A Perilous Journey Through the Health Care System - Personal Statement Example

Internship Report Introduction The internship program which I went through was one of the most significant experiences of my life. In terms of knowledge, it instilled in me much information about the actual conduct of activities in the practice. In terms of clinical experience, the internship equipped me with valuable skills which would help me eventually in my future practice. This paper will present a report on my internship in VITAS which is a clinical hospice center. It shall focus on how I managed to apply the four basic functions of management, which include: planning, leading, organizing, and controlling. It shall present first an overview of the organization where the internship was conducted. A breakdown of the 200 hours shall then be presented in terms of the work conducted, the number of hours worked per week, duties and responsibilities, additional skills or knowledge involved, and how beneficial the internship experience was in my professional development. Finally, this paper shall also present the relationship of the internship experience to the MS-HCA program. This paper is being conducted in order to present a summary and an assessment of my internship experience. The goal of this paper is also to provide a clear and comprehensive picture of the internship program in terms of leadership qualities and its application in actual practice. Discussion Overview of Organization VITAS Innovative Hospice Care is a center specializing in hospice care or palliative care. It was first established in 1978 and is now considered one of the leading hospice centers in the country. Their mission or overall goal is to maintain the quality of life of those who do not have much time to live (VITAS, n.d). This center provides adult and pediatric services covering a wide range of chronic care illnesses including (but not limited to) cancer, heart disease, stroke, lung, liver, and kidney disease, multiple sclerosis, ALS, Alzheimer’s disease, and AIDS. This center focuses in providing relief from the physical symptoms of their disease, especially pain, and also in providing emotional support and therapy for patients (VITAS, n.d). The VITAS health care team is composed of trained health care givers who have the appropriate skills to carry out the specific services of the center. The team is composed of the nurse who assesses and manages pain, and also provides hands-on care; social workers who provide emotional support and financial assistance to patients; physicians who coordinate with the patient’s primary care physician in the management of pain and of other symptoms; home health aides who provide personal care like bathing and oral care, and who assist in light cleaning, light laundry and occasional shopping for the patients; chaplains who provide spiritual support; volunteers with hospice training who provide assistance especially when it is most needed; and bereavement specialists who provide grief and loss counseling, memorial services, and support for family and loved ones (VITAS, n.d). On a more specific note, VITAS offers services in relation to prescription drugs, over-the-counter medications, medical equipment and supplies which are focused on treating life-limiting disease (VITAS, n.d). It also offers routine home care or residential care in the patients’ homes through partnerships with long-term care facilities and nursing homes, assisted living facilities for the elderly; Continuous Care by providing shifts of hospice staff at the home for brief periods in order to avoid hospital admissions; dedicated inpatient units which provides arrangements with hospitals and similar facilities for patients who need more than home care – providing necessary care which help patients return to their home at the soonest possible time; and respite care, which is care limited to five consecutive days providing brief respite for the patient’s primary caregiver through admissions in hospitals even without the patient meeting the necessary admission criteria (VITAS, n.d). VITAS services are paid for by Medicare, Medicaid, private insurance providers, and other forms of reimbursement for services (VITAS, n.d). This center is defined by the needs of its patients and it is focused on helping the patients stay at home even as they suffer from a chronic disease. Its values are focused on patients and families first, on taking care of each other, on doing one’s best today and even better tomorrow, and being proud to make a difference in a patient’s life (VITAS, n.d). It is a center which strongly advocates for patient’s rights and appropriate care based on their condition and specific needs. The VITAS center was founded in 1978 as Hospice Care, Inc., and from then it started offering hospice care for various patients. The idea to build the center came from Westbrook, a minister and Colliflower, a registered nurse who saw the gaps in the treatment of patients with terminal illness (VITAS, n.d). Since then, the center has focused in finding and identifying gaps in services and filling in such gaps in order to ensure adequate care for patients. As a hospice center it also led a bipartisan effort in championing for the inclusion of hospice care in the healthcare payment system (VITAS, n.d). Since its inception, this center has actively provided crucial care for patients. It is a center whose leadership is guided by the vision of its founders. It is focused on providing the needs of the patients based on what each patient and his family actually needs. It is a continually evolving organization, but its vision and mission remains constant – that of prioritizing families and patients. Breakdown of 200 hours For each week, in general, I worked for 24 hours divided into three days of 8 hours each. On the first 30 minutes to one hour of each working day, I spent the time reviewing patient files, especially the files of those who needed priority care. After reviewing the files, proper endorsement was made to the executive assistant for review and subsequent endorsement to the nurses and other health care professionals involved in the patient’s care. During the rest of the eight hour shift, I then mostly carry out administrative work in one of the offices in VITAS. This administrative work mostly involved clerical and office work which primarily focused on reviewing patient files and reviewing the conduct of daily hospice services. For the eight hours I spent in VITAS, I assisted the volunteers whenever it became necessary. When the volunteers were noticeably shorthanded, I also rendered care and assistance for the patients. There were times when patients had simultaneous needs and volunteers had to be called in to assist the other health care professionals on duty. Assistance to volunteers also included assistance in inviting new volunteers for the hospice center. Recruiting volunteers can prove to be difficult and challenging and my task was to encourage people with the right background to volunteer and to share their services to the hospice center. In my 200 hours, I was able to successfully call in about 5 volunteers who are now actively involved in rendering services to patients. These volunteers mostly run errands for patients – light cleaning and grocery shopping for them. I also helped in carrying out orientation of these volunteers, especially in introducing to these volunteers the different possible cases they would encounter while they are connected with the organization. I assisted in the orientation process by explaining to the volunteers the specific needs of the patients they would likely encounter and how they should deal and address such specific needs. More importantly, I introduced the volunteers to what VITAS is all about, including its mission, vision, goals, functions, roles, and responsibilities. In the process, I also introduced the volunteers to the different health care staff they would likely encounter in VITAS, as well as the functions of these staff in the center. The different processes and protocol being followed in the center was also explained to the volunteers. In the orientation, I assisted in arranging the venue for the orientation, as well as the audio-visual material needed during the orientation. I also coordinated with the center in setting schedules for the orientation, based on potential volunteers and on the availability of speakers who would be involved in the orientation process. Part of my daily functions while connected with VITAS was to collect donation checks from donor individuals, corporations, and organizations. Various philanthropists, organizations, and corporations have been interested in making financial contributions to the organization. I usually pick up the checks from these people and later send such checks to the patients who are in dire need of financial assistance. The determination of financial assistance is usually done by the finance officers of the hospice center. My role is to coordinate with these officers and review which cases and which patients need the most financial assistance. I also follow an executive assistant of the hospice center and in the process, I work with him in calendaring and scheduling for Tele-care. In shadowing the executive assistant, I also review patient’s charts in order to determine patient needs and the volunteer or health professional which can be called in to render care to the patient. Each patient’s needs are enumerated and then the available staff members are matched to each patient, depending on needs. For example, a cancer patient needs to have some grocery shopping done and needs his medicines to be filled in. I would coordinate with one of the volunteers or home health aides to do some grocery shopping for the patient, and to schedule an appointment with the pharmacist in order to have the patient’s medicine filled. A physician also needs to be scheduled for an appointment with the patient in order to have the patient’s symptoms reviewed and to determine the necessity for adjustments in the dosage or even the type of medicines the patient is currently taking. Such services are to be coordinated through the telephone and eventually through personal contact between the healthcare givers and the patient. Part of my work in the 200 hours of internship also involved the distribution of sale material. Sale materials have to be distributed to the different patients, as well as their primary caregivers. In some occasions, they also had to be distributed to the health professionals employed by VITAS. Such materials included data on the services offered by the center; and information on how such services can be accessed by patients and interested individuals. It was part of the promotional and advertising strategy of the center to draw in more patients under hospice care. I was also involved in event planning. Events and social occasions were held occasionally in VITAS. Such social gatherings allowed the patients, their families, and the health care staff to relax, exchange stories, and to socialize with each other on a more informal ground. Such social gatherings involved a lot of preparation and coordination with patients, with their families, and with the health care professionals, as well as the managers of the hospice center. Coordination of date, venue, games, financing, and similar details had to be worked out and I was one of those who had to coordinate these details with the different people who would likely be involved in the socialization. I also made invitation cards and mailed such cards to the patients and to the health professionals who would be involved in the gathering. These invitations were mailed in to the concerned parties after the plans for the gathering were finalized. The invitations also included possible follow-up in order to assess head count and confirm participation by patients and by staff. These invitations were also opened and offered to the philanthropic individuals, organizations, and other corporations who were generous with their time and their money. I also provided packets to nurses. Home care and nursing home packets were convenient packets for making the different health professionals aware of the specific services and care they needed to deliver to their patients. I had to provide such packets to the nurses and I had to check that each packet contained all the necessary tools they would need in order to successfully deliver patient care. I also had to make sure that each packet would fit the patient that the nurses would care for. A nursing home packet and a continuous care packet would contain differences in data and I had to check that each packet contained the correct information. It was also part of my job to make a bereavement letter for the patient’s families. Such letter was phrased in the most sympathetic manner in order to condole with the families and to let them know that VITAS is very much ready and willing to offer them emotional and spiritual assistance in their time of grief. I composed the letter with the social workers, the other health professionals who took care of the patient, and the other volunteers who contributed to the care of the patient. Their input is often necessary to give the letter a more personal touch. I would then stamp the mail and go on to mail such letters with the post office. I would also get a lot of information about the HIPAA and OSHA in order to determine the elements of compliance and how well VITAS and the health care staff complies with the standards set forth by the regulatory agencies. I also checked with these agencies for regular updates on policies and on possible inspections and visits which they may conduct in the center. The center’s compliance with the standards of the OSHA and HIPAA are also checked and assessed. Gaps and issues with compliance are reviewed and are later reported to the managers of the center. I would also help in filing relevant information from the OSHA and HIPAA in order to ensure that the necessary data is stored and made easily available to the concerned authorities and to the health care staff. As a representative of VITAS, I also had speaking engagements in the community on topics related to end-of-life care. Through these speaking engagements, I made sure that I was imparting the right and the correct information about end-of-life care. I made sure that I would negate their often wrong and preconceived notions about hospice care. I also emphasized that those who are at the end of their life still deserve care which would help ensure that the last days of their life would be comfortable. I would also highlight the fact that the center offers a chance for terminally ill patients to enjoy the last few days of their life in the comfort of their own homes. These speaking engagements were made in coordination with local community leaders and school leaders. I also helped the volunteer children in the local communities in coming up with projects in school which they could later send to the patients during special occasions like Christmas, Halloween, Valentine’s, or Thanksgiving. I coordinated with schools and teachers in order to conceptualize such projects and to give them the names of some patients they could send the projects to. In so doing, the projects were personalized to each patient and the children also had occasion to visit some of the patients. One of the major issues of hospice care patients has always been their emotional state with many of them falling victim to depression. The projects made by the students helped to cheer the patients up, especially during the Holiday season. Finally, I was also involved throughout the day in minor clerical work like typing, faxing, and copying. These activities were often in line with the work of the executive assistant, or the work of the nurses, doctors, and other medical staff. Faxing or copying was also often carried out in coordination with other hospitals and health care centers involved in the patient’s care. In terms of additional skills and knowledge I was able to develop or acquire as a result of my work, I learned how to be more patient, and to be more organized and orderly in my activities. Before my internship, I often was impatient in carrying out my daily activities. I sometimes rushed through these activities. Although I was able to accomplish these activities successfully, I found out during my internship that rushing through things can often lead to unfavorable consequences. I sometimes ended up repeating some of my activities because I did them wrong. In the end, I learned to take each activity one step at a time and to also savor the experience of carrying out such activities. I also learned how to organize my activities. Before my internship, I usually just kept a mental picture of what my activities for the day are and how my activities would be carried out. I found out that applying this technique in VITAS was not effective because I often ended up forgetting some of the activities and how to carry them out. In the course of my internship, I learned how to plan my activities – to organize them in terms of time and in terms of priority. For each activity, I also learned to outline how I would carry out each activity – from the first step up to the last step. During my internship, I also found out different information about the most important care which end-of-life patients need. I learned that their needs mostly are emotional, mostly coming from worry about their families whom they would leave behind. This internship was very much beneficial for my professional development because it armed me with crucial skills which I would need in the actual practice. The internship also helped identify my weaknesses as a practitioner and the different adjustments I can make in order to address such weaknesses. The internship also gave me a chance to apply the theories and knowledge I gained in school, and to apply such knowledge on a more practical context – to assess the application and review the process and decide whether or not such procedures and knowledge are appropriate for the patients involved. Relationship of the Internship Experience to the MS-HCA Program The Master of Science majoring in Health Care Administration is one of the programs offered in the university which primarily focuses on health care policy analysis, the development of healthy organizations and the community, the health care finance and budget, the legal and ethical issues in health care, information technology in health care, public health, and health economics. The program is meant to prepare the student for administrative positions in hospitals, managed care, mental health facilities, long-term care centers, governmental health agencies, and similar organizations. It is a program designed to analyze the health care system, the managerial skills of the health care professionals, the financial management of the health industry, and the implementation of ethical practices in health care. It is a program which consists of online and face-to-face sessions, with the help of an industry-relevant curriculum, and the networking of professionals in a team learning environment. The MS-HCA program is meant to teach the health care professionals: how the health industry functions from a policy standpoint; the methods for successful leadership; the importance of solid finances; the ethical concepts of behavior; and the legal theories that healthcare providers have to apply. In the MS-HCA program, I was able to gain valuable leadership skills which helped me with my internship experience. The program taught me how to be a leader. The MS-HCA program set me up in managerial situations and helped develop my leadership skills in order to objectively and fully address the issues being raised in the situation. Before entering the program, I did not consider myself a strong leader. But being in the program thrust me into situations which I was encouraged and prompted to resolve. The program, in effect, gave me more confidence in my internship program. It gave me the drive to be a strong leader and to take initiatives when the situation required it. In terms of knowledge, the MS-HCA program equipped me with important knowledge in relation to the ethical means of practicing. The program familiarized me with four ethical principles, including respect for autonomy, beneficence, non-maleficence, and justice (McGrath, 2007). And these principles gave me an instant insight on how to resolve ethical issues based on the four considerations and the impact of such considerations on the patients and in the general practice. In my internship, the ethical knowledge I gained during the MS-HCA program guided me in my decision-making and in my assessment of patient issues. I had occasion to encounter an ethical issue whereby one of the patients signed a DNR order and requested that his family not be informed of such decision. I reviewed the patient’s chart and in the process, I was able to assess whether or not the physician and the other health care givers were right in respecting his decision. By applying the ethical principles, I was able to review the patient’s case and decide that the patient had the right to autonomy and to self-determination and he had the right to decide on the care (or the lack of care) which would be administered to him (Thompson, 1990). I noted also that the physician was in the process of convincing the patient to inform his family about his decision. The physician’s contention is that it would make the confidentiality process less complicated and would make the family be more involved with his decisions and his care. The theories of developing healthy organizations and communities which were set forth in the MS-HCA program helped me in my internship experience. The theory emphasized the importance of coordination between organizations and communities in order to ensure that the members are linked with each other regardless of the complexity or of the diversity of the tasks which are being conducted by the organizations (Bodenheimer, 2008). In my internship experience, this coordination process helped me in accomplishing the different tasks in the organization. The different departments, staff, and the communities involved in the patient care were all important elements in the delivery of quality patient care. By coordinating with these elements, I was able to easily carry out my daily activities and I was able to simplify these tasks. With the assistance and through the coordination of the different departments and health care staff, I was able to gain better cooperation from the staff and therefore to carry out the tasks easily and quickly. In the theories of developing organizations, I learned that it is important to involve the immediate community in order to ensure that the members of the community are involved in the implementation of activities and in order to help make the patients more involved and more engaged in the activities (Hunt, 1990). The members of the community are familiar to the patients and most of them enjoy socializing with them. With the implementation of projects during holidays, the center was able to accomplish several things at the same time. It was able to implement activities for the children and for the members of the community; it was able to involve the community in caring for the end-of-life care patients; and the patients were made to be a part of the community. These patients, as a result, were likely to feel less depressed and alone and the members of the community were enlightened about their condition. The MS-HCA program also included a course and theories on health care financing and budgeting. Health care financing is one of the major challenges in the health care services at present. With the global economic crisis, the health care sector’s budget has been adjusted and reduced in order to ensure proper distribution of limited resources (Walker, 2008). As a result, no new staff was hired and limited health supplies became major issues in health care delivery. Through the MS-HCA program, I learned about different ways of managing limited resources and how to manage such resources based on priority needs. One of the important proposals we studied in the program was on rationalization of health care expenses. Rationalization is about the justification of every item in the health care budget – based on the need of the patients, and on the ability of the organization to provide such need (Beattie, 1998). In applying such concept in my internship program, I implemented this concept in the planning of the socialization activity with the patients and the health care staff. The management gave us a limited amount to use for the preparations of the socialization activity and we had to work within the budget. We rationalized every expense that was expected in the activity (Langenbrunner, et.al., 2009). The items which were not rationalized as necessary to the activity were not included in the budget. While planning all other financial considerations with the executive assistant, I also had occasion to apply the concept of rationalization. In the process, we were able to stay within the budget, while still being able to provide for the essential elements to make the activity successful. Information technology is an important learning which I gained in the MS-HCA program because it informed me of the latest information technologies available and how such media and technologies could be used in order to implement the different activities in the internship program (Medpac, 2004). This information became particularly important when I had to send notice and inform other people about the upcoming socialization activities which the center would be involved in. The internet, more specifically, the social networking websites are the latest in information technology (Medpac, 2004). I found them important tools in the information dissemination process and in the coordination of activities. In order to set-up a date for the socialization activity which would be convenient for the greater majority, I set up a poll through Facebook and sent it to the different parties who were invited to the occasion. The most common date was chosen and the information about the occasion was also sent and notified through Facebook and through electronic mail. The patients and the family members who were not online were informed via invitation cards sent through snail mail, atleast a week prior to the occasion. Information technology was also useful in checking the consistency of the filing and the documentation process. The computer helped to provide an electronic, unbiased, and an objective assessment of the charts. Public health is yet another important element of the MS-HCA program. This program introduced to me the concept and the elements of public health and how the different agencies and interest groups coordinate with each other in order to ensure the adequate delivery of health services to those who need it the most (Turnok, 2009). Public health has often been likened or associated with low quality in health services. Through the MS-HCA program, I found out that it is a service which is as vulnerable to the same pitfalls as private health care. Public health is however equipped and staffed with the essential elements of health service. With the right people and with adequate management and resources, it is possible to reach the same quality of services seen in private health organizations (Turnock, 2009). In the course of my internship, I found out that public health is funded by Medicare and by Medicaid and in general, by government funds. Such sources are therefore limited. However, with the application of the principles and theories of health financing and budgeting, I found out that it is possible to carry out the essential activities in the health care practice while still working within a limited budget. I also found out that with the assistance of philanthropic groups, individuals, and corporations, it is possible for the organization to render more services and to improve such services (Turnok, 2009). These philanthropic organizations are important partners in health care because they have given adequate access to programs and resources which would not have been normally available to the organization. And through proper coordination, it is possible for VITAS and for these benevolent organizations to benefit from their partnership and collaboration. In general, the internship program gave me the skills of leadership in order to effectively arm me with important tools in my future practice. The internship program taught me how to plan my daily activities. Through the internship program, I learned how to be more organized in my activities by planning them and planning the details which go with them (Hersey & Duldt, 1989). In so doing, I was able to create a dynamic and organized system which did not allow for confusion and mistakes. As a leader, I was also a director (Kazandjian & Lied, 1999). My directing skills were crucial when we were planning the socialization activity because I had to direct people to certain tasks in order to ensure the successful conduct of our socialization. This was a major challenge, but I discovered that a leader had to have the right amount of authority and leniency to direct and guide other people into carrying out orders (Gordon, 2003). As a leader, I also learned how to control all the elements which made up the different activities I was involved in. In this case, I learned supervisory skills; and being in control means exerting supervisory skills on the staff members (Savedoff, 2008). Supervising meant that I had to monitor activities and ensure that they were headed in the right direction. It also meant that I had to allow other people to do things the way they wanted, but made sure that they got the work done. Conclusion In this internship program, I learned valuable skills and information which now make me more confident in my future practice. This program, as aided by the MS-HCA program, has made me more confident as a leader. This process has been very memorable because it has exposed my weaknesses – weaknesses which I need to address before I can be the best administrator I can be. Works Cited About VITAS (n.d) VITAS. Retrieved 26 November 2010 from http://www.vitas.com/Aboutus/History.aspx Beattie, A. (1998) Sustainable health care financing in Southern Africa: papers from an EDI health policy seminar held in Johannesburg, South Africa, June 1996, Volume 434. Washington: World Bank Publications Bodenheimer, T. (2007) Coordinating Care: A Perilous Journey Through the Health Care System. New England Journal of Medicine. Retrieved 26 November 2010 from http://familymedicine.medschool.ucsf.edu/cepc/pdf/BodenheimerCareCoordination2007.pdf Gordon, P. (2003) Pfeiffer's Classic Activities for Developing Leaders. New Jersey: John Wiley & Sons Hersey, P. & Duldt, B. (1989) Situational leadership in nursing. New York: Appleton & Lange Hunt, S. (1990) Building alliances: professional and political issues in community participation. Health Promotion, volume 5, number 3, pp. 179-185. Kazandjian, V. & Lied, T. (1999) Healthcare performance measurement: systems design and evaluation. Wisconsin: Quality Press Langenbrunner, J., Cashin, C., & O’Dougherty, S. (2009) Designing and implementing health care provider payment systems: how-to manuals, Volume 434. Washington: World Bank Publications McGrath, J (2007) Ethical Practice in Brain Injury Rehabilitation. New York: Oxford University Savedoff, W., Gottret, P., & World Bank (2008) Governing mandatory health insurance: learning from experience. Washington: World Bank Publications Thompson, A. (1990) Guide to ethical practice in psychotherapy. Michigan: University of Michigan Press Turnock, B. (2009) Public health: what it is and how it works. Massachusetts: Jones & Bartlett Publishers Walker, E. (2008) Financial Crisis Will Impact Healthcare Heavily. MedPage Today. Retrieved 26 November 2010 from http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/11237 Washington Information technology in health care. (2004) Medpac: Report to the Congress: New Approaches in Medicare. Retrieved 26 November 2010 from http://www.medpac.gov/publications%5Ccongressional_reports%5CJune04_ch7.pdf Read More