of handling a Review the process of handling a grievancegrievance

GrievanceGrievance

A complaint that usually results from A complaint that usually results from a misunderstanding, a misunderstanding, misinterpretation, or violation of a misinterpretation, or violation of a provision of the labor agreementprovision of the labor agreement

Formally presented to management Formally presented to management by the unionby the union Begins at the department levelBegins at the department level Can be appealed to higher levelsCan be appealed to higher levels

Grievance ProcedureGrievance Procedure

Shop steward presents grievance at Shop steward presents grievance at department level (usually)department level (usually)

Appeal is handled by the union Appeal is handled by the union business representativebusiness representative

There are time limits for each step to There are time limits for each step to be finishedbe finished If not achieved, grievance is referred to If not achieved, grievance is referred to

arbitrationarbitration

Guidance to SupervisorsGuidance to Supervisors

Be well versed in the contract Be well versed in the contract clausesclauses

Try to dispose of as many complaints Try to dispose of as many complaints and grievances at the department and grievances at the department levellevel

Consult with the labor relations Consult with the labor relations specialist in human resourcesspecialist in human resources

Complaint HandlingComplaint Handling

Supervisor:Supervisor: Schedule meeting in a timely fashionSchedule meeting in a timely fashion

Respect time limits of the contractRespect time limits of the contract Listen sympatheticallyListen sympathetically Do not lost emotional control Do not lost emotional control Listen carefullyListen carefully

May catch inconsistenciesMay catch inconsistencies Define the problemDefine the problem Obtain facts related to the complaint or Obtain facts related to the complaint or

problemproblem

Record KeepingRecord Keeping

Supervisor should keep records and Supervisor should keep records and documents related to grievance documents related to grievance decisiondecision

This issue or a similar one may This issue or a similar one may resurface and the actions taken resurface and the actions taken previously may serve as a precedentpreviously may serve as a precedent

Burden of proof is on the supervisorBurden of proof is on the supervisor

Emerging Influences in Emerging Influences in HealthcareHealthcare

Seminar 8Seminar 8


Recognize the many different forces Recognize the many different forces affecting healthcare and healthcare affecting healthcare and healthcare management todaymanagement today

Apply traditional management Apply traditional management principles to address a rapidly principles to address a rapidly changing healthcare environmentchanging healthcare environment

Emerging IssuesEmerging Issues

New occupations are emerging dailyNew occupations are emerging daily Many of the college graduates today will Many of the college graduates today will

move into positions that did not exist a move into positions that did not exist a few years agofew years ago

Aging baby boomersAging baby boomers Will place a strain on healthcare systemWill place a strain on healthcare system

Vacancy Rates RisingVacancy Rates Rising Nursing and pharmacyNursing and pharmacy Other healthcare occupationsOther healthcare occupations


Consumer InvolvementConsumer Involvement Consumers are educated and Consumers are educated and

technology savvy and can find technology savvy and can find information about healthcare servicesinformation about healthcare services

Consumers expect customer serviceConsumers expect customer service Consumers are more health conscious Consumers are more health conscious

and health literateand health literate


Technology and MedicineTechnology and Medicine Genetics, cloning, tissue engineering, stem cell Genetics, cloning, tissue engineering, stem cell

researchresearch Alternative medicine—herbals, acupuncture, Alternative medicine—herbals, acupuncture,

biofeedbackbiofeedback TelemedicineTelemedicine Security of health dataSecurity of health data Generation X, Y, and Millenials are technology Generation X, Y, and Millenials are technology

proficientproficient RoboticsRobotics


Changing economicsChanging economics MergersMergers Declining reimbursementDeclining reimbursement Rising number of uninsured individualsRising number of uninsured individuals

Changing policies and regulationsChanging policies and regulations Ever-growing number of agencies Ever-growing number of agencies

enforcing policies and regulationsenforcing policies and regulations


Changing Staff IssuesChanging Staff Issues Demand for specializationDemand for specialization Work environment demands and Work environment demands and

worker expectations since 9/11/2001worker expectations since 9/11/2001 Multi-generational employeesMulti-generational employees Workplace diversity and cultural Workplace diversity and cultural

differencesdifferences EthicsEthics ComplianceCompliance

Story Time-the FutureStory Time-the Future

What do you think will be the three What do you think will be the three most important emerging issues in most important emerging issues in healthcare in the future?healthcare in the future?

Goodnight!Goodnight!

Thank you for attending the seminar. Thank you for attending the seminar. Have a nice evening.Have a nice evening.

introduction to us health care caring for special populations

Documents

us health carecaring

control process

special populationspeople

external needs

external requirements

avoidance of carenot

major depressionocd

social functioningdepression