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Introduction
The current report revolves around the legal framework followed by organizations in Australia. There have been a set of regulations imposed on the organizations in health and social care sector. In order to provide high quality of services, it is necessary for the organizations to understand the fundamental of legal and ethical principles that highly affect the work environment. In addition, these legal and ethical principles have large impact on the legal relationship between the service provider and the customers. Like every other developing countries Australia has the most highly regulated healthcare industry. Therefore, the organizations that provide or pay for as well as regulate the healthcare services are influenced by the regulations. The legal framework is established; thereby, a minimal standard of action necessary action needed by the service users and the organizations can be established. Some legal policies have been developed to regulate the services effectively. Thus, in order to understand the applications and the influence of the regulations on the service provider, Alexandra District Hospital has been selected for the current report. The current operation at the selected the organization provides an insight about how the legal framework that is highly affecting the organization. Lastly, based on the evaluation of the framework, further recommendation has been provided.
Alexandra District Hospital is one of the largest hospitals in Australia providing the services over the years. The organization ensures effective services for the wellbeing of the patients. There have been different departments in Alexandra District that provide a series of medical as well as surgical specialist clinics (Alexandra Hospital. 2016). In addition, the outpatient department of the organizations provides the top quality and consumer centered services for the individuals who require the care and treatment without a long duration in the hospital. The healthcare provider divides its products and services into different categories to make it little easier for the patients. As multiple departments have been developed, the staff at each department takes the responsibility of ensuring the respective care services. The categories of services include acute services, theater services, medical image services, community health services, and some other services. The acute services include medical and surgical attendance, throat surgeon, orthopedic service and discharge planning services.
Alexandra District Hospital has long tradition of providing the high quality of services; thereby, in order to continue serving the community effectively as well as maintaining the top standard of patient care remain as the first major concern. It is also observed that the health facility is an accredited facility according to the Australian Council on Healthcare standards.
The heads of Alexandra District Hospital is responsible for the governance activities of the healthcare and acquires its authority to provide the services in accordance with Health Service Act 1988. Likewise, the conduct of Board is run by the Health Service Bylaws that is usually amended.
While dealing with the regulations imposed by the government, the healthcare organizations need to ensure that faulty in the services could lead to serious consequence (Glasby & Dickinson, 2014). Especially, in the healthcare industry the quality of services must be maintained to satisfy the needs and demands of the customers. In addition, there is an increasing pressure from Australian government in terms of advanced quality of services
There have been some incidents in the healthcare sector that tarnishes the images of the healthcare organization and the consequences are even leading to termination of the license. For example, the recent incident occurred at Lidcombe Hospital, Bankstown, where two newborn babies died due to the dose of wrong gas. If the sources are to be believed the babies have been given nitrous oxide instead of oxygen.
As a result, one of the babies died within an hour after giving the gas and another baby suffered from critical conditions. After a continuous investigation, it has been identified that the babies were treated with nitrous oxide inappropriately dispensed from an oxygen outlet in healthcare’s neonatal resuscitation unit. In order to compensate the family and resolve the issues, the regulatory bodies and the legal general counsel for NSW Health asked BOC Limited seeking an urgent suggestion on how the accident took place to confirm whether any technical or systematic issues occurred at other hospitals (Hockenberry & Wilson, 2014). This incident has shaken the healthcare sector in Australia. The departments of NSW Health made changes in the regulations that should be implemented in all organizations in healthcare sector. Therefore, the organizations in health and social care are facing these issues regarding the extension of regulations.
There are a significant number of sets of State and Federal legislations. The organization needs to comply with the regulations (Parrott, 2014). Some principles included in the regulations imposed by the government are implemented by the organization. Some of them are Health Service Act 1988, Financial Management Act 1994, Public Administrative Act 2004, and Audit Act 1994. Thus, as per the principles of Health Service Act 1988, “The Board of Management” of organization is consisting of 6 members (Aveyard, 2014). In addition, “The Board of Management” of Alexandra District Hospital comprises of the other aspects such as the functions, membership and responsibilities. Thus, the function of the board of management may involve the hospital to ensure the healthcare services provided by itself comply with the requirements and standards mentioned in the Act as well as objects of the hospital (O'riordan, 2014). In addition, the board of management must ensure that Alexandra District Hospital has specific policies and the procedures to satisfy their legal and ethical responsibilities.
On the other side, there have been certain responsibilities taken by the board of management of Alexandra District Hospital. The Board includes the approval, endorsement and monitoring of strategies and policies that ensure to mandate health relative initiatives and health related requirements in the community. The board also includes monitoring the financial performance on a daily basis. The heads of the organization need to ensure that risk management systems that are in place to cover the organizational key risks areas (Epstein & Buhovac, 2014). These areas include operational, financial, and environmental as well as asset related risks.
On the contrary, Alexandra District Hospital faces some managerial issues that highly affect the operation. The issues may include physician alignment strategy and the ability of hospitals to remain independent. Moreover, the government hospitals like Alexandra District Hospital may have to deal with some major challenges these challenges derive from increased costs of medical advances and the requirements to make sure that there are comprehensive, efficient as well as the transparent processes for evaluating the health technologies. On the contrary, the healthcare centre may have to deal with the issues with the health workforce supply as well as distribution (Grajales et al., 2014). Similarly, the government pressures on the service providers increases the concerns regarding the quality and safety of health services. In addition, there is a presence of uncertainty regarding how effectively public as well as the private sectors need to be balanced in the provisions as well as the funding of health services. Alexandra District Hospital also faces the issues of understanding the fact that achieving equity in health particularly for indigenous Australians, which require more than just providing the healthcare services. Health management of the organization is also concerned with the management of diseases, illnesses as well as the injuries using a variety of services (Kavaler & Alexander, 2012).
A list of legislations imposed by the government could contribute to the operation conducted by healthcare providers. Some principles have been amended Health Services Administrative Act 1997, which regulates the operations of the company. The execution of these principles helps to identify the potential risks associated with the operation (Ventola, 2014). One of the major issues usually faced by the organizations in health sector is service quality. The faults in the services could lead to termination of the services. Therefore, the organizations need to focus on the regulations mentioned by the government and NSW Health.
Non-compliance to the regulation leads to expected outcome for healthcare organizations. For example, once a patient namely Rogers at Alexandra District Hospital had to go through a tough situation due to some medical negligence. The right eye of Rodger had been blind due to one incident in childhood. After 39 years later, she agreed to surgery with the expectation of restoring some sight to the right eye. However, the operation has not been successful. She received no improvement instead the operation results to inflammation in that eye, which is “sympathetic ophthalmia “. Hence, the issue was not that the doctors had failed to conduct the operation appropriately. Here, the case turned on the failure to make the patient aware of the risk of “Sympathetic Ophtalmia”. The high courty in Australia found that the doctors were in breach of their duty of care in not informing or warning the patient of the risk associated with Sympathetic Ophtalmia”. According to the principles of Civil Liability Act 2002, the doctors had to give an apology to the patient, which may not be admissible.
Health Insurance Portability and Accountability Act 1996- The principles of this Act increase the restrictions on patient information confidentiality by developing the standard for patient information sharing. The principles of the regulations are enforced by Australian Health and Human services (Oliver, Foot & Humphries, 2014).
“Patient Protection and Affordable Care Act of 2010”- This set of legislation involves the individuals to buy health insurance by 2014 (Healy, 2014). It is contested by different states for its constitutionality; Australian Government revises the provisions of the acts.
“Occupational Safety and Health Act of 1970”- The principles of this act involves the healthcare organization to develop and provide a safe as well as healthy work environment. In addition, the act also provides the guidelines for hazardous chemical and it is enforced by the “Occupational Safety and Health Administrative”.
“Equal Pay Act 1963”-According to the principles of the Act, the organization has to provide equal pay to both genders that hold the same positions with similar responsibilities and skills. Australian Government has enforced the principles (Graves & Zheng, 2014).
“Drug free work environment Act 1990”- The principles of this legislation involve the organization to receive the federal grants that have the federal contract of $20,000. The law provides the educations to their staffs about the drugs abuse. As mentioned by Gunn & Taylor, (2014), many healthcare organizations have now started offering drug testing.
The above-mentioned legislations largely contribute to the success of healthcare operation of .Alexandra District Hospital. By implementing the principles of these regulations, the organization could easily identify the potential risks and hazards that appear due to the long-term operation. In addition, it is also necessary for the organization to provide required benefits to their employees. As mentioned by Mitchell et al. (2014), by satisfying the needs of the employees, the organization could positively increase the service quality demanded by the patients. Moreover, in healthcare industry, standard quality of services is highly required for the wellbeing of the service users. Therefore, the regulations that govern the industry are frequently amended as the needs and demands of the patients change over time. Due to the regulatory pressure from Australian Government, the organizations in the healthcare sector are also in the rush of developing the service quality.
As argued by McGorry et al. (2014), health and safety issue is one of the major concerns in healthcare industry since due to the poor services and security, the service user or the patients may have to suffer from unnecessary hazards in the care home. For example, the lack of fire safety in the hospital may cause serious damage to the patients. This could further lead to the termination of the service providers. Therefore, the organization needs to implement the policies mentioned in the legislation to avoid the possible hazards at the workplace.
Service risk- It is evident that service risk is one of the major risks faced by the healthcare organization. The needs and demands of the service users have been changing; thereby, the requirements of the services are also changing. Thus, the poor service should be avoided by the organizations. Some major incidents have been observed that have damaged the reputation of the healthcare organization. For example, as discussed earlier, the incident at Lidcombe Hospital regarding deaths of the newborn babies. The babies have been the wrong gas, which causes deaths. Such type of incidents should be avoided while maintaining the quality of services. It is necessary for the organization to develop the service quality as per the standards mentioned in the regulations developed by NSW Health. As mentioned by Lawton & Sandel (2014), non-compliance of the regulations could lead to the termination of the services. It is certain that organization needs to develop its quality of services.
Financial risks- Due to the implementation of the regulations that public organizations like Alexandra District Hospital have to go through particular financial risks. It is evident that due to the increasing pressure from the Australian Government, the organizations in health and social care sector are in the rush of developing the quality of services. However, a significant concern of the healthcare businesses is financial damage because of these legal liabilities. Risk handling managers in the organization try to recognise the areas in the organization that could expose the healthcare centre to financial loss. As commented by Whiteford et al. (2014), an unexpected or the adverse situation occurs, the attempt is put forward to reduce the severity of the loss with the help of risk control strategies. This may include hospital bills, family representative to solve the issues or thee grievance and personal meeting with the services users. In addition, according to the regulations, it is mandatory for the healthcare home to disclose the poor outcome of the care to the service users or to the patients as well as their families. However, many healthcare home are observed to be reluctant to discuss about the bad consequences for fear, which indicates that discussion may be interrupted, as action of guilt. In addition to this, it is also observed that health service providers could incur legal barriers with full disclosure.
Compliance with regulatory and accreditation agencies- It has been identified that risk management usually include the duty to comply with regulatory as well as accrediting bodies like occupational safety and Health Administration.
Inadequate staffing- The federal laws of the country hold the nursing facilities. Abundant of staff include a sufficient number of competent staff to responsibly assure the safe care. Based on the patient equity, it is necessary for the healthcare organizations make appropriate allocations of the nursing resource. This may turn out to be the major challenge for nurse administrators as well as other healthcare leader. In addition, it is identified that floating is one of the general requirement in times of shortage of the staffing (Baum et al. 2014). On the contrary, it is also identified that managers, nurse and the supervisors have the responsibility to manage or staff the nursing units. However, when the resources are constrained, the supervisors or the managers have to appraise the consequence as well as carefully distribute the personnel considering the needs of the patients with the skills and knowledge of the nurse.
Quality Process Improvement- It has been identified that the reforms in healthcare has brought a significant focus on the quality of services along with the quality measure, which has a considerable impact on reimbursement. Thus, in order to improve the consequences as well as recover the highest compensation possible, the healthcare organizations should execute evidence-based techniques as well as reinforce the reliability of their clinical process. Therefore, appropriate monitoring is required to identify and address the breakdowns. Conversely, it can be added that poor monitoring of the services could damage the reputation and tarnish the image of the organization. Hence, the non-compliance with the regulation could generate serious impact such as cancellation or termination of the services. Subsequently, the hospitals as well as healthcare organizations should implement the actions by assuring that they are aware of such potential issues, which should indicate that they have comprehensive risk management programs.
Data breaches: As mentioned by Fraser et al. (2014), the breaches of electronic data has now become a major problem as the services providers switch to electronic systems. Moreover, interoperability of the systems is observed to be creating more breaches since the large set of information is traded between the networks. As per the regulations, the hospital authority does not have the right to disclose any confidential information in terms of the services, patients and other significant information. As mentioned by Watson et al. (2014), almost 24% of the reported breaches occurred due to the habit of laptop left intentionally, which is a common type of breaches.
Drug discount program: It is observed that requirements under 340B drug discount program are often appeared to be complicated and the instruction given for the regulations are not clear. Subsequently, a new regulation was developed in the mid of summer 2015 (Abdelhak, Grostick & Hanken, 2014). However, the implementation of the regulation was postponed leaving the hospitals with unclearly. Notwithstanding, the healthcare organizations need to enhance the system as well as data analytic processes to recognise as well as remove patients and drugs that are not appropriately eligible.
It has been identified that as hospitals as well as healthcare centre adapt to changing regulatory, trends associated with technological and demographic; these critical issues could ask for the attention in the coming months and the years. It is observed that some of these issues are already making headlines in some of the communities in Australia. However, later, these issues could start affecting the hospitals.
In order to deal with the potential legal risks and other workplace risks, the healthcare organization needs to develop certain procedures or techniques that could further enhance the quality of healthcare services. Following are the approaches, which should be implemented by the organization to deal with the legal risks.
Effective patient care practices: It is noted that the enhancement as well as the execution of the healthcare risk management programs are relied on the extensive ongoing studies. The risks managers of the organization should be aware of the relevant information in the healthcare centre as the outcome of the research could prove contradictory to presumptions that could somehow enhance the risk management practices.
Quality of Care: It is observed that in the current years NSW Health has decided to consider the quality of care to be the top priority segment for the evaluation, investigation as well as enforcement. NSW Health could expel the healthcare entities from the participation in federal healthcare programs if one of the entities provide unnecessary element in the services. The healthcare organizations need to develop and implement a quality assessment as well as the performance enhancement programs that could certainly identify the safety issues as well as avoids the faults in the services (Galliers & Leidner, 2014). The hospital needs to maintain the accuracy of data.
Laboratory Services- It has been observed that laboratory services should be included in the claims development as well as submission category. However, the hospitals have earned their own risk category because of different regulatory bodies to which the healthcare centre are supposed to run the operation. Moreover, laboratory should comply with the FDA and regulations of NSW health.
“HIPPA privacy and security”- It is observed that the regulations of “Health Insurance Portability and Accountability 1996” have been developed to address two areas of the protection for individuals health information, which includes the privacy and security. However, these areas are significant areas to be addressed in the series of daily actions taking place in a health facility (Bauer, Briss, Goodman & Bowman, 2014).
Compliance program effectiveness- It is evident that hospitals with the appropriate organizational culture that values the compliance with the regulation are probably increase developed compliance programs and gain the ability, detect as well as correct the fraud and abuse. Whereas at the same time the healthcare centers could further the core mission of the organizations and offer the best quality of services to the hospitals (Hopkin, 2014).
Research- It has been observed that Medicare should cover the daily costs of significant clinical trials reasonable and necessary elements, tools and the services implemented to diagnose as well as treat complications appearing from participation in the clinical trials. In addition, the healthcare centers in Australia that participate in the clinical trials should review the requirements for submitting claims for the service users who take part in the clinical trials. Moreover, it has also been identified that informed consent regulation might require the clinical examiners to gain legally effective informed consent in an appropriate manner.
Apart from above-mentioned strategic options to deal with the risks, the organizations in health sector need to implement the regulations and apply other policies to recover the damage that occur in healthcare services. The compliance with the regulation is one of the strategic options that help the organizations to avoid unnecessary hazards.
In order to provide to effective quality of the healthcare services, the organization needs to develop the effective patient care services. By developing the quality services, the organizations may gain the ability to avoid the potential hazards, risks and other workplace related issues (Enthoven, 2014). Hence, the organization may have to make large investment to provide appropriate training and education for the staffs. The healthcare organizations need to hire highly skilled professionals to provide such training. As the needs and demands of the people in the healthcare sectors are changing, the organizations should be aware of the fact that poor services may damage the reputation of the healthcare centre. In addition to the services, the healthcare organizations need to alter the organizational culture or the management style. For example, they could adopt open management style, where new the people or the trainees could learn from the senior staffs of the healthcare centre apart from receiving training from the care home.
In addition, the healthcare organizations need to develop the equipments of the laboratory. Thus, any new disease or existing diseases can be researched and a proper solution can be developed within short time. The healthcare organization may face some financial constraints in developing the services. Conversely, the healthcare also needs to focus on the implementation of the regulations. Appropriate implementation of the regulations keeps the care home away from unnecessary hazards and potential risks (Bowling, 2014).
It is observed that organizations in the healthcare industry should always focus on the developing the quality of services as the needs and demands of the people are changing. This industry require appropriate monitoring and maintenance of the services as there have been many regulations imposed and other regulatory bodies. Therefore, while offering or developing any service, the healthcare organizations need to focus on the standards mentioned in the regulations or NSW Health (Schulte et al. 2014). Therefore, the quality of services can be developed through the implementation of the different phases. The phases or the techniques have been mentioned in the following section of report.
“Duty of care”- It is certain that all required changes in the service delivery, systems and the equipments resources need to be measured against the effect on the standards of the services provided (Ley, Hamdy, Mohan & Hu, 2014). Thereby, no change should be authorized or executed with timely or the recorded consultation with the skilled professional staffs whose services could be affected by the new changes. In such context, NSW needs to provide a comprehensive as well as integrated health services. The departments NSW Health should gain the ability to exemplify that relevant priorities have been selected within the existing resources. The healthcare organizations need to ensure that patients and their families have properly been treated in a particular manner and they are informed about the treatment and care. In addition, the duty of care should be established in between the person alleged to have been negligent as well as the person whose treatment was allegedly neglected.
It has also been identified that risk management is not treated as the top-down position. Every individual has the ability to provide safe services to the patients and increase the protection of the information. Hence, the principles of Enterprise Risk management could be served as the wide strategic risk management approach, which could help to lessen the impact of the risks (Gaspar et al. 2012). By understanding the concept as well as developing ERM, the organizations could find it easy to deal with the potential risks and lead the operation in the strategic direction. Eventually, it is significant for the individuals to understand that they have the stake in risk management.
Conclusion
On the completion of the report, it can be mentioned that healthcare industry is one such industry where the quality of service is biggest concern. Therefore, the every organizations in health and care sector should be aware of the fact of developing the service quality. In addition, the compliance with the regulation is another significant aspect of the service should be maintained by the healthcare home.
Reference list:
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Aveyard, H. (2014). Doing a literature review in health and social care: A practical guide. McGraw-Hill Education (UK).
Bauer, U. E., Briss, P. A., Goodman, R. A., & Bowman, B. A. (2014). Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. The Lancet, 384(9937), 45-52.
Baum, F., Freeman, T., Jolley, G., Lawless, A., Bentley, M., Värttö, K., ... & Sanders, D. (2014). Health promotion in Australian multi-disciplinary primary health care services: case studies from South Australia and the Northern Territory. Health Promotion International, 29(4), 705-719.
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Enthoven, A. C. (2014). Theory and practice of managed competition in health care finance. Elsevier.
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