Chapter 2: Health Care Organization and Administration in Athletic Training

1. Chapter 2: Health Care Organization and Administration in Athletic Training

2. System of Healthcare Management • Strategic Plan Development • Determine why there is need for such a program • Determine function of program and what the goals should be • Decision of administrators will determine extent of health care program in athletic training • Develop written mission statement to focus direction of program

3. Strategic Plan Development (cont.) • Strategic plan development must include administrators, other allied healthcare providers, student-athletes, coaches, physicians, athletic trainers, parents and community health leaders • Ongoing process that reviews strengths and weaknesses of program

4. Development of Policy & Procedures Manual • Creation of policies and procedures for all involved in health care • Policies = clear written out statements of basic rules • Critical element for operation of athletic training clinic • Procedures = describe the process

5. Issues Specific to Athletic Training Program Operations • Scope of Program • Who will be served by program? • Athlete: to what extent and what services will be rendered (systemic illness, musculoskeletal injuries) • Institution: who else can be served medically and educationally and what are the legalities • Community: outside group and community organizations with legalities again being an issue

6. Providing Coverage • Facility Personnel Coverage • Appropriate coverage of facility and sports • Setup of treatments, rehabilitation, game and practice coverage vary • Sports Coverage • Certified athletic trainer should attend all practices and games • Different institutions have different levels of coverage based on personnel and risks involved with sports

7. Hygiene and Sanitation • Athletic Training Clinic • Rules concerning room cleanliness and sanitation must be set and made known to population using facility • Operation should abide by policies set forth by OSHA • Examples • No equipment/cleats in the athletic training room • Shoes off treatment tables • Shower prior to treatment • No roughhousing or profanity • No food or smokeless tobacco

8. Cleaning responsibilities should be addressed appropriately by athletic training staff and custodial staff • Division of responsibilities • Maintenance crew • Sweep floors daily, clean and disinfect sinks and tubs, mop hydrotherapy room, empty waste baskets • Athletic Training staff • Clean treatment tables, disinfect hydrotherapy modalities daily, clean equipment regularly

9. Gymnasium (general issues concerning facility and equipment cleanliness) • Facility • Cleaning of gymnasium floors • Drinking fountain and shower/locker facility disinfecting • Mats cleaned daily (wrestling) • Equipment and clothing • Proper fitting equipment • Frequent clothing and equipment laundering • Appropriate equipment for weather conditions • Use of clean dry towels and equipment daily

10. Athlete • Promotion of good health and hygiene is critical • Prompt injury and illness reporting • Follow good living habits • Showering after practice • Avoid sharing clothes and towels • Exhibit good hygiene practices • Avoid common drinking sources • Avoid contact with athletes with contagious disease or infection

11. Emergency Telephones • Accessibility to phones in all major areas of activity is a must • Should be able to contact outside emergency help and be able to call for additional athletic training assistance • Radios, cell and digital phones provide a great deal of flexibility

12. Budgetary Concerns • Size of budget • Different settings = different size budgets and space allocations • Equipment needs and supplies vary depending on the setting (college vs. secondary school) • Continuous planning and prioritizing is necessary to effectively manage monetary allocations to meet programmatic goals

13. Supplies • Expendable • Involves supplies that cannot be reused- first aid and injury prevention supplies • Non-expendable • Re-useable supplies - ace wraps, scissors…etc) • Yearly inventory and records must be maintained in both areas

14. Equipment • Items that can be used for a number of years • Capital (remain in the athletic training facility including ice machine, tables) • Non-consumable capital (crutches, coolers, athletic training kits)

15. Purchasing Systems • Direct buy vs. competitive bidding • Lease alternative • Additional Budget Considerations • Telephone and postage expenses • Utilities – heating/cooling, electricity • Contracts for outside services • Purchases relative to liability insurance and professional development

16. Developing a Risk Management Plan • Security Issues • Accessibility to athletic training clinic (staff, physicians, athletic training students) • Athletic training students must be supervised when in the clinical setting • Coaches may have access in secondary school settings • Fire Safety • Post evacuation plan in case of fire • Smoke detectors/alarm system and fire extinguisher should be tested and in place

17. Electrical and Equipment Safety • Major concern • Be aware of power distribution system to avoid accidents • Emergency Action Plan • Accessing emergency personnel outside setting in the event of emergency • Include transportation of athletes to emergency facilities • Meeting with outside personnel is necessary to determine roles and rules regarding athlete and equipment care

18. Accessing Community Based Health Services • Must have knowledge of local and community health services and agencies in the event of referrals • Referrals should be made with assistance from a physician • Parental involvement is necessary when dealing with psychological and sociological events

19. Human Resources and Personnel Issues • Assembling appropriate personnel to achieve program goals and objectives is critical to success. • Recruitment, hiring and retaining qualified personnel is necessary to be effective • Specific policies are established relative to hiring, firing, performance evaluations and promotions • Must adhere to these principles

20. Roles and responsibilities must be established • Job descriptions - job specifications, accountability, code of conduct, and scope • Head athletic trainer must serve as a supervisor and work to enhance professional development of staff • Performance evaluations should take place routinely

21. Athletic Training Facility Design • Design will vary drastically based on number of athletes, teams, and various needs of the program • Size • Varies between settings • Must take advantage and manage space effectively • Interact with architect relative to needs of program and athletes

22. Location • Outside entrance (limits doors that must be accessed when transporting injured athletes) • Double door entrances and ramps are ideal • Proximity to locker rooms and toilet facilities • Light, heat and water source should be independent from rest of facility

23. Illumination • Well lighted throughout • Reflective ceilings and walls will aid in process • Natural lighting is a plus

24. Special Service Areas • Treatment Area: area that accommodates 4-6 adjustable treatment tables, 3-4 stools, and hydrocollator and ice machine accessibility • Electrotherapy Area: area that houses ultrasound, diathermy, electrical stim units, storage units, grounded outlets, treatment tables and wooden chairs, under constant supervision

25. Hydrotherapy Area: area with centrally located sloping floor to drain, equipped with 2-3 whirlpools, shelving and storage space and outlets 5 feet above the floor • Exercise Rehabilitation Area: area that provides adequate space and equipment to perform reconditioning of injuries • Taping, Bandaging & Orthotics Area: 3-4 taping tables and storage cabinets to treat athletes with proximity to a sink

26. Physician’s Exam Room: space for physician to work which may hold exam table, lockable storage, sink, telephone • Records Area: space devoted to record keeping which may include filing system or computer based database, that allows access only to medical personnel

27. Storage Facilities • Athletic training facilities often lack ample storage space • Storage in athletic training room that holds general supplies and special equipment • Large walk-in storage cabinet for bulk supplies • Refrigerator for equipment, ice cups, medicine and additional supplies • Space should be designated for storage of patient belongings

28. Figure 2-2

29. Athletic Trainer’s Office • Space at least 10x12 feet is ample • All areas of athletic training facility should be able to be supervised without leaving office space (glass partitions) • Equipment should include, desk, chair, tack board, telephone, computer and independent locking system

30. Additional Areas • Pharmacy Area: separate room that can be secured for storing and administrating medications (records must be maintained concerning administration) • Rehabilitation Pool: if space permits, must be accessible to individuals with various injuries, with graduated depth and non-slip surface • Restrooms:Should be at least one available within the facility

31. Figure 2-1

32. Issues Specific to Athletic Training Program Operations in Clinic, Hospital Corporate of Industrial Settings • Staff must be prepared to provide care to a wide range of patients • Pediatrics • Adolescents • Young adults and adults • Geriatric patients • May also involve additional duties in management, marketing, outreach, along with fiscal and financial responsibilities

33. Scope of Practice • Diverse patient population • In hospital settings time may be spent with in-patient, out-patient and/or ambulatory care • Owner of out-patient facility will dictate patient population seen at clinic • The AT may be involved with patient care, onsite employee fitness, ergonomics, work hardening programs, outreach programs, athletic event coverage • Limitations and restrictions will be dictated by state regulatory statutes

34. Location of Clinic • Patient base is critical and therefore location is key to attracting patients • Other factors • Zoning • Traffic concerns • Physician referrals • Will physicians use athletic trainers to provide services • Can the clinic provide additional services relative to industrial rehabilitation and workplace assessment • Sports medicine coverage for schools • Direct and indirect competition

35. Hours of Operation • Clinic will need to be opened at times that do not conflict with normal working hours • Early morning and evening hours • Weekend hours may also be useful • Clinic Personnel and Human Resource Issues • Athletic trainers will work with multiple healthcare provider in clinical/corporate and hospital treatment centers • Formal job descriptions are critical for all individuals working in environment • Communication and team approach is critical

36. Potential Athletic Training Duties • Ergonomic Assessment • Ergonomics is the science of designing products, machines and systems to maximize comfort, efficiency and safety • Based on anthropometry and biomechanics • Applied to industrial engineering • Used to design, adapt and alter workplace environments to accommodate to a person’s strengths, limitations, sizes and shapes • Primary goal often involves injury and accident prevention in workplace by minimizing risk factors • Postures, vibration, repetition & force

37. An athletic trainer may work with an occupational therapist or ergonomist to assess environment • Will provide assessment, make recommendations, provide instruction on injury prevention techniques • Report is generated and provided to site administrators with follow-up reviews often conducted to ensure implementation of recommendations Figure 2-3

38. Work Hardening/Conditioning Programs • Intensive outpatient therapy for individuals injured on the job • Work conditioning = treatment 3 hours/day, 3 days/week • Work hardening = 8 hours of treatment daily, 5 days/week • Goal is to restore functionality and return to full duty capacity • Both an evaluation and report are assembled and are used to develop a rehabilitation plan

39. The evaluation involves: • Musculoskeletal examination (strength, posture, flexibility, gait, neurologic screening) • Functional capacity evaluation • Prolonged sitting, standing • Hand grip strength and lifting abilities • Ability to perform repetitive tasks • Carrying capabilities • Balance • These elements are continually monitored and allow for program adjustment in order to facilitate the patient’s return to appropriate levels of performance Figure 2-4

40. Wellness Center • Athletic trainers may be involved in organizing wellness screenings and workshops for: • Asthma & diabetes • Hypertension & stroke • Cholesterol • Osteoporosis • Prostate/skin cancer • Designed for early detection, awareness and prevention • Programs designed to educate individuals on nutrition, health and safety may be offered • Health fairs are often an effective means of providing screenings and education

41. Community Outreach and Marketing • Some athletic trainers may be clinic or hospital based in the morning and may provide athletic training coverage in afternoons and evenings • Outreach may occur in the collegiate setting, secondary schools or for single athletic events • Serves as an effective marketing tool to promote and advertise clinic • Also provides visibility for the clinic to other healthcare providers and potential future consumers/patients

42. Corporate Fitness Programs • Involves in-house fitness programming for employees • Provides numerous health-related benefits to employees • Also serves to reduce health costs, increase productivity, reduce absenteeism, improve morale, lower healthcare expenditures and reduce sick leave • Often involves fitness screening and individual program design Figure 2-5

43. Drug Testing Programs • Athletic trainers may be asked to oversee drug testing programs • Program may act as a deterrent to employees coming in unfit for duty • May be necessitated by federal guidelines or pre-employment screenings • Legal defensibility is the most important aspect of any drug-testing program • The corporation should use federally certified testing laboratories with all positive tests results confirmed via a medical review department

44. Fiscal Management • Having a basic understanding of business practices may be necessary in for-profit clinical settings • Knowledge of billing practices is critically important • Maintaining positive accounts payable vs. accounts receivable ratio is the goal of all successful businesses • Other responsibilities may include • Financial planning • Establishing contractual obligations • Efficient billing and collection systems • Budget formulation

45. Record Keeping • Major responsibility • The rule not the exception - accurate and up-to-date • Medical records, injury reports, insurance information, injury evaluations, progress notes, equipment inventories, annual reports

46. Maintaining Confidentiality in Record Keeping • Release of Medical Records • Written consent is required • Waiver must be signed for any release (include specifics of information to be released and to whom)

47. Health Insurance Portability and Accountability Act (HIPAA) • Regulates dissemination of personal history information (PHI) by coaches, AT’s, physicians or other members of sports medicine team • Guarantees athlete access to information and control over disclosure • Athlete may provide written authorization for release of information

48. HIPAA Authorization • Description of information to be disclosed • Identification of parties authorized to provide and make use of PHI • Description of each purpose of the use or disclosure • Expiration date or event • Individual’s signature • Description of his/her authority to act for the individual if signed by personal representative

49. Family Educational Rights and Privacy Act • FERPA = law protecting privacy of student education records • Provides parents with certain rights with respect to child’s educational records • When child turns 18 rights are transferred to student • School must have written permission prior to releasing information

50. Administering Pre-participation Examinations • Initial pre-participation exam prior to start of practice is critical • Purpose is to identify athlete that may be at risk • Should include • Medical history, physical exam, orthopedic screening, wellness screening • Establishes a baseline • Satisfies insurance and liability issue