INTRODUCTIONManagers are found in every organization. They apply principles of management to address basic organizational needs. Systems thinking provides a useful paradigm and structure for managerial activities. Quality initiatives and good customer service enhance the operations and potential for success of any organization. This chapter introduces all three subjects: management, systems thinking, and quality improvement.INTRODUCTIONManagement inside of organizations is undertaken within the larger context of laws and regulations governing commerce in the United States. are rules developed and approved by legislative bodies and enforceable in the courts. are rules developed by governmental agencies or by private organizations that have been assigned authority by the government, usually to enact the provisions of laws. Still more rules are established by discretionary decisions of administrative agencies of the government, because all situations cannot be covered by laws and regulations. For example, the federal government’s Centers for Medicare and Medicaid Services (CMS) makes eligibility and reimbursement decisions for the highly complex Medicare health insurance program; those decisions essentially become rules.Compliance with laws and regulations is a prominent task in larger and complex organizations, and management is responsible for ensuring that employees are aware of and follow relevant laws and regulations. Larger health organizations retain compliance managers and legal counsel to assist in compliance management. For example, management of human resources is subject to a host of laws and regulations. Financial laws and regulations govern financial reporting. In this chapter, the focus is on laws and regulations that are specific to the health sector.The concept of health policy is broader than laws and regulations. refers to the principles and activities guiding the allocation of resources that affect the health of patients and populations. Health policy is heavily influenced by the laws and regulations formulated and implemented by governmental units. In addition to governmental action, private organizations affect health policy in the United States. For example, hospitals must be accredited by The Joint Commission (a private organization) or another similar accrediting body in order to receive federal funds from Medicaid and Medicare. In addition, the decisions made by large private insurance companies regarding reimbursement of specific health services shape health policy. Private nonprofit organizations, as well as private for-profit organizations, are highly involved in formulation of US health policy.Managers can benefit from an understanding of how health policy is formulated. The process of policy formulation is outlined, with an emphasis on governmental action.
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