Monthly Archives: April 2016

Healthcare Reform: How Doctors and Nurses View Universal Care and Current Reform

Background:

Even with a bill passed in both houses of Congress, Healthcare reform and the issue of a universal or national healthcare system continues to dominate discussions on the hill. There is talk of repealing the bill and potentially leaving millions more Americans vulnerable and uninsured. Some argue that repeal is for the best because the current bill gives the government too much power and circumvents our individual rights and freedoms. Still others argue that the bill does not go far enough to grant every single American the right to healthcare services. These views are polarizing both the Representatives on Capitol Hill and their constituents who live on main-street.

Nurses and physicians work in the field taking care of the insured, the under-insured, and the uninsured. These healthcare professionals see first-hand how the ability to pay for healthcare services shape people’s perception of illness and their willingness to seek medical assistance in a timely manner. Given how highly charged the issue is, it is important to know what these nurses and doctors think of all the hoopla that still surrounds the issue of healthcare.

Healthcare Workers’ Viewpoint:

The opinions in this article are those expressed by the nurses and physicians at a Dallas hospital. For confidentiality reasons the names of said nurses and physicians, as well as, the name of the Dallas area hospital where they work will not be used. Based on their experience in the system, these healthcare workers pointed out their frustrations with the current system, reform, and universal healthcare. The issue is healthcare reform and universal healthcare. How do nurses and doctors view this?

CONs:
On the other hand, there are some nurses and physicians who vehemently oppose the idea of universal healthcare and reform that have been passed. These healthcare workers state the following:

Healthcare is not a right. It is the responsibility of each individual to work hard and pay for the care they require. Many people do not think their hard earned money should be syphoned to take care of individuals who are not pulling their own weight. A system that provides healthcare for all rewards people who are not contributing members of society. Even more, those who oppose healthcare reform and universal healthcare insist that it is not their place to take care of individuals who are lagging in their duties to self and society. These people become a drag on the system. Universal healthcare encourages the weaker members of society to stay weak and non-productive. If people had to pay for the services they receive, they are motivated to find work and everyone wins.
Paying for such a system will require an increase in taxation. This means more money taken from hard working Americans; money they can use to take care of their families, co-pays and deductions, as well as anything they think necessary. Increased taxation also limits funds available during retirement.
Some physicians and nurses believe that Medicare is a blithe on the healthcare system. In a free market society, insurance companies should be allowed to compete freely without a government run system that undermines the free market. Ideally, a free market will take care of pricing and completion will reduce the overall cost of healthcare. Hospitals and insurance companies that meet the demands of society will prevail. People who work hard will have access to healthcare services.
It is common knowledge that physicians in the United States earn more than physicians in other industrial nations. Extensive training and hard work is rewarded by respectable pay checks. Many worry that their living standards will drop if a national healthcare system is passed. Moreover, current reform advocates preventative care which may live certain specialties out of the loop. After years of training to be of service to society, these specialties may become obsolete.
Many people like to know that if they are insured, the care they need will be available to them when it is needed. It is perceived that extending healthcare benefits to all will lead to long waiting lines and if this were the case, many individuals are rightfully afraid of the cost to their lives and quality of living.

PROs:

Patients are more likely to get preventive care if they are insured. Healthcare services cost a lot of money. Many people have been bankrupted as a direct result of their inability to pay medical bills, which include hospital stay, physician and auxiliary care visits (home health nurses & therapists), as well as, pharmaceutical aids and medical supplies. This means that the health and financial well-being of patients are affected by any laws that offer improved access to healthcare services.
Preventative care saves hospitals and tax-payers money. Although not a primary concern for nurses, they were quick to point out that the under-insured and uninsured patients who make it to the hospital only arrive when they are so sick that they may never be completely healed from a disease that could have been prevented with the right out-patient care. Due to the advanced progression of their illness upon admission, these patients stay longer in hospitals and respond less to conventional therapies. The result is a very high cost for the care provided. Since these individuals cannot pay, in many instances, the hospitals are stuck with the bills. In order to pay off debts accrued the hospitals increase the cost of care for those who can pay. It is a logical solution that now affects law abiding tax payers which could have been prevented.
People that are chronically ill cannot work and pay for healthcare. Some end up homeless and become society’s problem relying on assistance from private parties or city government. If everyone was insured, many people who require frequent medical care will be taken care of, thus reducing the number of homeless people in society.
The U.S. is the only industrial nation that does not offer healthcare coverage to all its people.
In a system that relies solely on profit motivated insurance companies to provide compensation, access to certain needed therapies become limited if they are not approved by the patient’s insurance company. These used to be most prevalent with the introduction of HMOs and have since improved. Still it is a stain many organizations prefer not to discuss. As people whose sole reason for being is the care of patients it is no wonder that many will like a system where compensation did not play such an indelible role.

Conclusion:

Overall, during the interview process that led to this article, it became apparent that most healthcare workers opinions on access to healthcare were greatly influenced by the role they played in the care of their patients. It was quite apparent that the nurse’s role as patient advocate greatly influenced their view on healthcare reform and a universal healthcare system. An overwhelming number of nurses were in support of a system that offered coverage to every patient that walked through the hospital doors. Physicians, who were more likely to voice concerns over structure, efficacy, and compensation, were less likely to provide support of a system that will drastically change the existing landscape.

Investing In Healthcare

The baby boom cohort has changed the world in which we live and the lens through which we view it. The aging of this cohort (roughly one third of the population) will continue to usher in dramatic changes across most business sectors and areas of our lives in the years to come. The boomer demographic in North America is also presenting unique challenges for government run social programs and presenting unprecedented opportunities for businesses with the right entrepreneurial mindsets and resources. While boomer consumptive patterns have evolved over time, there are still strong correlates between their wants/needs (and the wants/needs of their children) and the flow of capital across virtually all economic sectors. Clearly, as boomers are aging, their spending habits are evolving as well. This re-prioritization of spending has become an area of study for governments and investment organizations alike. One area that surfaces repeatedly and is becoming pre-eminent in the study of boomer consumption patterns is healthcare.

Healthcare is one of the industries that are most acutely impacted by this demographic shift. While many boomers will continue working, many are also retiring or are getting close to retirement. Most boomers are or still view themselves as reasonably young (mentally and physically) – the oldest, born in 1946 one year after the “boys came home” from WWII. For those of you without a calculator handy, the oldest boomers will be 62 years of age in 2008. This small but important factoid is lost on many bullish investors who see the present time as the “halcyon days” in healthcare investment in seniors housing options or Long-term care. Yet it will be 15 to 20 years before the leading edge of the boomers reach the age where these services will be in higher demand.

What many people, including even professional investors, forget or never learned is that much of the the current demand for healthcare is being driven by WWI babies, or what has been coined The Greatest Generation. The Greatest Generation is compromised of those who reached adulthood just before, and served in WWII. Many came from rural areas of Canada and the U.S. and settled in the larger centers after the War. This generation was entirely different than succeeding generations. While the differences are beyond the scope of this article, suffice to say that those who seriously study demographic shifts expect the baby boom generation to have an entirely different set of expectations regarding healthcare service and other services than their parents.

So, to recap thus far, there are a significant number of opportunities in the United States and Canada in healthcare investment; but these opportunities are not limitless and nor are they a sure bet. Demographic shifts are significant drivers of healthcare consumption patterns. It is important to attribute healthcare supply and demand drivers to the market and demographic to which they rightfully belong.

So, while healthcare investment opportunities abound, there is no replacement for sound judgment based on analytical inquiry. This is true of any investment decision. It is also key that current and projected changes across the following domains are reviewed in detail: demographics, finances, macro-economics, geography, consumer attitudes and behaviours, motivating factors (e.g., luxury, fear), urban/rural, SES, educational, cultural, risk orientation, and other personal and group-related factors. While this article zeros in on the effect that the baby boom will have on the healthcare investment market, there are a multiplicity of other factors and population segments that are, and will continue to exert significant pressure on healthcare economics and consumption patterns.

The following businesses related to healthcare delivery are and will continue to be worthy of consideration by individuals, private equity, and venture capital investors. Again, it should be noted that the list is only a starting point, and that investment decisions should be made on the best current and projective information possible. It will be necessary to use an array of analytical tools and methods (e.g., Porter’s Five Forces and other financial and statistical methods and models) to assess the industry/sector/business opportunity prior to making a significant investment into healthcare. Having said this, potential healthcare investment opportunities exist in the following areas:

Integrated Healthcare Centers, i.e., primary care (particularly where physician services, diagnostics (X-ray, CT, MRI), laboratory, and pharmacy are delivered within a short radius)
Providers of products & services for diabetes management, congestive heart failure, COPD, coronary artery disease, and other high incidence chronic diseases
Providers of mobility and other daily living assistive devices for those with a range of impaired gross or fine motor skills or other mobility limitations (e.g., caused by pain, arthritis, joint immobility)
Pharmaceutical and biotechology innovators and providers (care must be exercised due to patent limitations, proliferation of substitutes – generic drugs, lengthy approval processes, and other process and outcome risks such as the Vioxx controversy )
Health and hospitality services outsourcing (again, highly contextual and requires significant demand/supply driver analysis, political, environmental, union/non-union and other forces analysis)
In-home healthcare services (e.g., nursing, physical therapy, occupational therapy, care and support)
Medical or surgical retreats (highly specialized, significant risk)
Assisted Living or Long-term Care (these resources are capital intensive and targeted at the parents of the boomers, i.e., the WWI babies) – it will be 20 years before boomers will require these services in any great volume (be careful)
Major equipment and major/minor supplies providers (e.g., MRI, CT, ultrasound through to re-useable and disposable equipment)
Providers of re-furbished medical equipment to secondary markets, which include more price-sensitive purchasers (e.g. re-furbished CT scanner for a smaller rural hospital)
Alternative medicine centers (e.g., offering Ayurvedic Medicine, acupuncture, traditional Chinese Medicine)

Since information technology is a core function in healthcare, the following is a stand alone list of technology-related opportunities related to data/information collection and transfer:

Devices: quick, simple to use, portable, and ease workflow in high stress healthcare environments (e.g., emergency departments, tele-health)
Devices whose operating systems converge with mainframe of networked systems that admit, track, audit, and generate reports with minimum input and robust rule-based error checking
Devices or system that integrates disparate healthcare network data and traffic
Devices or systems which accurately expedite services
Devices or systems which improve the accuracy and speed of diagnosis
Devices or systems which improve reduce human error and increase the probability of appropriate and targeted treatment options
Translational devices and applications of all sorts, i.e. translating actual “hands-on” data into useable, and interoperable information which can be used for diagnostic, treatment, recovery, and planning purposes
Electronic dashboard technology for strategic decision-makers
Providers of software applications that integrate disparate healthcare value chain and supply chain fragmentation
Providers of software applications that integrate in-hospital processes (e.g., admission, discharge, transfer); care-finance-payments; care-supplies-payments and other A/P and A/R alignment platforms and applications
Providers of software applications which refine, simplify, or facilitate the care planning of patients
Providers of systems integration
Providers of software applications for Human Resources, CRM, Finance, and other corporate functions

These are a few opportunities which currently exist in the healthcare context. As you might guess, many areas are being explored by larger firms. Healthcare IT is particularly attractive to larger, more highly capitalized companies and software developers. The competition amongst these groups is fierce due to the large volumes of funds in healthcare and the market opportunities driven by demographics and the need to constantly improve system performance. To date, there is no one firm with a strategic competitive advantage in any one area, though some healthcare sectors (e.g., diagnostics) have a high concentration of highly capitalized firms (e.g., GE and Siemens competing in the CT, MRI market).

Whatever investment decisions you decide, the amount of money you risk should be in proportion to your risk tolerance. Even “slam dunk” opportunities can turn out to be dogs if the circumstances are not right; or a context specific barrier is not weighed; or social attitudes do an about face.

If you are scanning the healthcare markets for opportunities to invest, be sure to do your due diligence and get help to investigate this complex and ever-expanding area. The due diligence you do prior to investing significant capital is essential to ensuring high double digit returns whilst minimizing your risk.

Healthcare Executive Recruiting – Bet on the Horse or the Jockey?

Experience breeds intuition when it comes to healthcare executive recruiting. Does it work for horse racing too? I will not attempt to prove whether experience improves your outcome at the track. However, healthcare venture capitalists often use horse racing analogies when discussing ideal investments. These venture capitalists prefer to bet on the jockey versus the horse. Their logic, it’s the people that drive the business.

A healthcare venture capital firm’s success is dependent on their ability to recruit and retain a high-performing Jockey, a.k.a. “the CEO.” If it was only so easy to win The Kentucky Derby or deliver a ten-bagger return. My healthcare executive recruiting experience working with healthcare venture capital firms provides intuition in defining the firm’s CEO need. Once understood, identifying and recruiting the CEO and building a solid support team for the CEO requires experience, extensive networks, new and real-time research and a thorough process. The intent of this article is to offer outcome-driven insights for the healthcare venture capital firm that chooses to search internally for a portfolio CEO versus retaining a healthcare executive recruiting firm.

Recent quarters show an increased level of new capital investment from healthcare venture capital firms. The Health Care M&A Monthly reported in March 2008 that healthcare services deal volume in February 2008 totaled thirty completed deals. Looking back to 2007, total funding for healthcare venture capital deals was more than $9 billion across more than 480 deals. Healthcare venture capital investment increases the demand for these firms to conduct a thorough and accurate executive search process in order to identify, recruit and retain the CEO. While a healthcare venture capital firm often retains a healthcare executive recruiting firm to assist in CEO recruiting efforts, healthcare venture capital firms can mimic the search process of the top healthcare executive recruiting firms.

Insights from healthcare executive recruiting firm processes will lead to an improved exit:

1. Healthcare venture capital firms are committed to recruiting a proven CEO for the portfolio business and may occasionally be inclined to conduct an in-house CEO search process. The approach is to put a CEO in place that is known by the healthcare venture capital firm from previous experiences and business dealings. However, many times these healthcare venture capital firms will admit they “don’t know what they don’t know” about the business, the segment, or the pool of available CEO talent. However, if there was any doubt at the onset, it quickly becomes clear they need to bet on the jockey to run an unfamiliar race. It is at this point the firm should consider duplicating the search methodology that healthcare executive recruiting firms utilize for CEO assignments.

Healthcare executive recruiting firms are engaged to identify and recruit leading CEOs for high-growth, venture backed businesses. To reduce the risk of making a hiring mistake, a healthcare venture capital firm’s internal search process should assess those executives the firm knows and trusts in parallel with proven executives who are newly introduced to the healthcare venture capital firm. Ultimately the CEO may be selected from the firm’s personal rolodex. However, the value of benchmarking known CEOs against a broader CEO talent-pool will prove valuable.

2. CEO contingency and succession planning belongs early in the healthcare venture capital firm’s investment. Recruiting strategies to recruit key CEOs, senior leaders and board members are at the foundation for a portfolio company’s success. Common practice is for the healthcare venture capital firm to identify and recruit a seasoned and industry-experienced board member, one capable of leading the business if the current CEO cannot finish the race. The immediate need is fiduciary but both succession and contingency planning should be considered too. While some individuals believe that succession planning should be below the CEO, healthcare venture capital firms are interested in developing concepts and financial carry more so than developing future leadership talent. Therefore, succession and contingency planning belong in the board room for two reasons: one, if the CEO in place is successful the new board member can maintain his or her fiduciary duties. However, if the CEO loses control of the business or the market, this board member is engaged and able to step in immediately. This hedge strategy can be effective to dramatically reduce downside risk.

If the CEO loses control of the business or the market and the healthcare venture capital firm did not plan appropriately, there will be many sleepless nights. It’s during those sleepless nights when the unprepared healthcare venture capital firm will incorrectly pursue one of these three options:

o Retain a healthcare executive recruiting firm. However, the search is often initiated on quick sand as the healthcare venture capital firm needs to recruit a savior. Conversely, the venture capitalist may decide to avoid retaining a healthcare executive recruiting firm as it is perceived to be too cumbersome of a process during this time of panic. Neither scenario leads to a high-multiple exit.

o Turn to someone the healthcare venture capital firm knows from previous dealings. This option is not focused on growth but rather on building a floor to minimize investment loss.

o The healthcare venture capitalist will take over the business and act as CEO. My experiences say that poor planning and a subsequent reactionary jerk will not deliver a positive cash outcome.

The success of a risk-taking healthcare venture capital firm is based on hiring and recruiting the right Jockey for the business. While healthcare executive recruiting firms are often critical resources to venture firms, there are occasions when a healthcare venture capital firm chooses to conduct their CEO search internally. In those occasions, healthcare venture capital firms should mimic the proven search process of the top healthcare executive recruiting firms. Healthcare venture capital firms will benefit by conducting an unbiased and thorough executive search process tied to board level contingency and succession plans. This will develop strong businesses and deliver solid returns.

Evolving Healthcare Trends

The model trends in the healthcare system have been changing over the period of time. The old trend gave importance to the individual patients and the emphasis was on treating illness. The goal of the hospitals was to do inpatient admissions, fill up the beds and more emphasis was given to acute inpatient care. The role of managers in the old paradigm was to run the organization and coordinate services. In the old system, all providers were essentially the same. The hospitals, physicians and health plans were separate and not integrated.

The newer trends that evolved gave importance to the population as a whole. It not only treated illness, but emphasized on promoting the wellness of the people. The goals of the healthcare system after being transformed over the years is to provide care at all levels which is continued. The role of managers in the new paradigm is more broad. They see the market and help in quality and continued improvement. They not only run the organization, but also go beyond the organizational boundaries. In the evolving system, the providers are differentiated according to their ability. The hospitals, physicians and health plans have formed an integrated delivery system.

One of the current trend in the healthcare delivery model is that continued care is emphasized. The key professionals are not only treating patients for their illness, but they are promoting and managing quality of health. For example, a patient with high cholesterol visits a doctor. He is not only given one-on-one medical treatment, but he is also offered to attend a group session where information is provided on how lifestyle and behavioral change can help. The patients learn from the clinicians and also from each other. Another current trend is to take care of the health of the defined population and not only individual patients. All the health needs of the population as a whole are identified and served. It is emphasized that the community uses the health and social services provided. Healthcare has become more population-based. Another trend that has evolved is that the hospitals, physicians and health plans have got connected and have formed an integrated delivery system. More investments are being made with a goal of providing services to the customers and retaining them.

There is a beneficial impact in the transformation of healthcare towards emphasizing continued health. The way healthcare has been viewed in the past has been changing. The shifting of care from treating acute illnesses to providing continued care is resulting in enhancement of the health of the people. The only appropriate and feasible model is to provide a continuum of care with the emphasis firmly on the family and community. The health of the population and community is considered as a whole. This is advantageous as it creates value in the healthcare delivery system. The healthcare providers work with the community as a whole and consider to improve the health of the general population. Even though this requires new kinds of ways of organizing and managing healthcare services, it helps in understanding the health needs of the target population. By studying their needs, the right health and social services could be provided to them. Examples of promoting wellness of the whole community are organizing health campaigns and providing preventive education to the people in general. Another example is providing awareness about flu vaccines and encouraging people to get the vaccination.

Integrating the healthcare delivery system has led to certain advantages to the patients. For example, they can be offered alternative sites of care depending on their convenience. It helps in meeting the needs of the customers and their preferences which is taken into account. The number of providers are expanded and the patients get to have a choice. The relationship between providers and health plans are organized in the current trend and this ensures that the right care is provided in a convenient way to the customers.

There are defined budgets and expenditure targets for the populations which implies that there is a need to be efficient and productive. The formation of strategic alliances, networks, systems and physician groups can also add value. There are capitated payments and budgets allotted to the healthcare organizations. These are used to provide care to the defined population. The organization might like to improve on the payments and budgets as the expenditures of the companies increase. This results in the management to make decisions like forming strategic alliances with other organizations and increase the total resources. The growth of such networks will help in providing better care to the customers. Financial resources greatly influence the efficiency and productivity of the organization.

The aging population is influencing the healthcare delivery. There is increased demand for primary care of people over 65 years and for chronic care of people over 75. The ethnic and cultural diversity is also influencing the healthcare delivery. This provides a challenge in meeting patient expectations on one hand and diverse workforce on the other. Biological and clinical sciences have met with technological advances and have led to new treatment modalities. This has led to open new treatment sites and manage across the organization. External forces change the supply of certain areas of health professionals like physical therapy and some areas of nursing. The management needs to compensate for such shortages and they need to develop different teams of caregivers at different work sites. Changes in education of health professionals implies that the management be more creative in offering healthcare services. With an increase in diseases like AIDS and morbidity from drugs and violence, there is more and more need to work with community agencies, form social support systems and there is a need for more chronic care management. Advances in information technology is another area where there is a need to train the healthcare employees in new advances. They also need to manage issues of confidentiality and rapid information transfer. Increasing expansion of world economy has led to more competitive management of strategic alliances, care of patients across the nations and of different cultures.

Current environmental trends impact the healthcare delivery model. Organization’s success depends on its external and internal environment. The complex environments made up of uncertainties and heterogeneity of components leads to different organizational designs. The current environmental trends influence managerial and organizational decision making. The unique challenges facing the healthcare delivery organizations should be analyzed in order to develop and implement new and effective operational processes and strategies. As an impact of current environmental trends, the healthcare delivery system needs to improve individual, team, and organizational accountability and performance. The impact of advances in medical knowledge and information technology on the process of healthcare delivery should also be examined, and it should be leveraged to improve quality of care, process and cost controls, and revenue. New strategies would need to be identified and implemented for learning and performance improvement to create a culture that supports accountability, safety, and high-quality care. Innovative models in healthcare delivery would also be required in order to develop and implement strategies that promote organizational success and competitiveness.

Due to the current environmental trends, more emphasis is given to the customers and there is more of a patient-focused care. The healthcare delivery model has been shifting to the community based care. There has been an increased modification in care processes. The traditional ways are being challenged and more experiments are being performed to fulfill the demands to improve the quality of care. Due to the shift in the environmental trends in the healthcare delivery model, more emphasis is given to quality improvement. This will help improve the performance levels of key processes in the organization. The performance levels are being measured, the defects are eliminated and new features are being added to meet the customer’s need efficiently.

There is a new emerging contemporary trend in the U.S. healthcare system. Presently, the management research and assessment have been offered increased recognition. The emerging trend seen is that this is slowly forming an integral part of managerial and organizational effectiveness. With the emerging efforts in information management, it is leading towards clinical and financial networking. The trend seen among the physicians and nurses is that they are being increasingly involved in managerial activities. The managerial trends are also changing with respect to role performance and changing values. The managers role is getting more and more recognized in managing finance and human resources. Management training, lifelong and distance learning is being offered in preparing future managers.

The healthcare executives and managers will be faced with the major responsibility and challenge in the years ahead. They will be working with other healthcare providers and will be creating a competitive future for their organizations. They will not only be managing organizations but also a network of markets, services and joint ventures. Formation of more and more strategic alliances and partnerships will lead the management to manage across boundaries. The management will change from managing a department to managing the continuum of care. The management will be following a community-based approach. Trend in management is also shifting from just coordinating services to providing improvements in quality.

As the demands in healthcare are increasing, the management is responsible for forming performance standards. The management is also challenged to maximize the productivity and quality to serve the health needs of the community. The management is looking after the demands of the external environment as well as attending to the performance of the internal environment. The management is responsible for the performance of the organization.

Healthcare organization leadership will be responding to new trends and competitive forces. It will respond to continuum of care, overall health status of the population and more complex organizational structures. These emerging trends in the healthcare system will effect the organization’s leadership. The future managers would need leadership skills and vision to integrate the organizations and help in providing the best care. The managers will have to be committed to leadership and work on giving their organizations the best place and help their organizations adapt to the changing circumstances. More value will be given to leaders who will be able to lead the change process. As changes are inevitable for the betterment of the organization, the leaders should be able to identify how the change is to be received and how it is to be communicated at all levels of the organization without damaging the implementation process. The leaders might have to deal with increased pressures due to organizational complexity.

The leader in the organization provides strategic direction to the organization, manages diverse stakeholders, becomes mentors for management, is willing to take risks, helps the organization interact with the external environment and attends to the internal needs as well. Where required the leader will involve physicians in governance process and align physician and organizational interests. There will be a need for formation of learning organizations. Transformational leadership will create the required vision for the organization. Leaders will have a greater role complexity and they themselves will have to adjust rapidly to new situations. The healthcare organization leadership will have to live up to the values of the organization and will help in fulfilling the mission of the organization.

Individuals and groups within the healthcare organizations require more and more competencies. An enhanced lifelong learning is required due to the fast, changing environment. The individuals and groups within the healthcare organizations will be benefitted as there will be rapidly developing medical technologies which will result in increased services. More sophisticated health services will be provided to the consumers. The range and quality of services provided will be regulated for the benefit of people requiring home care, long term care and ambulatory care. The anticipated future development will also result in the increased competition among the health services organization. The individuals and groups will be involved more and more with the community for issues like drug abuse, teenage pregnancy and violence.

Individuals and groups will be faced with increased strategic planning and management in the healthcare organizations as there will be ever increasing involvement by the trustees and physicians. As the future environment in the organizations will be more complex, the individuals and groups in the healthcare organizations might feel more pressurized. They will need to serve the changing demands of the community as the population of elderly patients will increase. These individuals will require more professional training, increased levels of education and should be taking part in continuing education programs.

Due to the anticipated future development in the healthcare organizations, those individuals and groups will be valued, who are adaptable, committed, are able to add value and embrace change. These individuals will be required to experiment more and help in redefining the mission and goals of the healthcare organizations.