Workplace Diversity: The Variety in Healthcare Settings By Christina Thielst, FACHE Just as there are different types of health administration positions; there is also a wide variety of settings where the work of caregiving is performed. They range from small, rural, community-access hospitals to large, academic and integrated systems. According to the American Hospital Association, there are 5,686 registered hospitals in the United States. Hospitals come in many different shapes and sizes and can be non-profit (tax exempt), investor-owned (for-profit) or government-owned. Some are integrated and also provide other types of care, such as ambulatory, skilled nursing or home care services. Others are part of large networked systems that include multiple hospitals and other facilities. Common hospitals include: Small rural and critical access hospitals that may also provide clinical, skilled nursing or other services to fill the needs of the community. Flexibility is important in these facilities since health administration staffing can be limited. Community hospitals are most often located in suburban and urban environments and historically have focused on this core business. As the healthcare delivery system evolves, these organizations are looking to broaden their scope of services and/or create affiliations with other types of healthcare organizations. Teaching hospitals are usually part of a university or they may be a community hospital that has a formal relationship with specific residency programs. They can be larger than the average community hospital and with a broader scope of services, there are additional opportunities for health administration managers. Specialty hospitals have narrow scopes of service and are often focused on children, psychiatric/behavioral health, orthopedics, cancer, or ambulatory surgery. Government hospitals include those operated by federal, state, county and local municipalities. They include prison, military and Veteran Affairs hospitals, as well as state forensic hospitals. Safety-net or public hospitals treat individuals irrespective of their ability to pay and are most often operated by county or state governments. The concept of hospitals actually grew out of early Christian and secular almshouses that provided housing for the poor, old and distressed. Today’s faith-based hospitals are owned by religious organizations and this culture is reflected in their policies and practices. The healthcare delivery system reaches out beyond the walls of hospitals and into many types of care settings, such as: Ambulatory Care - Tremendous growth is expected for ambulatory care settings due to the pressures to reduce reliance on inpatient care. The scope includes multispecialty clinics, local public health centers, tribal clinics, group practices, small provider practices and even outpatient surgical and free-standing emergency or urgent care facilities. Community-Based Healthcare – Health services for special populations are provided in a variety of settings and have missions that range from disease prevention to end-of-life care. Examples of these community-based healthcare providers include hospice, visiting nurse, free clinics, dialysis centers, homeless and mental health outreach programs, wellness centers, laboratories, imaging centers, behavioral health, addiction recovery and more. Senior Care Facilities - The growing population of older adults and more choices for living independently have resulted in some residential communities integrating care facilities into their communities so residents can remain as their care needs progress. The range of services may include assistive and rehabilitative home care, occupational therapy, physical therapy, and skilled nursing facilities. International Aid - Non-profit organizations such as Direct Relief, See International and Doctors Without Borders provide humanitarian relief and austere care services following disasters or to fill a need when poverty and access to care is severely limited. They rely heavily upon donated resources, volunteer clinicians and staff with strong logistical skills. Virtual Care - Telemedicine, nurse advice lines, and social networking care coordinating platforms extend the provider/patient relationship beyond face-to-face encounters as patients and caregivers are increasingly separated by distance. These virtual care environments also mean that some health administration workers may work remotely. Leading these virtual teams requires that healthcare managers are comfortable with technology and have an ability to establish strong relationships when physically separated by distance. A degree in health care administration can prepare you to work in any or all of these environments – from the smallest clinic to the largest healthcare corporation. In general, larger facilities will have more opportunities for health administrators, especially for those who have specialized skillsets. Smaller organizations however, often rely on health administrators with more of a general background or specific skillsets in multiple areas. For example, the human resource manager could be doubling as the information systems manager. According to Brina Hollis, PhD, CAHIMS, Columbia Southern University’s Program Director-Healthcare Administration, “As has been stated, opportunities in the health care industry are very diverse. The Health Care Administration online program at CSU provides a great foundation and CSU’s faculty and staff will offer you individualized support throughout your academic journey.” A degree in health care administration can prepare you to work in any or all of these environments – from the smallest clinic to the largest healthcare corporation. Understanding a little about the unique needs of each of these environments also helps you to identify the setting(s) that best fit with your unique skills, interests and passion. Bio: Christina Thielst has experienced the evolution of the healthcare system over the last 30 years as both a hospital administrator and consultant. She received a bachelor’s degree in social science/management from Louisiana State University and a Master’s of Health Administration from Tulane University, School of Public Health and Tropical Medicine and is a fellow in the American College of Healthcare Executives.