Environmental Services
Most of the other Departments reviewed in other posts are ones whose names you see on office doors or hospital bulletin boards. The ones I’m about to discuss are the silent heroes of healthcare. They are rarely on display but are present everywhere in the hospital environment. Nothing can be accomplished without them. They are the departments that keep the organization running efficiently and safely, the unsung heroes of healthcare. The departments that ensure patients’ essential needs are met every day – food, water, linens, safety, transportation, cleanliness, supplies, communication, equipment that works, and a safe building. Without all these things, no one would want to come to a facility to receive care. I want to make sure you recognize who they are when you see their “healthcare” name. As with everything else, most people who are not associated with healthcare or business call it one thing, while the formal name is something else. Here’s a list of both.
Formal Name | Common Name | Formal Name | Common Name |
Food and Nutrition | Dietary | Materials Management | Supplies |
Environmental Services | Housekeeping | Patient Transportation | Call for a wheelchair |
Facilities Management | Grounds, Maintenance, Construction | Safety and Security | Security |
Valet | Parking | Telecommunication | Operator |
Finance Department
Hospitals can deny admission to a patient who cannot pay their bill. However, they cannot deny care to a patient for inability to pay if the patient presents with a medical emergency or high-risk labor. To make that determination, emergency room staff conduct a medical screening upon the patient’s arrival (prior to admission) to determine whether an emergency condition exists. If the patient does not meet the criteria for a medical emergency or high-risk labor, they can proceed with regular financial screening for hospital registration.
A hospital can refuse to admit a patient for the following reasons:
- The patient requests treatment that is not medically indicated or contrary to established medical standards, including medications or procedures that are not appropriate for their condition.
- The patient is abusive, disruptive, or poses a danger to staff or other patients unless the behavior is a symptom of a medical or psychiatric condition.
- There is no established doctor-patient relationship, which typically requires a formal agreement to provide care.
- The patient’s admission is for non-emergency routine care or a procedure.
If your doctor advises you that you need a procedure performed at a local hospital, often the doctor’s office calls the hospital to schedule the procedure for you, or the hospital calls you to determine a time and date directly. The call you receive generally comes from the Scheduling Office of the department performing the procedure. Depending on the organization, the Scheduler may also register you at that time. If so, they will collect your insurance and personal information, as well as backup payment details. If they don’t collect it, they might ask you to complete a preregistration check-in via the patient portal or to arrive minutes early for the procedure to complete paperwork with the Patient Registration Office. In either case, they are likely to ask you for a copy of your insurance cards and driver’s license, so come prepared to show them.
These days, you often receive an estimate before your procedure, indicating how much they anticipate you will pay. You can either pay the cost up front or have them bill your insurance and pay the difference. If you don’t have insurance, contact the Financial Counselor once you get the estimate. The Financial Counselor will help you set up a payment plan that you can afford.
If you are not familiar with using a Patient Portal, I encourage you to learn how to use it. By using a Portal, you can talk to your healthcare provider if you have questions, find out the results of your tests before going to the doctor’s office, see when your appointments are scheduled, and check your Medical Records. Also, if for any reason you need copies of Medical Records to take to other healthcare providers at another organization, you can usually request them through the Portal.
Departments that Protect Your Rights
In conclusion, there are a few departments I hope you never have to use, but I want you to know about them in case you do. These departments exist to help you in the event you feel you are not receiving the care you deserve, or you believe you or your family have been harmed in some way.
Patient Safety
The Patient Safety Officer investigates any injuries that patients or family members might sustain while staying at or visiting the hospital. All hospitals have some type of incident or accident reporting system. If you get hurt while staying at the hospital or visiting there, ask the person in charge of the unit where the accident occurred for an accident report form. Ask when it must be turned in, where, and to whom. Also, it’s important to ask whether you need care or need to see someone a few days after you leave. May you see your own doctor, or do you need to see a doctor from their facility? If they say it must be someone from their facility, get the name. I recommend getting that answer in writing. Following these steps is vital if you are hurt. They can refuse payment if the steps are not followed, and you need medical care later. However, if someone at the hospital gives you information on what to do and you follow what you were told, they are obliged to pay you if the treatment meets all the rest of the requirements.
Patient Relations or Customer Service
Patient Relations, Customer Service, Patient Services, Quality Services, Patient Complaints-Every hospital calls this department something different. It’s the one where you file a complaint about something that went wrong while you were at the hospital, and everywhere I’ve been a patient, they bury the title of this department in a way that makes it very difficult to find. It’s often under the guise of Quality something. If you’re lucky, it may be under a customer service title. If you find a reference for Patient Rights, you are getting close; don’t give up. When you find that number, it’s the department you must have if you hope to get any action.
Patient Relations staff can get things done. Even doctors will listen when they ask for something (at least some of them will). Explain to the Patient Relations person what you need. If they don’t answer when you call, leave a message and record when you did so; even record the message you left. If they don’t call you back by the next day, keep calling and keep notes of your attempts to reach them.
Shift Supervision – Nursing and Medical
If you need help after 5 pm, on a weekend, or on a holiday, call the Evening or Night Shift Supervisor or the Clinical Administrator. The Clinical Administrator is especially helpful if you have a problem that needs to go over someone’s head to get resolved. Unfortunately, some in the healthcare world fail to realize that family caregivers know much more about the patient than they do. They refuse to listen to the information you need to share, which is vital to the proposed treatment plan they intend to implement. If you find yourself in a situation where you are not being heard and a health care provider is about to take an action that will cause harm to your family member or is not providing essential care that will cause negative outcomes, you have a right and responsibility to tell them to STOP what they are doing immediately until you can speak to the next level person in charge. If it’s a nursing chain-of-command, you can go Nurse Manager, Nurse Director, Nurse Clinical Administrator, and then all the way up to the Chief Nursing Officer. If it’s a doctor, you can start with the chief of service for that specialty, usually called the Chief of “_____” (“Medicine”), and, if that doesn’t work, the next level is the Chief of Staff. If necessary, even say you refuse any further treatment by that person until you speak to someone else in authority. Usually, an in-house Clinical Administrator or Clinical Supervisor is in charge, depending on the organization’s size. If you are trying all this and it’s still not working, begin recording everything you are doing as soon as you realize what is happening, and keep recording. In Virginia, if they tell you that you cannot record something without their permission, you can record a conversation as long as one of the parties consents to the recording.
What Happens After an “Incident”
If they do not stop and a serious injury occurs within an organization, an investigation by Risk Management is required. In addition, Insurance Services needs to file a claim to prepare for a lawsuit if the hospital is found negligent or at fault in any way and is required to pay the claim. Risk Management gathers all the facts about what happened; however, because its focus is on the hospital, the information gathered supports that perspective. They will attempt to interview everyone involved and gather testimony from as many people as possible while the details are fresh. Be truthful and cooperate but tell only the facts. Do not add details you are not sure about.
If your family was injured, you may want your own representation. Do not believe any promises they make to you. Do not make excuses for anyone trying to take up for someone from the hospital. Only state what you saw happen. Do not guess. If you did not see something or do not know something, do not say anything. If you are trying to be nice and say something like, “I’m sure X would never do anything like that,” or “I don’t think I remember X doing that,” and then later, when your mind is clearer, you definitely remember it, your first statement will be used against you. The hospital will try to gather information to reduce the amount it must pay if you file a lawsuit. It’s best if you just say, “I don’t remember right now.”
How They Try to Fix The Problem
Once the investigation is complete, Risk Management, in consultation with the Legal Office, recommends that the Department involved consult with the Quality Improvement (Quality Assurance) Department or Human Resources to address what happened with the employed parties. If the investigation indicates that the event was due to employee misconduct or incompetence, Human Resources will assist Department management in determining the appropriate corrective action to prevent future recurrence, including possible training from the Office of Education and Training. If evidence suggests the event was related to a process flaw, Quality Improvement will establish a team with the Department to examine the current process and identify improvements to prevent a recurrence.
Regulatory Monitoring
In addition to Risk Management and Quality Improvement, two other departments monitor organizational compliance with regulations and laws. Compliance Services monitors the hospital’s compliance with financial practices, especially those related to federal funding from Medicare and Medicaid. Regulatory Affairs helps all hospital and outpatient departments maintain compliance with the thousands of regulations that healthcare organizations must meet to remain in business. Most healthcare organizations are accredited by The Joint Commission and must be licensed by their state, but they are also regulated by the Occupational Safety and Health Administration, the Drug Enforcement Administration, and many others that are too numerous to list here.
Computer Systems
In describing almost all the departments, I failed to mention how the technology network connects them. For years now, Information Technology (IT) has held the string that pulls healthcare together, much like a puppet master. No one unfamiliar with IT would likely ever guess how complex a healthcare system’s technology must be. Of course, there is the basic network that connects all departments (i.e., the primary computer system, telephone, and data storage that make up the administrative system). Add to that the payroll, patient care, security, and each specialized piece of medical equipment that must be integrated into the patient monitoring system and patient medical record. Alas, don’t forget that much of this must be encrypted, so no one can see personal, private health information. It must also be fool-proof and have backups to backups because the system can’t go down on a ventilator patient. It’s mind-boggling.
Hospital Leadership
So, what’s left? Hospital Administration and Marketing. Marketing handles all public-facing events, billboards, giveaways, signage, advertising, and articles you read about the organization. They are the ones who put a positive spin on difficult circumstances and smile about it. They have a tough job.
Hospital Administration includes all the Vice Presidents and the President. These people are very busy trying to figure out what is really going on because everyone brings them what they think they want to know, rather than what is real. Few people want to tell leaders what they really think because they don’t want to lose their jobs, and if they can spin the truth from negative to positive, they will.
