An Analysis of the Indian Health Service Change

A BRIEF SUMMARY OF THE CASE

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Dr. Michael H. Trujillo was the first Director of the Indian Health Service who was of full-blooded American Indian descent when he took up his position in 1994. The Indian Health Service had a clear mandate of providing quality health services to Alaskan Natives and American Indian people. Before the formation of Indian Health Service, Bureau of Indian Affairs was responsible for healthcare affairs of Native Americans; however, services that were provided were of poor quality. The health status of American Indians had always been low when compared with that of the general population before formation of the IHS. American Indians and Alaskan Natives beliefs about sickness, wellness and treatment had always been different when compared with that of the general public. The Indian Health Service played a major role in improving the health status of the Indian people by reducing their infant mortality rate and improving their life expectancy. Dr. Trujillo had been taught from an early age by his parents and grandparents to feel an obligation to his American Indian people. Dr. Trujillo was the first Native American to graduate from the University Of New Mexico School Of Medicine. Prior to being appointed Director of the Indian Health Service, Dr. Trujillo had held numerous positions in the Institute. After being appointed director of the Indian Health Service, Dr. Trujillo communicated his vision for the institute. He did state that he foresaw a situation whereby the Institute would develop the best primary care and rural health system in the world that recognized dedications and contributions of its employees together with ensuring its employees took an active participation in its programs. Dr. Trujillo also foresaw a situation whereby the Indian people would have an active participation in the institute and the institute would become more effective and efficient with the aim of improving quality care for the American Indian people.

The Indian Health Service faced a changing external environment that included a shifting political picture, new demands, and new needs. Dr. Trujillo was of the view that honoring past treaties, beliefs and spiritual convictions of various American Indian tribes was vital in ensuring that the Indian Health Service achieves its mission. Dr. Trujillo was determined to improve the health status of American Indians despite IHS being accorded meager resources. Indian tribes, on the other hand, were self-determined to improve their health status.

Health care that was accorded to American Indians and Alaskan Natives was delivered through interlocking programs. The Indian Health Service headquarters and offices had ties with Indian tribal governments. Indian Health Service Headquarters also had ties with American Indian urban operated projects, Indian Health Service Area Offices, service units, hospitals, health clinics, extended care facilities and referral facilities. The Indian Health Service was in the Department of Health and Human services. The headquarters of the Indian Health Service was located in Rockville, Maryland. The headquarters was responsible for all management, policy and operations decisions. Indian Health Service area offices were located in Portland, Billings, Aberdeen, Bemidji, Nashville, Albuquerque, Navajo, Phoenix, California, Tucson, and Alaska.

Programs that were provided by IHS covered medical care, behavioral health, environmental health, preventive health and engineering services. Initiatives that were provided by IHS focused on issues such as AIDs, women health, care for the elderly, sanitation facilities, injury prevention, and traditional medicine. The IHS contributed tremendously in improving the health status of its target population during its few years in existence. The IHS was instrumental in making infrastructural changes such as community health education programs, sanitation facility construction and increased primary medical care services that saw an improvement in health status of its service population. The majority of the Indian Health Service workforce were of American Indian or Alaskan Native descent. The IHS personnel consisted of individuals from behavioral, social, health and environmental health services. The majority of the IHS staff were employed in service units followed by in area offices and lastly in the headquarters. The Indian Health Services programs were instrumental in reducing cases of suicide, alcoholism, homicide, pneumonia/influenza, accidents, infant deaths, maternal deaths, Gastro-Intestinal diseases and tuberculosis among American Indians and Alaskan Natives. Funding of the IHS came from the Federal budget and third-party billing collections.

DISCUSSION OF THE MAJOR PROBLEMS PRESENT IN THE CASE AND THE RELEVANT IMPORTANCE OF EACH

A third of American Indians and Alaskan Natives were not eligible to access services such as healthcare and education that were provided by the Federal government. This is because some American Indians and Alaskan Natives tribes had not signed treaties with the Federal government (Agnelli, 2014).

Increasing healthcare costs, excessive demand for health services and a growing number of beneficiaries had a negative impact on the Indian Health Service operations.

A shift in disease patterns had a negative toll on the effectiveness of services provided by the Indian Health Service.

Urban programs provided by the Indian Health Service continued to face challenges due to an increase in migration of Indian populations to urban settings.

The IHS lacked necessary facilities and equipment to provide comprehensive services in some locations.

The IHS experienced problems in recruitment and retention of qualified and dedicated professionals. This is because most IHS sites were remote and lacked amenities such as schools and stores that could retain high caliber professionals. The IHS pay scale was low when compared to the pay in the private sector. As a result, the IHS experienced problems in attracting and retaining high caliber professionals (Capper et al., 2002).

Changes that were occurring in the IHS made health professionals concerned about their future careers gave that with time; local tribes would assume the responsibility for the health services. Employees were concerned about the future of their programs because of the cuts that were being made to the IHS programs.

A DETAILED ANALYSIS USING SWOT ANALYSIS AND CAUSE AND EFFECT ANALYSIS INCLUDING AN ANALYSIS OF ANY LEGAL, POLICY AND ETHICAL ISSUES IN THE CASE

SWOT ANALYSIS

Strength

-The Indian Health Service management ensured that it involved its personnel at all levels of its change process.

- Federal recognized Indian tribes were given an option to involve themselves in staffing of the Indian Health Service.

- A strategic business plan was developed by Indian tribal leaders that led to an effective and efficient use of resources in partnership with the Indian people. The plan included improving revenue generation, cost control and making internal business improvements.

-Dr. Trujillo was committed to the Indian's spirit of self-determination in improving the health status of the American Indians and Alaskan natives.

Weakness

-The IHS management used the Internet and electronic mail to address anxiety of its employees about their prospects based on changes and cuts that were done in the organization. The management should have communicated in person with their employees about the latters concerns.

-Creation of the Tribal Self-Governance Demonstration Project allowed Indian tribes to take over health care services that were initially run by the Indian Health Services, compromising the quality of services in the long run.

-IHS was unable to bill and collect adequate funds for all the services that it provided.

-IHS did not receive adequate funding from the Federal government to support its operations.

- Most of the IHS services were underfunded.

-The IHS was under-billed by about $8.5million each quarter of the year.

- The IHS had a shortage of staff.

- The IHS had untrained staff.

- There was a lack of controls for the IHS operations.

-Most state governments refused to fund IHS programs.

Opportunities

-IHS was a dynamic organization that was staffed by professional personnel. The dynamism and professionalism of its staff could be harnessed to improve quality of healthcare accorded to American Indians and Alaskan Natives.

-IHS was a unique healthcare provider that could be used to promote culture, religion, values and traditions of American Indians and Alaskan Natives.

-The spirit of determination by the Indian people could play a major role in improving their health status.

Threats

-Stakeholders in Indian health were advocating for changes to be done on the IHS.

-Economic changes were signaling a need to come up with innovative and new ways to fund the HIS programs.

-Indian tribes were continuously asking to have more control over the healthcare of its members.

-Treaties signed between the Federal government and the Indian tribes were constraining activities of the IHS.

-The Indian Health Service was considered a discretionary agency of the United States. As a result, it did not receive the attention that it deserved.

-False expectations created by the spirit of self-determination of the Indian people could be damaging to the activities carried out by the IHS.

-Failure to involve Indian tribes in local health affairs could be damaging to IHS operations and services.

CAUSE AND EFFECT ANALYSIS

Some Indians were not eligible to IHS programs

Failure by some Indian tribes to sign treaties with the Federal Government

A negative impact on Indian Health Service operations

Increase in healthcare costs and excessive demand for healthcare services

A negative effect on services provided by the Indian Health Service

A shift in disease patterns plus failure of the Indian Health Service to be involved in Research

Urban programs provided by the IHS continue to face challenges

An increase in American Indians and Alaskan Natives migration to urban settings

Failure of the IHS to provide comprehensive programs

Lack of necessary facilities and equipment by the Indian Health Service in provision of their services

The IHS experienced problems with recruiting and retention of qualified and dedicated staff

Most of the Indian Health Service hospitals and clinics were located in remote areas

The IHS experienced problems with recruiting and retaining of qualified professionals

The Indian Health Service pay scale was low when compared with the pay scale in the private sector

Indian Health Service employees were uncertain about their future at IHS

Political and economic changes were going on in the Indian Health Service

Employees were jittery about their future prospects at IHS

Financial support from the Federal government towards the Indian Health Service was in a continuous decline

A DETAILED APPROACH FOR RESOLVING IDENTIFIED PROBLEMS INCLUDING RATIONALES FOR YOUR APPROACH AND ANALYSIS OF THE EVIDENCE THAT GUIDED YOUR DECISION MAKING

All American Indians and Alaskan Native tribes should have signed treaties with the Federal government so that all their people could become eligible to access health services that were being provided by the government through the Indian Health Service. It was a prerequisite for a person to belong to an Indian tribe that had signed a treaty with the Federal government so that he or she may access healthcare services through the Indian Health Service.

The Federal government and state governments should have involved themselves in lowering healthcare costs. For instance, taxation on medical and pharmaceutical products should have been lowered to ensure prices of the products drop.

Wasteful spending in programs run by the Indian Hea...