Organizational values in the provision of access to care for the uninsured

Abstract

Background For the last 20 years, health provider organizations have made efforts to align mission, values, and everyday practices to ensure high-quality, high-value, and ethical care. However, little attention has been paid to the organizational values and practices of community-based programs that organize and facilitate access to care for uninsured populations. This study aimed to identify and describe organizational values relevant to resource allocation and policy decisions that affect the services offered to members, using the case of community access programs: county-based programs that provide access to care for the uninsured working poor. Methods Comparative and qualitative case study methodology was used, including document review, observations, and key informant interviews, at two geographically diverse programs. Results Nine values were identified as relevant to decision making: stewardship, quality care, access to care, service to others, community well-being, member independence, organizational excellence, decency, and fairness. The way these values were deployed in resource allocation decisions that affected services offered to the uninsured are illustrated in one example per site. Conclusions This study addresses the previous dearth in the literature regarding an empirical description of organizational values employed in decision making of community organizations. To assess the transferability of the values identified, we compared our empirical results to prior empirical and conceptual work in the United States and internationally and found substantial alignment. Future studies can examine whether the identified organizational values are reflective of those at other health care organizations.

Infringement of the right to surgical informed consent: negligent disclosure and its impact on patient trust in surgeons at public general hospitals – the voice of the patient

“…The similar pattern of wrongful conduct in these upsetting experiences across hospitals and surgeries leads us to contend that the existing practice of unintentionally nullifying IC does not stem solely from lack of communication skills or patronization. Similar to Harrison and Taylor [80], we contend that findings may reflect organizational values in the hospital that the management supports in order to facilitate shorter waiting times and increase the number of surgeries. Managements and surgeons may view the IC process as consuming valuable time and irrelevant for patient decision-making in life-saving surgeries [3].…”

“…Changes must take place at both the organizational and team levels. Firstly, organizational and professional values regarding surgical IC may be mapped and clarified as they were mapped for community health organizations [80]. Second, organizational quality measures should ideally include the assessment of proper IC disclosure as experienced and reported by patients.…”

General orders for the embedded researcher: Moorings for a developing profession

“…Broadly, Menar and colleagues 58 observe learning health system values include adaptability, equity, inclusiveness, open innovation, scientific integrity, shared accountability, solidarity, and transparency. Harrison and Taylor's 59 earlier work similarly observed stewardship, care quality and access, organizational excellence, decency, and fairness among other values care‐providing organizations espouse. These altruistic values align well with the general orders described here.…”

Healthcare resource allocation decisions affecting uninsured services

“…The qualitative research methodology contrasting two diverse cases has previously been reported; methods are summarized noting details relevant to the findings reported here (Harrison and Taylor, 2016). The study used a case study approach and multiple data types to triangulate and gain a detailed understanding of the context and process of CAP resource allocation decisions (Creswell, 2006, p. 73; Yin, 2008).…”

“…Tracing the relationship and factors affecting it could provide a baseline against which future projects can compare the influence of values and contextual, procedural, political, and economic factors in other healthcare organizations, such as insurance benefit package and health system design. As previously described, nine organizational values common to the two participating CAPs were identified as relevant to organizational decision making: stewardship, care quality, access, service to others, community well-being, member independence, organizational excellence, decency, and fairness (Table I) (Harrison and Taylor, 2016). This manuscript describes resource allocation and policy decisions relevant to providing health services to low-income and uninsured individuals and describes the relationship between organizational values and decisions.…”