Department Problem: Holter Monitors Not Being Returned - Essay Example

Department Problem: Holter Monitors Not Being Returned  College Introduction This essay aims to closely analyze an organization’s cardiology department that offers Holter heart monitors to patients who often take them home for further monitoring. A holter monitor is a device that is used to continuously record the heart’s rhythms and is usually worn for one to two days to so as to get accurate readings during normal day to day activities by the patient (Adair, 2005). The test is performed by attaching tiny electrodes onto the patient’s chest that are the connected to a recording monitor. The Holter monitor is battery operated and is then carried around by the patient either in his pocket or around the neck. The patient is required to record his activities and symptoms to enable the doctor dealing with him to match these with the patient’s Holter monitor settings. The Holter’s electrodes are required to be very firmly fixed to the chest to enable the monitors to get accurate readings of the heart’s activity. The patient is also advised to avoid the following areas/ devices that may lead to inaccurate readings of the Holter; High-Voltage areas, Electric blankets, Metal Detectors and Magnets. The patient is strongly advised to proceed with doing his normal activities while wearing the monitor. He may even do some exercises if the symptoms have appeared in the past when he was doing his daily exercise routine (Lindh, 2010). The electrodes are often replaced when they get loose or fall off the chest. The patient has to reveal to the doctor whether or not they are allergic to adhesives or tape. It is also required that they take a shower before beginning the test since they will not be able to do this when the monitoring is in progress (Malloch, and Porter-O’Grady, 2009). The monitors have to be held close to the body. The Holter monitoring technique is normally used to determine how well the heart responds to the patient’s normal daily activities. This monitoring is also done after a heart attack, in diagnosing rhythm problems in the heart, before starting new medication and also in incidences of slow heart rate (Lindh, 2010). This information is given to the patients verbally as well as written down on a paper to act as a constant reminder. By giving the information this way, it ensures that the patient is fully aware of what is expected of him or her during the entire period of the monitoring. Looking at the nature of conducting this heart monitoring, it requires the patient to take these equipment home. The cardiology department has started experiencing problems with the patients not returning the monitors in time or sometimes failing completely to return them back to the hospital. This affects the smooth and efficient running of the departments and negatively affects its ability to effectively service other patients with similar problems. The department currently has about 40 monitors according to its recent inventory check. The department routinely receives several referrals spanning 24 hours, 48 hours, 72 hours or even 7days. It fits an average of eight or nine holters on a daily basis (Brazier, 2011). One of the department’s staff recently discovered that the department’s Holters inventory was shot by about 15 in number that is about 35% of the total stock. This shows that signs of this being a problem in future had been detected earlier on but the department was not proactive in dealing with it. This large shortage led to several appointments being cancelled leading to a reduction of the work available to the department’s staff and consequently negatively affecting the department’s overall business targets (Brazier, 2011). The standard time allocated is normally 24 hours although several doctors routinely make requests for much longer time periods. In cases dealing with atrial fibrillation, doctors often request for longer time periods that may reach up to seven days. This will mean that these patients will be taken up by one patient for up to one week at a time .This means that the monitors are out of service for 7days. A root cause analysis can be used to critically analyze this problem in the department and look at its causes and what disadvantages it brings to the department. The 5-why analysis is the most effective method in this case. The first why is how one would start the analysis? This seeks to find out why the department is facing these problems. The department’s problems seem to concentrate or center on the management of the Holter dispensing unit to its heart patients. The main issue that arises out of this is the failure by the patients to play their part in returning the device back to the hospital to be used by other patients who may need them. The department also seems to leave it late before they realize they have a shortage of monitors thus inconveniencing other patients whom they had already booked appointments with. This undermines the ability of the department’s staff to perform some of their key duties (Belbin, 2013). Another major cause can relate to the fact that the department mainly deals with elderly patients. This is because they are more prone to suffer heart diseases and will need these monitors to in their treatment process. One cannot rule out the fact that these elderly patients may have memory loss problems brought about by ageing. This can make them honestly forget to return their monitors when needed to. The other causes of the delayed returning of the Hotler devices my relate to simply recklessness on the part of the patient who may be of the view that the hospital has in its possession more Hotler monitoring devices that can be assigned to other patients thus removing the urgency to return those they have in their possession. Lastly on the issue of cancelled appointments, this can be due to the fact that the employees manually check their monitor stock to ascertain how many are in stock. This is an inefficient means that can lead to over booking of appointments relative to the monitors in stock. The second why in the root cause analysis will have to answer the question of why the employees do not seem to keep track of the number of monitors that are available or need to be returned so as to avoid the issue of lack of the devices. This question can be answered by the fact that the department does not operate an efficient record keeping and management system. This is the main culprit since it means the staff are not keeping proper track of the monitors at their disposal. The third why deals with the query of how the department allowed itself to get this far without an efficient record keeping and patient tracking mechanism. This may be due to the fact that the number of patients it was initially serving was a manageable lot in terms of numbers which made it easier for the staff to keep up with the number. The department has however grown to deal with patients from across the county as well as neighboring counties and the previous simpler methods used just cannot cope with the growing numbers. In trying to deal with these causes of departmental inefficiencies, the department may have to start with the simple task of improving its inventory management process. A successful implementation of an improved system will lead to some cost savings which will lead to a much healthier bottom line for the department. This will help streamline inventory control and cut down the time spent by the employees checking on the inventory. It may also help the department make appointments with an informed number of Holter monitors available in mind to prevent cases of cancellation that lead to patient complaints. The department’s wastage will also be greatly reduced (West, 2012). There has to be an improvement in the department’s ordering process. As it stands now, majority of the orders are done manually by being put on paper and the regular stock checking was done via visual inspection through physical counts which by all accounts is an inefficient and time consuming method of inventory management. Majority of the staff at the department get frustrated by the time they spent on managing and ordering the Holter monitors’ inventory. From a management’s point of view, this time could be put in much better use if it was used managing the patients and ensuring the monitors are returned in time. A new and more efficient inventory management system can give the department a much more clear insight into the items available for the department’s use. As it stands, the department uses about 40 hours in a week on managing its inventory which greatly ties up valuable human resource. The new computerized system will be able to display the number of items that are in stock versus the expected demand for the Hotler monitors in the next 24 hours, 48 hours, 72 hours as well as one week in advance so as to hasten efforts by the employees to recover the Hotler monitors that are over due to prevent patients from missing out (Health & Care Professions Council, 2008). Patients will also be key beneficiaries upon the implementation of this new system as the department will have the ability to attract much more qualified staff in the field of Cardiology since they will feel that their skill are being put into much better use working more on the patients than constantly doing repetitive duties like inventory management and confirming the numbers of Hotler monitors in stock and physically going through patient files to be able to know how many of these monitors are expected back and in what particular time period (Pickering, 2003). The department will have to deal with the problem of elderly patients and the common occurrence of forgetfulness in several ways. They can opt to take every patient’s contact information including the address of their residence. This will come in handy when the agreed date and time for the return of the monitors fast approaches. The staff assigned can call them via cellular or house phone to remind them of the need to return the gadgets and their monitors for future use. This hand on action by the employees will go a long way in reducing the delays that are currently experienced in the department. The employee tasked with the giving of the Hotler monitors can also make a point of encouraging the elderly patients to come for this initial appointment with relative or their care taker. Both of their contacts can then be submitted to the department’s records which will be used for contacting. It also decreases the probability of the patient forgetting the crucial appointment since at least one of them will remember that the date and time that the monitor has to be returned. A much more long term strategy is to have the monitors come equipped with a programmable alarm system that alerts the patient when it’s time to be returned to the hospital for analyzing the data that has been recorded. This alarm can be varied depending on the duration agreed upon by the doctor handling the particular case. In severe cases of patient neglect with the full knowledge of what is required of him, the department can come up with a fine/penalty system to be levied on the patient that does not have a particularly convincing reason as to why he or she failed to return the monitors to the hospital when the time run out. This should be done properly to take into considerations particular ethical guidelines to ensure that the final method that is arrived at does not contravene any ethical guidelines that the department ought to obey in the medical and health practice guidelines (Mendonca & Kanungo, 2010).The new strategy to improve this issue is to provide the patients with a prepaid envelope so they don’t have to pay for returning the monitor. This is the strategy that the manager wants to implement and this should be the key. The manager can use soft system methodology to implement and follow up on the success of the prepaid envelopes. This methodology compares the situation as it is and the situation as it might be after the implementation. The whole process is a process of mutual learning. The first stage is when the problem situation is initially experienced by the relevant subject in this case the cardiology department. The problem is then expressed in detail on how it affects the department’s day to day running. The solution is then developed in this case the prepaid envelope and is tested as to how it will be received by the workers as well as the patients. This will enable the management to see how it can function in the real world since up to this point it has been nothing more than a concept or a theory. If the results are positive, it will be incorporated in the daily running and the culture of the cardiology department. On the other hand if the results will not be too desirable, appropriate changes will be made that have been informed by the initial experiences of the staff. The most effective model of decision making that should be applicable here in my opinion is the rational model of decision making. (Zey, 1992) This is a systematic step by model whereby information obtained via observation or experience is used in coming up with long-term business or organizational decisions. It is sometimes referred to as the rational economic model. Departmental heads or managers are usually the ones that have the responsibility to make key decisions when faced with a challenging situation like this regarding delays in returning the Holter monitors. The main steps that are involved in this model are; Pinpointing the problem in the first place; Coming up with the suitable alternatives; Evaluation of every alternative available in tackling the problem; Selecting the most appropriate choice or choices that will effectively deal with the problem (Health & Care Professions, 2008). The first step of defining the problem typically involves asking of the following questions; What is the problem affecting performance in my department?; How immediate or urgent is it to solve this particular problem? The second step typically involves coming up with the various alternatives that can be used to tackle this problem. This second step is where the department head has to come up with the objectives or goals that the department seeks to accomplish. There is also the factoring in of the effort required, complexity as well as cost in order to achieve the set goals. We have already gone through the first two steps of this model which were;- Problem identification Coming up with alternative solutions (Bushe, 2010). The department should select all the three solutions in order to ensure that the problem is effectively dealt with both in the short and long term as well. There are bound to be challenges in trying to incorporate these new decisions on the day to day running of the department. The process of implementing new and efficient ways of doing work in an organization is challenging and complex. The department head has to critically observe the organizational processes in order to determine the existing gap between theoretical evidence of the viability of the solutions and the practical part in the real day to day activities in the cardiology department. This is because most of the successful decision making practices in organizations are usually informed by workplace norms, values resources and policies as opposed to solely scientific evidence (Bushe, 2010). For the new policies and decisions to be swiftly implemented and adopted by the workers, the decision maker has to consider taking the following approach; Developing a decision making group that includes employees from each section of the department in order to generate much more support for the new decisions and innovations. Making a point of aligning the new policy changes and innovations to fit in with the existing organizational values as well as goals. The new decisions and policy have to be closely monitored to determine along the way whether they are having a positive impact on the department by tackling the problems they were set out to deal with in the first place. The management should have several communities of practice developed in the department that would sustain and champion the newly implemented modes in order to sustain them and avoid a situation where the enthusiasm would fizzle out. The problem experienced by the cardiology department is needs to be tackled by all the stakeholders of the department i.e. the staff, management as well as the heart patients. This is because irresponsibility on the part of the patients inconvenience both the patients and the staff at the department hence they all have to work together to streamline operations. Conclusion The health and medical industry is a unique industry but also faces the same challenges that sometimes plague other organizations in industries such as finance and Technology. The modes of dealing with these challenges are also widely similar with small modifications being necessary from one industry to another but the underlying ideas remain widely the same. Reference List Zey, M. 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