Increasing Efficiency and Enhancing Value in Health Care - Admission/Application Essay Example

 PROBLEM STATEMENT In today’s health care industries, there is growing concern over spending both during difficult economic conditions and during periods where the costs of providing health services continue to increase at the supply chain level. In order to offset some of the costs of health care provision, various health industries are forced to raise service and operational prices to remain competitive and in-line with corporate profitability expectations. To avoid pricing increases, internal analyses of the industry’s strengths and weaknesses should be evaluated to identify any area where cost reductions can be realized. At the same time, in the health care industry, there is considerable focus on improving quality, both in the actual service delivery and related to how organizational staff interact with various patients or consumers. Quality improvement (QI) efforts are usually created with the idea of improving consumer satisfaction, reducing costs by reorganizing the health care environment, or even the integration of various enhanced technologies to improve response times or simply enhance the overall service function. The issue for today’s health care industries is that quality improvement objectives typically come with added costs, therefore the improvement of service delivery might create a strain on working budgets. From a cost/benefit perspective, internal improvement efforts may not provide the desired organizational benefit without excess expenditures, something that a health care provider cannot afford in difficult and uncertain economic conditions. How, then, should a business implement a quality improvement campaign while still recognizing opportunities for cost reduction? Can efficiency and value go hand-in-hand during a new quality improvement campaign in the health care industry? This is an ongoing problem for the quality focused health care provider. LITERATURE REVIEW Liability and risk are two major concepts in the health care industry today, dealing with issues from patient-generated lawsuits to even employee grievances which cost the health care industry on an annual basis. “Risk management in health care is more than just managing liability and avoiding lawsuits, it is about understanding the whole continuum of care and focusing on performance improvement” (Grachek, 2002, p.34) This suggests that quality improvements, from a risk perspective, involve performing an internal analysis of the organization and then assessing how processes and policies impact the external stakeholder as well. Issues of human resources, organizational structure, service process, and even service accuracy should be addressed as part of this QI focus. Any noticeable future improvements are designed to minimize risk to the health care provider. However, can these types of QI strategies be accomplished without significant budget increases? Richardson and Gurtner (1999) offer several strategies for quality improvements which can be accomplished in a manner which is budget-conscious and provides both value and efficiency to a variety of health care systems. Clinical effectiveness is one of these concepts, dealing with doctors or other health-care providers maintaining the professionalism and human-focused strategies from the sociological and psychological perspectives. Simply training and developing existing health care staff to be more motivational and emotionally intelligent regarding basic human needs can be a low-cost QI effort which deals with customer satisfaction. Better professional and interpersonal relationships with consumers would likely create a more rewarding organizational culture and provide better quality of service from the social and psychological perspectives. Richardson and Gurtner also suggest that employee satisfaction is a fundamental QI initiative which can enhance value and quality simultaneously. Employee satisfaction deals with internal human resources functions, such as appealing to their basic needs for belonging or security using modern motivational theories. Employee satisfaction in the health care industry could reduce turnover rates, which hits the budget from the labor perspective, or simply provide overall better quality of care. “If you improve quality, using guidelines, order sets and a structured team approach, that often leads to efficiency improvements and better use of resources” (Terry, 2008, p.52). Team-focused methodologies appear to be valid QI concepts which do not strain the budget short of creating literature for training and development of staff and using theory to motivate workers through appeals to their social and psychological needs. Flynn and Mangione (2008) identify steps to build a successful team in the health care industry for improving quality and increasing efficiency. The first QI initiative is to facilitate communication, opening the doors to collaboration between different health care units or changing the medium by which communications occur. Another author-recommended QI effort is to recognize and overcome barriers to successful team development, such as noise within the organizational unit or division or people who might be resistant to change and uncooperative in team environments. The development of a team which remains focused on internal or external improvement projects would be a low-cost QI effort and would also improve efficiency in the process as multiple expertise brainstorm better methods of enhancing service quality and delivery. Changing the level to which the health care environment listens, especially true in hospital environments, can improve efficiency from the QI viewpoint. “Greater flexibility in treatment options and new quality and transparency initiatives will place more power in consumers’ hands” (Hall, 2008, p.76). With consumers, today, having a very influential voice in health care, it is vital to listen to the external stakeholder and publicize efficiency improvements through a marketing promotion campaign. Consumers appreciate transparency when dealing with health care issues and simply training and developing health care workers to empower consumers can improve the quality of care and bring a positive return on investment through marketing and advertising promotion. Block (2008) describes a situation in the health care industry where a high-quality electronic medical record (EMR) was implemented in order to enhance the management system and improve efficiency. This technological breakthrough, though not an inexpensive QI initiative, brought long-term gains to the health care industry in terms of cost-reduction. This one time investment into this software and technology package managed to assist physicians in their efforts to recommend patient tests timely and reminded the staff of follow-up visits for higher-risk patients. In the health care industry, many revenues are driven by service payments, such as when a patient is diagnosed in a CT machine for chest analysis. This EMR system provides physicians with opportunities to ensure that future tests are performed, when scheduled and appropriate, thus providing more revenue to the organization through the direct marketing opportunities provided by EMR systems. In manual appointment scheduling systems, lack of accuracy could lessen consumer-driven revenues, thus it should be considered that sometimes even short-term high investment in technology can bring long-term revenue gain. “To understand the principles of cost-benefit analysis, you will need to network and conduct research” (Bailey, 2006, p.13). The implementation of an EMR system could impose high short-run costs, however the collaborative and communication improvements offered can justify the expense if the organization has a long-term profit expectation model and the resources to wait for long-term positive outcomes in relation to efficiency and cost value. Research into the company’s short- and long-term missions as well as staffing competencies should be explored as part of ongoing cost-benefit analysis for QI and efficiency improvements. It was important to identify that sometimes in order to improve quality it is necessary to divest financial resources in order to bring the most valuable long-term gain, as part of strategic planning. It is not likely easy for the health care organization to determine whether or not they are receiving revenue gains or cost savings which stem directly from a specific quality improvement effort. For example, a health care organization which begins sending direct marketing literature to a client to discuss new treatment options or cost savings as a new customer might bring several new patients which add to the revenue stream of the organization. However, without a tool to measure whether it was the marketing QI effort or simply consumer sentiment about competing hospitals which brought the new patient, understanding of how costs are impacted with QI initiatives would seem difficult to achieve. The current economic environment would seem to create the need for a more focused evaluation of QI and the impact on costs during an internal analysis of the organization’s mission and service delivery process and policy. All of the literature proposed identifies that there are, potentially, short- and long-term strategies for implementing QI and also recognizing areas of cost. From an accounting perspective, a health care manager can recognize tangible financial data but there appears to be limited measurement tools available for this manager to recognize whether certain QI efforts are actually bringing revenue-related or cost-savings profitability. The need for such a measurement tool, along with the tools designed to foster better organizational efficiency through staff development, was the premise of this study’s design. OBJECTIVES This study has two main objectives: Discover what methods are available to today’s health care industries to improve efficiency and enhance value while recognizing cost reduction efforts. Determine whether short-term or long-term QI efforts bring the most value to the health care organization. It is hypothesized that the health care industry can increase efficiency and enhance value using low-cost, short-term expenditures which bring more long-term gain in areas of finance and budget and should not necessarily rely on high dollar, short-term expenditures. There is ample research evidence available which points toward a trend in encompassing the human resources function in order to improve cost efficiency and enhance quality. RESEARCH PROCEDURE The approach to research will be both quantitative and qualitative, in order to measure aspects of human emotions as well as hard, financial data needed to complete a QI investigation in the health care industry. Because costs and QI efforts seem to be invariably linked, it becomes necessary to understand the real-life operational and service delivery components in today’s health care industries in order to understand how costs impact each division or process within the organizational structure. Impact on consumers or patient care is also a fundamental methodology behind this study’s purpose and how these issues are linked with employee satisfaction, technology tools in the health care environment, and consumer values will be considered in this research approach. Research tends to identify that these aspects of service delivery and administration in the health care industry are important predictors of revenue creation, thus as part of any QI initiative they should be inclusive in the research design. The goal is to view a real-life health care environment, over a period of months, to determine whether tangible, measurable cost savings or revenue improvements have occurred as a result of QI ambitions in this organization. A single health care organization will be chosen for participation in this study. POPULATION AND SAMPLE The recruited population will be dependent on the health care organization chosen. It is likely that the researcher will be able to obtain more valuable results in a smaller-sized organization with a form of in-patient care or service provided. In this event, the researcher can build relationships with the staff, after contracting to participate in the study, providing better access to employee sentiment and job role function per service provider on staff. It is estimated that the required sample population for in-house health care expertise will be 4-7 staff members of differing organizational ranks and authorities at the health care organization. A secondary sample group will consist of a random sampling of patients in this smaller health environment with differing demographics to offer the study a wider perspective of values and beliefs. This sample group will consist of 20-30 patients who will participate in a preliminary survey and a post-study survey. RESEARCH DESIGN The study will take place in the natural environment where health care service delivery is regularly performed. A set of preliminary surveys will be created, after the fundamental discussions about study purpose and duration have been discussed with the willing organization, and staff members will be asked to identify patients willing to participate in the study. Upon agreement, the patient will be given an identification number which will correspond to their survey for use in the post-study survey. The researcher will create a template for the organizational staff to enter the identification number of the patient and their corresponding survey with only reference to age and gender. To satisfy ethical issues, no patient issue or treatment being pursued will be identified in the research for confidentiality to the participant group. Post-study surveys will be administered to this sample group in phase two. After identifying the appropriate organization which is undergoing quality improvement programs, interviews with two senior members of staff and one junior member will be conducted in the first phase of the study. After collecting the qualitative data, post-study interviews with the same sample group will be conducted to assess QI improvements and cost issues. INSTRUMENTATION AND DATA COLLECTION Surveys will be constructed with closed ended questions, in a ranking sequence, which rates the health care industry, as a conglomerate whole, in areas such as customer service, treatment transparency, motivation, and interpersonal relationships with staff. The surveys will have a quality theme to them to familiarize the sample group with the idea of QI efforts. Post-study surveys will consist of similar information to uncover whether this group altered sentiment about health care and quality. Interviews will be very open-ended, offering flexibility for the researcher to dig deeper into areas of finance and cost/budget improvements based on current QI efforts. The rationale behind choosing open-ended research formats was to allow the participants to freely express their opinions and experiences with QI efforts and how they perceive they bring value to the organization in terms of revenue or satisfaction. Questions about costs associated with supply chain versus inter-office improvements will be identified, as well as technology improvements to improve organizational growth and efficiency. Post-study interviews will assess these same concepts but with a stronger focus on short- versus long-term financial growth or speed of interoffice efficiency associated with QI efforts. All of these factors will depend largely on the specific health care organization recruited to participate in this study and the specific quality improvement goal being undertaken by the leadership. It is the hope that familiarization with this health care environment can, post-study, provide the researcher with much more accurate financial figures and cost-related aspects of the chosen health care provider to add further reliability to the study and its qualitative research data. PLANNED METHOD OF ANALYSIS Aspects of human behavior and employee sentiment require an expert background in psychology and sociology, therefore consultation with secondary research sources will occur in order to assist in analysis of interview data. Theories of motivation will be considered as well as the psychological and physiological outcomes of QI efforts or other internal change processes. Interview responses will likely be mixed with both tangible information (quantitative) and more emotionally-driven responses, therefore understanding what drives basic needs for staff members in the organization will be considered to validate analysis. When assessing the survey data, because they will be constructed in ranking format, will require reviewing whether a trend in sentiment exists with certain demographic groups. For instance, if all consumers over the age of 50 feel strongly about a particular health care subject, it can create a new template for making connections with this consumer demographic. Quality impacts multiple demographics, thus when analyzing the data any noticeable trends of this nature should be documented and discussed. This type of study does not rely on statistical analysis, but rather having an understanding of what drives organizational efficiency and value both in the mind of the staff member and in terms of tangible internal process or policy. Examination into a variety of organizational theory will be conducted as well as case studies where QI has been successful or led to negative results such as over-extended budgets or failing to achieve its fundamental objectives. TIME SCHEDULE Realistically, in order to measure whether any revenue or cost savings gains have been made from QI improvements, an elongated study needs to be conducted. Once the recruited health care organization has been chosen, along with their specific QI effort identified, the duration of the study will differ. For instance, if the recruited organization’s QI effort is the installation of new software programs, such installation can take up to six months depending on the sophistication of the software or hardware which supports them. Another health care organization may have a new marketing focus to outperform rival health care providers and be waiting to measure the return on the investment through new client registration. The evidence suggests that any QI effort is going to take time to achieve results, therefore this study proposes a four month investigational timeline between preliminary interview and survey distribution and post-study evaluation of participant groups. The following represents a proposed timetable for the duration of the study from phase one to the completion of phase two: November 2009 – Identify health care organization and specific QI effort. Perform preliminary interviews and survey administration. Data collection and analysis will occur after this phase one is completed and appropriate psychological, sociological, and financial results will be documented. December 2009 – Reintroduce the researcher to the recruited environment to discuss the QI process and its target focus. This should occur twice in the month of December. All recruited clients in phase one of the study should be contacted for their post-study surveys during this period. January 2010 – Conduct post-survey administration to client sample and staff sample groups. Analysis of data. February 2010 – Construction of research project. Analysis linkages discovered and discussed. Submission of final research project. RESOURCES NEEDED Fortunately, this study does not require significant resources other than various electronic systems with spreadsheet and document-processing capabilities in order to make research notations and construct the survey and interview templates. These items are commonly found in academic and home environments and represent no risk to the study’s administration. The template utilized for client recruitment will also be created using technology systems in similar fashion. Access to secondary research information is required to conduct a thorough, competent analysis of what is driving health care emotions and motivational efforts using contemporary psychological and sociological theory. This also does not represent a risk to the study’s administration as these are available in local libraries and university school environments. This study will also make use of the expertise and knowledge of school administration and instructors for assistance during the analysis portion of the study. Making use of available expertise in areas of sociology, psychology, and business or organizational studies is a logical data resource which satisfies both budget and also improves the study’s reliability in areas of data analysis. Practicing instructors and administrators have real-world experience in areas of quality improvements or simply in how the internal functions of the business impact the external stakeholder (and vice versa), thus the input from this group can give practical guidance to analysis of the interviews conducted. Access to various business or industry case studies will also be required to conduct a thorough analysis of quality improvements related to cost and cost-related benefits. Company publications such as annual reports or investor statements can give quality insight into whether any quality improvements have been made in a certain area and then comparing previous year financial histories prior to the launch of any identified QI efforts. This could act as important comparative data in the event that any identified trends discovered in this research correlate with existing QI outcomes or efforts. If such linkages are found, this could create a new, potential benchmark for QI efforts and cost-savings in the health care environment. PERSONNEL This study maintains the ability to be carried out by a single researcher, thus no need for additional personnel is present. A more ambitious research study, measuring QI efforts over a year or more, would likely require an experimental design with multiple researchers collaborating in diverse, multi-cultural environments. This study maintains a strong advantage in its simplicity and can be accomplished in lone-researcher method. BUDGET In order to carry out an effective research program, over this three month period, the researcher must maintain visibility in the recruited health care environment. Costs associated with conducting research are tangible and include the costs of supplies for template and survey creation as well as travel costs for being present on multiple occasions in the organizational environment. The proposed budget for this project, however, is estimated at between $50 and $100. NEEDED ASSURANCES The location of a qualified, interested organization willing to provide access to financial information and to staff and clients is expected to be one of the more difficult aspects of this study. When assessing potential participants, it will be important to maintain a blend of professionalism and courtesy to make a quality impression on the organizational staff and its leadership. To achieve agreement for participation in this study, the interested participants will be informed of the nature of the study, how it can best benefit their industry, potentially help to identify and improve cost issues, and also that their business information and financial data will be kept strictly anonymous. Consumer agreement to participate in sentiment surveys about the health care industry will also require consent, however this group will also be informed of the researcher’s ethical assurances about non-release of medical or personal information. This satisfies the ethical requirements of this study to ensure consumer privacy. Support from school administrators and instructors for periodic engagement to discuss aspects of the research design and analysis would need to be secured from willing staff members willing to devote their knowledge or professional opinion about the quality or content of data achieved through the survey and interviewing processes. It might be necessary, throughout the study, to schedule one-on-one sessions with the instructor or administrator, due to their personal and professional obligations, which will require coordinating both researcher and faculty schedules to achieve positive knowledge exchanges. REFERENCES Grachek, Marianna K. (2002). “Reducing risk and enhancing value through accreditation”. Nursing Homes, 51(11), p.34. Bailey, Greer. (2006). “Saving justifies the spend”. Occupational Health, Sutton. 58(10), pp.13-16. Block, Bradley M. (2008). “How We Improved Our Practice and Our Bottom Line with A New EMR System”. Family Practice Management, Leawood. 15(7), pp.25-31. Flynn, A. and Mangione, T. (2008). “Five Steps to a Winning Project Team”. Healthcare Executive, Chicago. 23(1), pp.54-56. Hall, Melvin F. (2008). “Looking to improve financial results? Start by listening to patients”. Healthcare Financial Management, Westchester. 62(10), pp.76-81. Richardson, M. and Gurtner, W. (1999). “Contemporary organizational strategies or enhancing value in health care”. International Journal of Health Care Quality Assurance, Bedford. 12(5), p.183. Terry, Ken. (2008). “Can Hospitalists Cross the Quality Chasm?” Hospitals & Health Networks, Chicago. 82(6), pp.52-55. Read More