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How does the external environment (stakeholders, regulations, accrediting agencies, etc.) affect the policymaking process?

Identify at least two medical management committees within an HCO and explain their roles. How can medical management committees influence the process of health policymaking outside of their HCO's? List some legal and ethical dilemmas to consider when creating new policies.

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How does the external environment (stakeholders, regulations, accrediting agencies, etc.) affect the policymaking process?
Effect of regulations on the policymaking process.
Some policies are perceived to be too cumbersome and so are relaxed:
HHS has signaled its intent to ease hospitals' regulatory
burdens by eliminating the minimum data set requirement,
a patient assessment tool used in critical access swing bed
- They're streamlining the paperwork requirements for non-
critical swing bed hospitals, and
- They're reducing the size and scope of the Medicare cost
The results - less time spent on paperwork and more time spent on
direct patient care.
In November, the HHS Regulatory Reform Task Force issued its
report and recommendations, with several that would help ease this
burden for hospitals.
But, many of the recommendations would ease the burden for
hospitals and health care givers when dealing with EMTALA, OASIS,
the minimum data set and HIPAA.
The intent - common sense regulations that will MAKE sense for
providers and patients alike.
There are international policies that effect decision making: These include
International agreement has been reached on a number of underlying
principles that govern either public health or safe management of haz-
ardous waste. These principles-outlined below-should be taken into
consideration when national legislation or regulations governing health-
care waste management are formulated:
The policy making process is affected by the conventions
and international standards:
The Basel Convention, signed by more than 100 countries, concerns
transboundary movements of hazardous waste; it is also applicable
to health-care waste. Countries that signed the Convention accepted
the principle that the only legitimate transboundary shipments of
hazardous waste are exports from countries that lack the facilities or
expertise to dispose safely of certain wastes to other countries that
have both facilities and expertise. Exported waste should be labelled
according to the UN recommended standards outlined in section 7.3
(page 65).
The "polluter pays" principle implies that all producers of waste
are legally and financially responsible for the safe and environmen-
tally sound disposal of the waste they produce. This principle also
attempts to assign liability to the party that causes damage.
The "precautionary" principle is a key principle governing health
and safety protection. When the magnitude of a particular risk is
uncertain, it should be assumed that this risk is significant, and
measures to protect health and safety should be designed accordingly.
The "duty of care" principle stipulates that any person handling or
managing hazardous substances or related equipment is ethically
responsible for using the utmost care in that task.
The "proximity" principle recommends that treatment and disposal
of hazardous waste take place at the closest possible location to its
source in order to minimize the risks involved in its transport. Accord-
ing to a similar principle, any community should recycle or dispose of
the waste it produces, inside its own territorial limits
A national law on health-care waste management may stand alone or
may be part of more comprehensive legislation such as the following:
law on management of hazardous wastes: application to health-care
waste should be explicitly stated;
law on hospital hygiene and infection control: a specific chapter or
article should be devoted to health-care waste.
The law should include the following:
a clear definition of hazardous health-care waste and of its various
a precise indication of the legal obligations of the health-care waste
producer regarding safe handling and disposal;
specifications for record-keeping and reporting;
The policy decisions are affected by the need for inspections.
specifications for an inspection system to ensure enforcement of the
law, and for penalties to be imposed for contravention;
designation of courts responsible for handling disputes arising from
enforcement of or noncompliance with the law.
In addition, hospitals should be run, and health-care waste disposed of,
in accordance with all other relevant national legislation, such as regula-
tions pertaining to:
waste in general;
effects on public health and the environment;
air quality;
prevention and control of infectious disease;
management of radioactive material
The policy document should outline the rationale for the legislation, plus
national goals and the key steps essential to the achievement of these
goals. It may contain the following:
descriptions of the health and safety risks resulting from mismanage-
ment of health-care waste;
reasons ...

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