Strategic Plan for Negri Health Service - Coursework Example

? Strategic Plan for Negri Health Service Table of Contents Contents Page …………………………………………….3 2. Background…………………………………………...4 3. Demographic Analysis………………………………..4 4. Demand Analysis……………………………………..6 5. Strategic Options……………………………………...9 6. Conclusion……………………………………………14 7. References…………………………………………….16 Abstract The Negri Health Region forms one of such fourteen regions determined for the administration of health services within CAMLO. The region’s population is about twelve million people. The area was chosen to carry out a project pilot to enable the service deal with increasing pressure from population increase in the region. The towns that are most affected by this population increase are Oldorando and Ottassol, especially with the upgrading of the highway through the region and increased tourism and settlement. To come up with a projection of how this would affect demand in the future, we will use bed occupancy rates and bed days or length of stay. This will show that there will be an increase in demand for bed space at the hospital and as such, action must be taken to come up with alternatives to alleviate this future problem. The delivery of health services in Negri will have to shift from large institutions to ambulatory, home and community based settings in order to solve for the forecasted bed shortage. Fundamentally, Negri Health Service will have to change the high dependency on acute service delivery. The Health Service will have to come up with a way to reduce the demand for acute bed services. Strategies aimed at this include preventive medical care, home and community self-care, no care requirement and primary, continuing care at community level, which in combination should decrease the need for bed space at the hospital. Patients will have to be educated on behavioural change to reduce the incidences of acute care need. These strategies will require input from the community, especially from the healthcare providers. Such drastic measures will come against resistance from an overworked work force as well as require a lot of funds. However, given its success in other countries around the world, it is worth a shot. THE BACKGROUND The Negri Health Region forms one of such fourteen regions determined for the administration of health services within CAMLO. The region’s population is about twelve million people. The region has seven states with state legislatures dealing with service administration for those services no catered for by the government. Health regions are used for the administration of health services based on various demographic characteristics in comparison to population catchments. The state, in collaboration with the National Government and a health director, plan and monitor the state’s health activity. The state director general has called a meeting to institute a pilot project for a radical change in service delivery, in the Negri Health Region. Negri was chosen because of its reportedly considerable pressure on the health system. The pressure was on an upward trajectory because of the growth in population, poor health statistics and changes in the economic base that had prevailed in the region over a period of five years. The Director General was adamant that unless they tried a new strategy, there was either going to be a shortfall in service capability or they would be required to inject a substantial amount of funds into the capital plant as well as the acute services. With the local legislative representatives beginning to complain with regard to the care levels offered, these would have to be met. Demographic Analysis In Ottassol, a main town to the south, the main economic base comprises of fishing and processing of fish. Beginning in 1980, internal migrant families and squatters had settled in the region giving added impetus to the development of the fishing industry. In the past ten years, mountain communities have also contributed to the current influx of immigrants into Ottassol. The area also serves a large number of tourists every year who come to see its active, historical society, small heritage museum, as well as numerous students who come to the area for excursions on a regular basis. Oldorando is Negri region’s main city, as well as its business and commercial centre. After paving of Pannoval road in 1915, the region became a holiday town for visitors from Europe as well as a camping and hiking destination after the declaration of its national park. Since the 90s, the tourist industry has again begun to thrive and provided Oldorando with steady growth. The area had seen a large influx of squatters from the mountain and rural regions, coupled with the building of a four-lane highway five years ago. This inflow has been caused by the increased opportunities of employment created by the tourist industry. However, with the low paying rates prevalent in the industry, this has led to an increase in youth unrest and crime, with alcohol and drugs becoming a concern, with the in-migrating families making continuous employment a problem. Osolima area is located on the main highway and was started as a useful centre for travellers and traders. Since the establishment of the highway, the area has begun to show new growth potential. The recent National Park development has provided associated retail services, especially with the added impetus of the western backpacker tourism on its way through to Laos. However, this region has not seen too much immigration, and most of its rural residents still earn income via farming of vegetables and rice. Finally, Matrassyl is set on a rich river plain that carries out wet rice production. The town achieved rapid growth after the establishment of the plantations in 1846 and rapidly grew as a farming town. However, the highway bypassed the town which was its main thoroughfare to the south. This meant that there has not been immigration into the region from surrounding areas although with the recent grant for the restoration of the town centre, there is bound to be some influx of workers. Demand Analysis The current increasing population in the Negri Health Region is expected to place a significant burden on its health services. This is especially expected to place pressure on Oldorando and Ottassol, which have seen increased commercial and trade opportunities attract immigrants from the rural and mountain regions. As seen in the table below, the present staffing at hospitals in the region is set to be rendered inadequate. Hospital G.P. Obs. Anaesth. Psych. Path. Rehab. Surgical Rad. Derm Rad. Ortho. Physic'n Paeds. Otolar. Urol. Ophth. Derm. Oldorando 28 2 3 2 2 1 5 3 1 3 3 5 3 1 1 3 1     2 (2) (1) (4)   Ottassol 10 (2) (1) (1) (3) 1 (1) (1)         Osoilima 3* (1) (1)         1 Matrassyl 5* (1) (1) (1) (1) (1)         Total 46 2 3 2 2 1 6 3 1 3 3 5 3 1 1 3 1 The figures with an asterix denote General Practice doctors with admitting privileges in these hospitals. The limitation of having decreased bed space because of increased in-patient admissions from increased population growth has impeded the efficient serving of patients. The average length of stay for patients from 6/30/2010 to 4/30/2010 was two days which is consistent with the average in the industry. Based on a daily census, as well as overflow data provided by the finance department for July 2009 to June 2010 shows that the units are overflowing thirty-eight percent of the time. This is expected to rise in the future. The use of bed occupancy as a measure of hospital performance has come under attack from both nursing and medical staff that are adamant that a vast difference exists between bead stead and beds with adequate service and staff (Berger, 2008). However, bed occupancy rate can be used to evaluate how hospitals are coping with increased needs for service within available resources. High rates of bed occupancy do not necessarily mean that a hospital is running more effectively since they can be indicative of longer stays, rather than increased numbers of patients being treated (Tulchinsky & Varavikova, 2009). In acute care situations, the best-known method for bed projections is via the use of bed occupancy rates and bed day (Nagelkerk & Huber, 2011). The formula for calculation of bed occupancy rates is dependent on bed days. This combines the number of patients under the care and the time they are on the bed. Therefore, it depends on the available number of likely separations and the average length of stay. Once the bed days are available, one needs to know how many beds would be needed every day, so this is divided by the number of days the hospital operates. This gives the number of beds required every day. Separations x Average Length of Stay (ALOS) = Average Daily Census 365 (days available) (Berger, 2008) Distribution of daily occupancy rates for general medicine from the four areas in Negri. The bed occupancy rates will most likely be highest from Oldorando because of the increasing population and least from Osolima because of its slow population growth. STRATEGIC OPTIONS The delivery of health services in Negri will have to shift from large institutions, to ambulatory, home and community based settings (Taylor & Taylor, 2012). Nursing homes and hospitals will be expected to serve more acutely ill patients, and an evolving care continuum will satisfy the needs of others. Integration of care across secondary and primary care will enable the patients move more easily between the community and hospital. Acute hospital roles evolve over time to gain more specialization since the less sick and more ambulant can be managed elsewhere. An example is those who live for longer with long-term illnesses who might require increased long-term care instead of in-patient hospital stays. In the end, this will provide a more effective outcome for the patient. Inappropriate admissions and overly extended stays in the hospital cause unnecessary pressure on the hospital and its resources (Williamson, 2011). It also offers a much lower quality of life. Additionally, less invasive surgery applied in day cases often portend better outcomes to the health of the patient, as well as faster recovery times for the involved patients. Long stays in the hospital could also cause a social breakdown for the patient. The proposed health system is to increase the prevention of illness, promote early detection, and emphasize on early intervention. Patients to be involved in caring for themselves regarding acute conditions will be aided by health care professionals. Additionally, the professionals will provide an advisory, supportive, educative, and skill-training role (Harris, 2008). The capacity, nature, and availability of community based responsive services will be configured to prevent admissions that are unnecessary to acute care and also facilitate early discharge and let the patient get back to being independent. Negri hospital internal processes will also be optimized to support high care quality, reduce delay for patients, and maximize on the utilization of bed space. The Negri Health System is highly dependent on acute services with many seeing them as the health system’s focus with provision of services centred on the system. The proposed health system aims to change this fundamentally. There are four vital care components in this proposed health system. These are acute care, self-care, no care requirement, and primary, continuing care at community level (Harris, 2008). No care requirement is characterized by emphasis on prevention of illness, early detection, as well as early intervention. The system puts a priority on informing and changing the population’s health behaviours before the onset of a clinical disease. The Doctor should institute the promotion of healthy-lifestyle behaviours, as well as place emphasis on educating the Negri population regarding high-risk behaviours like smoking and alcoholism. Preventive medical care will facilitate earlier illness detection and their treatment (Schulz & Johnson, 2011). These services will be instituted to enable the discovery of diseases while still in the initial stages and reduce acute bed demand. In this regard, the Negri Health Service should begin routine screening for a sizeable range of diseases such as stroke through discovering hypertensive tendencies in the population. Surveillance, propped by patient screening and good data, will support the measures put in place to prevent illness targeted at high-risk groups which will inform the making of decisions on health issues. The best way to handle this is through the health service carrying out surveillance with the aim of identifying “at risk” cohorts in the population, such as the elderly and young children (Moseley, 2009). Patient self-care involves the patients being partially responsible for their long-term, acute, and minor conditions with the health professionals providing educational, advisory, and supportive roles (Rabukawaqa, 2009). The Negri Health Service should institute a model for the management and prevention of long-term conditions and chronic diseases. Management of cases is done to prevent the occurrence of acute episodes while the patient’s expertise in dealing with their illness is also developed. In self-care, patients with long-term conditions can be supported via an integrated package that is inclusive of self-monitoring equipment, information on their illness, education on self-care skills, and building of self-care networks for support. Risk patients will be identified to avoid acute episode occurrence (Thomas, 2009). Patients are informed on the ways of contributing to this plan via behavioural change while they are provided with information and resources to monitor their illness. Telemedicine could be a useful information technology tool to aid the patient in self-management via provision of information on both audio and video tapes. Primary, community and continuing care is characterized by the capacity and availability of community based services that are responsive and configured to avoid admissions that are deemed as unnecessary for acute care as well as facilitation of early discharge followed by patient return to independence (Thornicroft, 2010). The burden caused by chronic disease has to be identified and managed actively throughout the Negri Health Service territory. To tackle these chronic diseases, the population will have to be stratified according to risk in addition to adopting population management approach which emphasizes self-management support, prevention, and disease management. Multi-disciplinary teams from the service will provide evidence and high quality care to support management of the disease inclusive of pathways and protocols. The service should have the capability of identifying and caring for patients with increased risk of acute incidents. A proactive identification of the groups at risk in the population also involves assessment of their needs, identification of health trends, and comprehension of activity levels and resources (Thornicroft, 2010). High-risk patients are actively managed via the use of case mangers that are responsible for working caseloads in an integrated system. A key worker, normally a nurse, will manage and join up these patients’ care. The service also needs to put in place a dedicated assessment of elderly management programs (Micronesia, 2004). Acute care involves internal hospital processes that undergo optimization in order to support high quality of care, reduce delay of patients, and maximize on the utilization of bed stock (Wolper, 2010). The Negri Health Service should plan bed capacity and manage it to meet demand. Allocation of bed capacity to specialties should also be done according to true demand rather than previous activity. Additionally, the hospital should match demand by day and hour with the management of inflow and outflow of patients done hourly. The daily discharge peak must be reached before the admissions peak. The capacity should be pitched to cope with high seasons, for example, when tourism is at its peak. The length of stay should be actively reviewed with performance management done by senior managers and clinicians. The place of care needs to be shifted from in-patient beds. Day surgery should also be encouraged to avoid unnecessary sleepovers. Increased care and treatment levels should also be provided as outpatient with diagnostics, patient assessment, and interpretation of results can be done in exclusion of hospital admission. To reduce the effect of acute patients on the effectiveness of service delivery to other patients, the hospitals, should also facilitate the opening of stroke units, chest pain units, and assessment units to provide acute care (Wolper, 2010). However, these reforms require wholesale changes to the work practices in Negri Health Services. They will require consultants to retrain them in procedures that are less invasive. The hospitals will also require alteration of their systems in order to avoid admitting patients unnecessarily a day before the operation which will also require changes in the behaviour of the consultants (Health Commission, New South Wales, 2010). Because the bed managers and nurses will work in collaboration with primary or community care providers to manage patient flow, the situation will require clinical championing and significant engagement on the ground. Improvement of performance also requires to be driven by a support infrastructure as well as defined standards to all hospitals. It will also require timely and accurate data to be provided to the health facility. For example, the NHS and other related organizations should provide the hospitals with detailed training and support, as well as detailed tools and benchmark targets to drive the improvement of hospitals (Health Commission, New South Wales, 2010). Risk Assessment, Costing Implications, and Workforce Issues Many hospitals across the world have formal processes that are used to measure monthly, weekly, and daily performances from their administration system and utilize this data to drive improvements on operations (South Western Sydney Area Health Service, 2009). Hospitals in the Negri region do not have an equivalent of this system. Therefore, they will require central systems and support on the ground from the NHS to deliver the discussed improvements. The performance management departments need to work with various hospitals to develop operational data flow around the system and needs to work implementing a pilot improvement of performance at a local level. This will involve the use of health service personnel who might not be willing to shoulder an increased burden. Additionally, this may require additional hiring of healthcare workers which will impact heavily on the NHS budget. Instituting preventive medical care involves assigning some of the healthcare workers to these programs. On top of adding more duties to an already overworked workforce, they will need to be remunerated. Some of the workers may not be willing to be out in the field especially if they already like their in-hospital duties. Funds for these programs will have to be sourced form the government and the ministry which have backed this program with an aim of reducing costs from bed occupancy. However, this jump in cost should only be considered as short term, especially the preventive healthcare system. Continuing care at community level can be considered as the only strategy that will take long-term costing measures. The NHS should, therefore, begin sourcing for funding for this service. Conclusion The health system is designed to deliver an overall healthier population in Negri. This is through providing citizens with an opportunity and information to manage their own well-being in addition to identifying those who need health services much earlier before the onset of diseases. It will improve the quality of life even as the population continues to increase by providing the populace with expert support and tools to manage their existing conditions in settings that they find to be comfortable. The proposal will also deliver an effective and efficient service for patients who require acute services. The NHS plan for transformation of the health care system is aimed at delivering a more efficient service delivery system. Such significant reform across what is probably the Negri region’s largest employer comes with immense challenges. It should, however, be remembered that the reform has been successfully delivered in such countries as Ireland and Australia with untold success. Furthermore, the alternative to go on continually adding beds to a system that will soon be oversaturated with beds is not workable. This is totally out of step with the other health services in the world while it is also most likely to be unsustainable. However, and this is the most important bit, it is not in the interest of the patients. References Berger, S. (2008). Fundamentals of Health Care Management. San Francisco: Josey-Bass. Harris, M. (2008). Managing Health Services: Concepts and Practice. Marrickville: Elsevier Australia. Health Commission New South Wales. (2012). Strategic Plan for the Development of Health Service. Sydney: Health Commission of New South Wales. Micronesia. (2004). Health Sector Strategic Plan: Detailed Rationale and Description of Activities in Matrix: 3rd National Economic Summit 2004. 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Thornicroft, Graham. (2010). Measuring Health Needs. London: Gaskell. Tulchinsky, Th. & Varavikova, E. (2009). The new public health. Amsterdam: Elsevier/Academic Press. Williamson, R. (2011). VA Health Care: Long-Term Care Strategic Planing and Budgeting Need Improvement . Darby: DIANE Publishing. Wolper, L. (2010). Health Care Administration: Planning, Implementing, And Managing Organized Delivery Systems. Sudbury : Jones and Bartlett Publishers. Read More