INTERNAL ENVIRONMENT ASSESSEMENT JACKSON MEMORIAL HOSPITAL Miami, Florida Major services/products provided including key technologies

Jackson Memorial Hospital in Miami Florida offers a variety of services and uses state of the art technology. In addition to patient medical services, it also provides educational programs, a clinical research facility and a variety of community service programs. Their list of patient medical services includes the following:

Bariatric Surgery

Bloodless Medicine & Surgery

Biscayne Imaging Center

Breast Health Care

Cancer Care

Cardiology - Heart & Vascular

Dermatology

Ear Nose & Throat

Emergency Care

Fetal Therapy

HIV / AIDS

Maternity Care

Mental and Behavioral Health

Neurology & Neurosurgery

Ophthalmology

Orthopaedics

Pathology

Pediatrics

Pharmacy Services

Radiation Oncology

Radiology

Rape Treatment

Ryder Trauma Center

Stroke Services

Surgery

Surgical (Perioperative) Services

Transplants

Urology

Women's Services

Other services provided include:

Health Screenings

Health Fairs

Health Awareness & Education

Speaking Engagements

Injury Prevention, Presentations and Demonstrations

Access and Referrals to Jackson Primary Care Centers

Employee Work/Life Services

2) Description of the unit in which you are working

I work in IT/PACS (Picture archiving and communication system). We store, organize and retrieve radiographs. We interact with all levels of hospital personnel including physicians, nurses and administrators.

3) A summary of the facility's history

Jackson Memorial Hospital opened in 1918 in Miami, Florida's Dade County as a 13 bed community hospital. It is now a part of a larger network of health care facilities that reside under the umbrella of the Jackson Health System. It is governed by the Public Health Trust, which consists of citizen volunteers acting on behalf of the Miami-Dade Board of County Commissioners is an accredited, tax-assisted, tertiary teaching hospital with more than 1,500 licensed beds.

4) Ownership (for profit, not-for-profit, government) and implications of ownership for the organization

Jackson Memorial Hospital is non-profit, and is supported by taxpayers. The owner and operator is the Miami-Dade County Public Health Trust. Regarding the implications for ownership, it is important to understand the nature of nonprofit hospitals as opposed to for-profit hospitals. Nonprofit hospitals were originally the only type of hospitals. They were usually established by either universities or religious groups and were not designed to make money, but to provide healthcare to those who needed it. When these hospitals started to need more money, they began to turn to investors, which essentially turned them into profit-making corporations just like Microsoft or Coca-Cola. While the primary focus was still on caring for the sick, making a profit became just as important. Despite the emergence of for-profit hospitals, according to Williams and Torrens (2010) "The largest grouping of hospitals in the nation are nonprofit community hospitals. Although their numbers have declined overall, they remain the primary source of hospital care for most Americans" (p. 185). There are also some hospitals that are combination of both profit and non-profit, and the number of these is continuing to grow.

Although the most obvious difference between nonprofit and for-profit hospitals is whether the money being made is pocketed by owners and investors, or put back into the hospital, there are major differences in philosophies as well. According to Picone et al. (2002) the for-profit hospitals, particularly those that are investor owned, make decisions not only with regard to what will happen to the delivery of health care services, but what will happen financially Generally, not-for-profit facilities make decisions primarily with patient care in mind; financial considerations play a secondary role. In terms of operational differences, for-profit hospitals are more competitive and aggressive in terms of marketing and advertising, and they are also likely to employee more management specialists than non-profit hospitals.

5) Organizational culture, mission, structure, personnel data (type, number)

The organizational culture is very open to diversity, participatory decision-making and positive motivational tactics. The hospital makes several pledges to the people it serves and the people who serve them. They believe their first responsibility is to the patients they serve. They respect the physical, emotional and spiritual needs of their patients and find that compassion is essential to fostering healing and wholeness. They also believe that patients and their families deserve the best possible healthcare experience. Therefore they are committed to the pursuit of excellence in all that they do. Teaching and learning are fundamental in their efforts. In terms of their service in the community,...

They also embrace diversity, stating that their organization must reflect the rich diversity of their communities, therefore they respect, embrace and derive strength from people's differences. The official mission and vision statements for Jackson Health System are as follows:
Mission Statement

"To build the health of the community by providing a single, high standard of quality care for the residents of Miami-Dade County"

Vision Statement

"Our strategic vision is to be a nationally and internationally recognized, world-class academic medical system and to be the provider of choice for quality care."

6) Major sources of reimbursement and implications for the organization

According to Jackson et. al., (2002), "One-quarter of the population in Miami-Dade County, Florida, lacks health insurance, a fraction well above the national average (about one-sixth of the nation's population is without health insurance)"(p. xi). With a population of 2,363,600 (Podunk, 2004), this signifies a tremendous amount of uninsured citizens in the county. Accordingly, as a result of this extremely high rate of uninsured citizens, JMH has experienced more than its fair share of financial ups and downs. These difficulties have affected both the staff and the patients in terms of the level of quality of their experiences with the hospital.

To alleviate some of the financial stresses associated with uncompensated care, the state of Florida in 1991 passed legislation permitting local taxing districts to hold referenda for approval of tax levies to finance health care for the poor, uninsured population. As a result, "In the past ten years, JMH has grown and improved financially and is a leader in treating eye disorders and pediatric patients" (Jackson et al., 2002, p. xi). However these improvements have not eliminated the negative impact that uninsured and underinsured patients on the community. According to Jackson's report:

Of JMH's nearly $714 million in operating costs, charity care accounts for 23%, and bad debt accounts for another 2%. This estimate, however, ignores the $142 million received from the surtax. To the extent that JMH is being reimbursed by the taxpayers for providing charity care, the burden of that care on the hospital's operating expenses would be reduced. In recent calculations, the Florida Hospital Association has arbitrarily assumed that half of the surtax proceeds are devoted to indigent care and half are used for other purposes. If the half for indigent care is subtracted from the costs of charity care, net charity-care costs total 13% of operating expenses (p. xii).

This is not to say that the surtax did not make a positive impact, however it has done nothing to reduce the number of uninsured patients. The intentions however were never to reduce the number of uninsured patients but rather to make sure that they did not go untreated or receive insufficient care. It was also not intended to supersede other funding already received through community tax dollars, but was designed to act as a supplement to these funds.

According to Jackson et al. (2002) "disagreement over the interpretation of the surtax legislation (i.e., how much of the proceeds were intended for indigent care) has caused a difference of opinion on whether and how the proceeds should be distributed" (p. xiii). Such issues are particularly significant when looking at the percentage of operating costs used for "charity care" and "bad debt," as the following table from Jackson et al.'s report demonstrates:

Jackson et. al.'s study makes it quite clear that while the surtax has undoubtedly been helpful to the poor, uninsured population of Southern Florida, many issues still need to be resolved:

Depending upon how the 0.5% sales surtax approved in Florida in 1991 is allocated to offset the costs of charity care, the level of uncompensated care at JMH ranges from being the highest proportion of operating expenses to being similar to that of other hospitals that provide significant amounts of such care. Thus, the results of our hospital financial analysis rest, in part, on the intent of the half-penny sales tax. If, as is often argued, the funds are to be used to maintain trauma and specialized services at JMH, the level of uncompensated care provided there clearly dwarfs that of other hospitals. If, however, the funds are used to provide care for the county's indigent population, the level of charity care provided at JMH is similar to that of other hospitals in the county. Regardless, the surtax revenues received by JMH represent a major source of income, covering nearly one-fifth of the hospital's total operating expenses (pp. 47-48).

JMH has experienced numerous problems as a result of serving such a large uninsured population. In addition to the expenses described previously, when the hospital serves as the major point of access for health care for the uninsured, it forces people to go to hospitals…