NATIONAL HEALTH usa

governance

G  L  O  B  A  L       T  A  S  K  S

7 pages                                                                                  —   1   —

INTRODUCTION 

“It’s not enough that we do our best;

sometimes we have to do what’s required.”

Sir Winston Churchill    (1874 – 1965)

It seems improbable that a set of 5 Tasks could define the entire spectrum of work to be done by an institution.  Despite the challenge, I propose that five separate  GLOBAL TASKS  define the essential domains necessary to encompass the distribution of specific tasks for a successfully functioning, three-layer institution.  Also, I propose to recognize the definition of an institution as proposed by Professor Elinor Ostrom (Ostrom 1996), intending for it to also include any association, cooperative, corporation, enterprise, or industry.  

   Citing the words of Professor Ostrom, her definition of an institution can be found on page 43 of the  DESIGN EPISTEMOLOGY  Sub-Page,  HEALTH PROSPECTUS  PAGE.   Be sure to read her DEFINITION for an Institution including the end of the last sentence.  The last two words are reminiscent of the last two words used by President Thomas Jefferson at the end of his brief essay about institutional change found inscribed on the wall of his memorial at the Tidal Basin in Washington D.C.  His brief essay is cited on page 6 of the  DESIGN  EPISTEMOLOGY  Sub-Page of the  HEALTH PROSPECTUS  PAGE.

   In the tradition of Sir Winston Churchill, the GLOBAL TASKS could, by their all-inclusive focus, promote a heightened commitment “…to do what’s required.”

ORGANIZE    GOVERNANCE

Using a derivative concept for governance, an institution commonly begins with a Charter.  Certainly, there are many institutions that have only an informal understanding as a basis for a Charter.  For a Family, there may be at least a marriage license even if it was only defined by common law.  As a sign of change, this provision of Common Law is no longer recognized in most States.

   Neighborhood groups are more likely to have only an informal understanding as a basis for their Charter.  A contemporary version of a Charter uses the concept of a Visioning Statement that includes an aspirational goal, mission statement, and set of operational moral-reasoning principles.

   Among the world’s nations, an advanced/developed nation will have a Constitution as a basis for its central governance.  Following the formation of the UNITED NATIONS, these constitutions have increasingly included the concept of Human Dignity.  In turn, a nation’s central government would establish the rules for recognizing the existence and the importance of institutions to support its national Constitution.  For most institutions, a nation’s central government would act: 1) to define or control the interactions among their nation’s institutions and  2) to provide for any taxation.  In addition, the national government may establish a cluster of rules that proscribe further national, state, and community regulations for the affairs of these institutions.

   The internal affairs of a corporation are most clearly defined by its Articles of Incorporation, By-laws, and any authorized OPERATIONAL STATEMENTS, such as its Policies or Procedures.  But, there is much less uniformity among corporations regarding the structure by which the Articles of Incorporation provide for their stability and adaptability. Specifically, to what extent does a Board of Directors determine the Policies for which it will retain final authority?  And, to what extent does the Board of Directors retain the right to have prior knowledge regarding the implementation or revision of any other Policies or Procedures? 

   Most importantly, how then are these issues to be structured, defined, monitored, and revised?  A format for structuring the answers to these questions represents the substance of this  GLOBAL TASK:  ORGANIZE GOVERNANCE.  A representative model as a basis for structuring the affairs of an institution, its  OPERATIONAL  DESIGN,  may be found as a Sub-Page of the  GOALs  PAGE. 

PURSUE    VISION

Even though the  NATIONAL HEALTH Proposal  PAGE  defines a preliminary  VISION  for  NATIONAL HEALTH,  a  PRELIMINARY  Operational Statement for a Strategic Projects Plan could provide the basis for its future reassessment.  This review process is the ultimate and most important responsibility of an institution’s governing body, its Board of Trustees or Board of Directors.                                         —   3   —

   It is likely that any subsequent revision of an institution’s  VISION  would occur infrequently since it should represent initially the essential or guiding purpose of the institution.  As described in the NATIONAL HEALTH Proposal PAGE, promoting a community by community collaborative commitment to assure the equitable availability of healthcare for the Basic Healthcare Needs of their resident persons, AND the community’s vigilance to maintain its  SURVIVAL COMMONS  collaboratively with their adjacent communities defines the core strategy for guiding the affairs of  NATIONAL HEALTH.

   A  VISION  and a Statement of  PRINCIPLES for most institutions establish the priorities for completing a task for which there was no proscribed course of action.  In addition, the  VISION  and its PRINCIPLES would serve as a basis for choosing the correct course of action when the institution had previously defined two or more competing alternatives as a basis for a certain course of action. 

   Finally, an institution’s VISION, MISSION, and PRINCIPLES promote their importance when used to structure the annual revision of a mentored Career Formation Accord by each Member, Associate, and Advocate.  Each  CAREER FORMATION ACCORD  would include a section for each Member, Associate, and Advocate to define their Professional Goals for the following year.  The Professional Goals section should require at least one personal commitment that supports the  VISION  of  NATIONAL HEALTH.     

   The collective connection involving each of the Members, Associates, and Advocates to support the  VISION  yields a unified focus for the daily affairs of an entire institution.  In the future, our Nation’s autonomy within the marketplace arenas for the world’s  Resources,  Knowledge,  and  Human Dignity  will eventually affect most modern institutions, including  NATIONAL HEALTH.   A precisely defined VISION  for the inter-connected affairs of these institutions, especially  NATIONAL HEALTH,  will be a vital contribution to promoting their support for our nation’s overall autonomy within the worldwide community.  

BUILD    COMMUNITY

This  GLOBAL TASK  defines the character of an institution that could be most recognizable by its statement of  PRINCIPLES.   To achieve this GLOBAL TASK for an institution, these PRINCIPLES should be a guiding influence on the “mutually experienced events” that form the cultural attributes within any new or evolving institution.  It guides the broadly expressed capability within an institution to express its  VISION  and  MISSION  in the absence of an applicable rule or set of rules.  This capability becomes important for a wide range of social dilemmas occurring for the Members, Associates, and Advocates of  NATIONAL HEALTH.  Trust, Cooperation, and Reciprocity become very important as a means to bind the affairs within the Board of Trustees with the  HEALTH  of each resident person.  

   The applicable Operational Statements for this GLOBAL TASK encompass its Risk Management Plan, any regulatory External Audit and the use of collaborative decision processes for complex implementation problems, such as the “Delphi consensus study” format for future planning.   The professional, social networks of each Member, Associate, or Advocate should become enhanced by the affairs of  NATIONAL HEALTH.   Identifying this connection provides a means to promote a broader connection for the steady enhancement of every community’s prosociality.

MANAGE    RESOURCES

This GLOBAL TASK for most institutions refers to its standard financial rules, viz., cash, accrual, or fund accounting.  For a non-profit institution with multiple funding sources, a combination of accrual and fund accounting rules commonly apply.  Possibly unique, this GLOBAL TASK should include a provision for the financing of a “rainy day” fund to assure the availability of resources for unexpected needs, including a provision for its sun-set termination.  This fund would be especially important for NATIONAL HEALTH given the remote, but real, possibility for an early termination of its Charter by Congress.  With a 3-6 month shut-down scenario, funding for the related expenses would be necessary for an orderly process to prevent disruptive effects for our nation’s healthcare industry.

   NATIONAL HEALTH  creates a population-defined, annual expense to the Federal government for  NATIONAL HEALTH.  It is the intent for NATIONAL HEALTH to form a relatively small institution given the $4.9 trillion that represented the 2021 health spending for our nation’s healthcare.  Annually adjusted for population growth and cost-of-living, the projected budget for  NATIONAL HEALTH  of $1.50 per resident person per year would represent a 0.01% addition to the ‘health spending’ expense by our Nation’s budget for our nation’s healthcare.     —   5   —

   There would be no direct involvement by NATIONAL HEALTH  in the payer structure for this healthcare.  However, a  NATIONAL  PRIMARY HEALTHCARE  BENEFITS PLAN  would be required to actuarially standardize the capitalization of our nation’s Primary Healthcare.  Doing so, it would contribute to achieving a national GOAL to optimize our nation’s ‘health spending’ to support our national economic stability.  This National Project along with another risk-management National Project would steadily decrease the portion of our national economy devoted to health spending.  Currently, in the early Post-Covid recovery, the portion of our economy devoted to health spending was 18.5% during 2022.  Over 10-15 years, the  Goal  should eventually be 13.0%.

   The legitimacy of  NATIONAL HEALTH as a basis to accomplish this GOAL will be especially enhanced by the absence of any perceived conflict of interest arising from the direct participation of NATIONAL HEALTH  in the distribution of financial resources for healthcare.  The Design Principles for successfully managing a common pool resource would apply.  These Principles were initially defined and verified by the research of the 2009 Nobel Prize for economics, Professor Elinor Ostrom.  (Ostrom 2005) 

   Except for philanthropic institutions, the liquid assets under the control of most non-profit institutions is minimal.  This is obviously not true for other institutions such as a for-profit corporation or financial institutions.  But increasingly, most institutions will recognize their true assets as the professional value of its personnel rather than its financial assets.  As described by Peter Drucker in 1993, institutions based on improving the professional capital underlying their analysis of information will survive better over extended time intervals.  He also warned that an institution whose assets are predominately defined by its analysis of information must have the means to “appreciate” the value of these professional assets in order to survive.  Herein, “invest” represents an economic improvement as opposed to “depreciate.”  The absence of this management priority within our nation’s healthcare systems may be contributing to its decreasing quality, viz., maternal mortality, as well as efficiency. 

DEVELOP    SKILLS                       

Much like the basis for defining the health spending for our nation’s healthcare, there is a need to define the basis for assessing the overall quality of our nation’s healthcare.  Already in place, there are national reporting processes.  However, there are instances of reports that may not represent a population-based measure of healthcare quality, state by state.   NATIONAL HEALTH  should have a responsibility to monitor this problem.  An association with the Department of Health and Human Services for a National Health Report Card is an option.  Since  HEALTH  status reporting already is occurring, a means to co-operate in the process of publishing these reports could also be an option for  NATIONAL HEALTH.   Peter Drucker in his book published in 1993, “Post-Industrialist Society” (2), described the importance of promoting the professional assets within any institution that is substantially defined by its involvement in the evaluation of information.  At nearly the same time, Stephen Covey et al (1) described a possible means to promote the improvement of these professional assets in his book published in 1994.  For institutions based on the use of information for the benefit of 330 million citizens, the combined observations of Peter Drucker and Stephen Covey lead to at least one process for increasing the professional assets of these institutions through the annual revision of a “Career Formation Accord” by each Member, Associate, and Advocate associated with  NATIONAL HEALTH.