Healthcare Practices - Term Paper Example

Abstract

This paper examines the system that Newland Hospital applied as it acquired primary care practices. It is worth noting that the hospital wanted to capitalize on the referrals, in a bid to increase the number of inpatients that Newland Hospital handle. However, the structure of managing the newly acquired primary care practices undermined the profitability of these spaces. The management failed to consolidate the management of the primary care practices, giving the physicians the authority to decide on the working hours and patient schedules. Nonetheless, such an environment has led to dwindling profitability in the acquired primary care practices and laxity on the part of primary care specialists. The primary care practices face ethical and legal issues, which should be addressed with urgency, if the management is keen to consolidate management practices in these primary care practices and return these spaces to profitability. The adoption of the Lean CQI principles is noted to be capable of bringing desirable changes, as the hospital cuts down on wastages and leverages on the use of the available resources.

Case Study 2: Healthcare Practices

Question 1. Describe the system the Newland Hospital created by purchasing the primary care practices. How do the concepts of optimization and sub-optimization of a system apply?

Newland Hospital System

System purchase primary care practices

When Newland Hospital purchased primary care practices, the aim was to ensure that the hospital remains profitable. The management was keen on promoting efficiency in operations. The combination of management of the hospital and primary care practice projected a cost effective system of management, given the hospital and primary care practices would share logistics, technology, and staff. The idea of having additional staff in the primary care practice made it easier to share the workload, justifying the idea of Newland Hospital to acquiring primary care practices. The drive to purchase the primary care practice was to ensure that Newland Hospital benefits from an increased number of referrals. It also aimed to facilitate coordination of activities between providers at Newland Hospital and professionals in primary care practices. Newland Hospital agreed to buy practices, employ physicians, and hire clinical and clerical support staff, deployed in the acquired primary care facilities (McDaniel et al., 2014).

Optimization

The expansion of the operations of the hospital was in line with the anticipation that the hospital would be able to handle an increased number of inpatients, through an enhanced referral system. The reason Newland Hospital hired medical professionals who had to report to the vice president of Newland Hospital was to improve its referral system. In line with its objective of increasing volumes of patients visiting the facility, Newland Hospital instituted a management system, which subsequently expanded the vice president role in managing the physicians working in the primary care facilities. The hospital management was optimistic that through optimization of primary care practices an increased number of patients would be referred to Newland Hospital. Improvement of the primary care practices was critical in reducing the overall costs of running the hospital, considering the primary care givers would equally handle patients leaving Newland Hospital. Indeed, such arrangement meant the responsibility of the vice president extended beyond monitoring operations within Newland Hospital (McDaniel et al., 2014).

Sub-optimization

Considering the hospital was keen on reducing the costs and ensuring that the physicians work towards improving efficiency, Newland Hospital wanted to capitalize on the referral system. Encourage the sharing of resources between primary practice and Newland Hospital was another obstacle. Indeed, most of the referrals came from the family primary care practice, a reason that the management considered worthy to acquire primary care practices. In this sense, the management largely concentrated on the primary care practices, at the expense of the Newland Hospital. Newland Hospital took a great risk in the acquisition of the primary care practice, with objective of ensuring of increasing referrals and streamlining management of resources within the hospital. However, Newland Hospital failed to consolidate management, which lead to complexities in managing primary care practices that were operating under separate regulations. Newland Hospital failed look into the intricacies related to running other primary care spaces in line with the Newland Hospital guidelines. As such, the primary care practices failed to maintain their profitability because the specialists selected their working time and patient schedule. In this sense, the resources in primary care practices were underutilized, considering non-commitment of primary care specialists (Peltokorpi et al., 2016).

Question 2: What reasons might explain why the practices are losing money?

The struggles of the hospital are attributed to failure to consolidate management practices in the clinics. For a healthcare organization, a change of ownership requires the restructuring of the model, as opposed to running new units as independent entities. The acquisition of primary care practices meant that the responsibility of the vice president expanded and he was to ensure that operations in primary care practices align to the overall objective of Newland Hospital (McDaniel et al., 2014).

Moreover, management of all the primary practices staff would not be easy for the chief medical officer. Such workload is likely to bring complications, which may have an adverse effect on the profitability of the hospital. For example, the management had to restructure the management model for the acquired primary care practices. This way, the staff members were to be made aware of the changes, including adhering to the policies that govern operations in the entire hospital, including the purchased primary care practice (Kumar et al., 2016). Considering the workload burden of the vice president, it becomes difficult to ensure all the acquired primary care practices comply with the regulations. As such, increased inconsistencies and lack of accountability has contributed to primary care spaces losing money.

Where the Newland went wrong with the new acquired practices

Based on a personal observation, the hospital management did not develop a comprehensive framework that would consolidate the profits from both the hospital and the acquired primary practice facilities. Indeed, this was wrong judgment from the management because they believed that physicians would be motivated to work in an environment that guarantees them this kind of freedom. Perhaps the management did not predict the risk of lack of a uniform structure in managing the acquire primary care facilities. Moreover, the decision making process is flawed, contributing to the struggles of the hospital. This is likely to compromise care provided to patients, leading to lawsuits from patients who may not be satisfied with intervention services provided (Renkema, Broekhuis, &Ahaus, 2014). In the event the hospital is found to have made poor decisions on care, it is likely to lose money to clients filing lawsuits. Moreover, linking an organization to unethical misconduct taints the reputation of the hospital, leading to further loses (Purtilo & Doherty, 2015).

As much as the hospital wanted to run the acquired primary care facilities as a unit, it was inhibited because it allowed the medial professionals from each unit work to separately and to develop their terms of service. Besides, the drawbacks were associated with lack of accountability and inconsistency in decision making process (Purtilo & Doherty, 2015). In order for operations to succeed, effective operational decision making is necessary. The vice president has to appoint a professional who will report about the performance of the different care practices, including the problems that physicians in these care spaces face. This is important in helping make important decisions that affect the entire healthcare system. Ideally, the primary care practice would be enhanced through adhering to framework, which stipulates the working hours of the physicians. Instead of the primary care specialists working under the overall rules of the hospital, they were given the freedom to choose the hours that they are free to work. Moreover, the patients schedule depended on the choice of the primary care specialist. This is likely to lead to non-commitment of members of the staff, which led to the organization losing money (Kumar et al., 2016).

Question 3: Identify the economic value of the clinics to Newland Hospital. Identify the noneconomic value.

Economic value

The use of technology in connecting the clinics and sharing of other logistic factors is essential in economic value to reduce the overall costs of running the operations in these hospitals. As such, the resources at Newland Hospital will not go to waste because these clinics will be sharing structures such as technology (Manz et al., 2006). Moreover, the additional staff members in the clinics are geared towards enhancement of the productivity (Woolcock, 1998). In this case, the hired staff members in these clinics could be conducted to help the nurses in the hospitals (Grosse et al., 2016).

Non-economic value

The presence of the clinics is vital to Newland Hospital, considering the hospital will benefit from the referrals. However, the operations of these clinics should be consistent to the framework established to govern the healthcare system. It is worth noting that lack of transparency to the patients being referred to Newland Hospital may lead to ethical issues. For instance, if patients are not aware that these care practices are part of Newland Hospital, they may feel the hospital only cares about profits and does not prioritize care. The greatest non-economic value is promotion of coordination of activities between staff in clinics and those at Newland Hospital. Coordination is instrumental for nurses at Newland Hospital and physicians in the clinics to work effectively and efficiently (Grosse et al., 2016). Patients will be encouraged to visit a Newland hospital or be treated in primary care facility, given these facilities will be easily controlled through one system. Indeed, nurses have access a management system that makes it easier for them to deliver their services. It is assumed that from these well-coordinated activities more and more patients will be willing to be treated at Newland Hospital. Patients recuperating at home could be closely monitored by the primary care specialists in the acquired clinics. As such, it relieves the burden from the nurses at Newland Hospital to make all the follow-ups for the patients leaving the hospital (Kumar et al., 2016).

Question 4: Outline a plan that applies CQI principles and concepts to improve the health-care delivery system composed of the primary care practices and Newland.

CQI Principles and Concepts

(Emergency and Cardiovascular Care, 2017)

Lean initiatives

Newland Hospital could adopt the Lean CQI initiatives, aimed to alleviate risks that have led to the hospital’s diminishing results. The team working in primary practice care could use Lean principles; in identification of the system changes geared towards bring positive changes in providing healthcare services (Hunter et al., 2017).The first step of the plan is to identify individuals to inspire change in the organization. In this case, a change of the management structure is critical, as it ensures that all the primary care practices report to one management. Ideally, the move focuses on creating value to the resources available for the hospital and the primary care practices (McFadden et al., 2015). The next step is to identify the internal and external perspectives. For instance, revising the terms related to the working hours of nurses in primary care facilities. Nurses need to have standard working time, as opposed to deciding the time when they want to work.

Lean Principle: CQI Chart

Source: (ToughNickel, 2016).

Hoshin planning

Alternatively, hoshin planning is a strategic approach to quality, with central focus on policy deployment, focused planning, or strategic quality planning (ToughNickel, 2016). In the case of Newland hospital, hoshin planning reinforces a customer oriented approach, where the planning process is centered on improvement of activities in areas the organization requires strategizing to harness its competitive position in the market and ensure satisfaction of the clients’ needs (Longest &Darr, 2014; McFadden et al., 2015).

Value stream initiatives

Source: (Systems2Win, 2017)

It is imperative to identify the value stream activities in the healthcare facility. In this case, the management intends to turn around the fortunes of primary care practices acquired by Newland Hospital. The value stream activities entail looking at areas where healthcare facility records losses and exploring the structures that should be introduced to restore the primary care practices remain a priority. The productivity of the physicians in primary care spaces has to be examined, revising the working hours per week from 40 hours to 45 hours per week. After these changes have been incorporated, the management has to test the administrative process, to ascertain the effectiveness of the management practices. The flow should be identified and documented and later tested for a final evaluation and decision making. Lastly, Newland Hospital will have to stick to the management approach that has proved effective, in line with the objective to return the primary care practices into profitability. Essentially, the changes that would have worked will become permanent processes in management of Newland Hospital and primary care practices (McFadden et al., 2015).

Communication is essential in an organization. As the management develops strategies, employees in the organization need to be aware of the changes incorporation. This is vital in ensuring that everyone is the same page. For this reason, the management should be concerned about development of communication system that enables sharing of critical information among different stakeholders in the healthcare facility. Importantly, after evaluating the progress the organization has made, relevant stakeholders should be provided with the information necessary to help the organization move forward. Besides, understanding the problems that hinder progress in the organization is crucial, however, communicating this information to the relevant stakeholders for action is of great significant to the organization (Peltokorpi et al., 2016).

In order to ascertain if the organization has made positive progress, the profits that the organization makes will indicate if these changes are working. Healthcare organizations that are properly structures provide quality and comprehensive care, which translate to high returns. Moreover, the efficiency and effectiveness in the coordination of staff is equally important. The physicians in the primary care practices and those in the hospital will take part in survey. The survey tool, a questionnaire, will be send to physicians through email. The participants are expected to fill the questionnaire and send it back to the researcher. The names of physicians will not feature in the questionnaire, as it is important to grant the participants their privacy. The researcher and his team will compile the data extracted from the questionnaire, as focus shifts on analyzing the written information. The researcher will provide a descriptive analysis of the data collected, through examining the responses and new knowledge drawn from the responses provided (McPeake, Bateson & O’Neill, 2014).

Survey Questions

• What is the problem the organization faces?

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• Does the organization require structural change(s)?

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• Which change should the Newland Hospital consider effective in solving the problems?

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• What is the new approach the organization should take?

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• Has the hospital witnessed better outcomes? If yes, how has the hospital improved?

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Conclusion

In conclusion, the decision of Newland management to acquire primary care practices was based on the desire to increase inpatient referrals at Newland Hospital. However, the primary care spaces were not centrally managed, which brought further complications in management of the independent primary care practices. For instance, primary care specialists were only allowed to work for 40 hours per week and decide on their own patients’ schedule. This led to a loss of revenue for the hospital because these spaced were underutilized. The hospital needs to eliminate the wastes related to underutilization of primary care practices. The Lean CQI initiative would effectively address shortages, as the primary care practices explore ways to get back to profitability. Alternatively, Newland Hospital may adopt hoshin planning, as part of the strategic planning. Hoshin planning is ideal for reinforcing a customer centered approach in the planning phase. It is also instrumental in providing the organization a competitive edge, considering it is centered on satisfaction of client’s needs. Considering the referrals to the Newland Hospital could evoke a conflict of interest, patients being treated in the primary care facilities should be informed that these care practices have been acquired by Newland Hospital. This is the transparency that the hospital requires, as it is aligned to the ethical practices. It is essential for the management to adhere to the professional code of conduct, with emphasis on transparency and accountability to the patient. Therefore, it will be up to the patient to visit Newland Hospital for further treatment or visit another hospital of their choice. Indeed, Newland Hospital needs to align its vision and mission, underpinned in its commitment to helping physicians coordinate and work effectively; including addressing the problems that have impeded care, as this is a perfect way to return primary care practices to profitability.