Community Health Assessment - Report Example

Service Line Development: Community Health Assessment Part A A Risk Factors Identified Risk in its common usage refers to uncertainty or exposure (Holton 2004, p.2). The major risk factors identified in the assessment relates to the hospital’s ability to: satisfy the needs of the community in the areas that poses the greatest health risk; arrive at a consensus regarding priorities in a timely manner plan the successful development of the three regional centers specified within the five year period; obtain the necessary staff with the required skills required to provide the level of service that will make the hospital competitive; generate the income necessary to recover any capital investment incurred to develop a regional cancer center, a regional orthopedic center, and a cardiovascular center. A. 1.1. Trinity Community Hospital’s Ability to Satisfy the Needs of the Community The hospital is currently looking at three areas in which it can grow. They have developed a strategic plan that targets oncology, orthopedic, and cardiovascular care. These are medical health risk areas in which there is a demand for which ongoing specialist care. There is currently no cancer specialist practice at the hospital and so there is no track record in offering this service. Cancer is one of the leading causes of death worldwide. The figures suggest that there will be demand for this service. A group of eight medical oncologists and two radiation oncologists has expressed an interest in developing a new cancer program. The other areas (orthopedic and cardiovascular) are also high risk as the older population suffers from fractures as a result of falls and cardiovascular diseases which are linked to other medical problems. A. 1.2 Ability to Arrive at a Consensus in a Timely Manner The Trinity Hospital Board members have divergent views. The risk is that they may not be able to arrive at a consensus in a timely manner. While there is the feeling that the services required will help to attract new businesses to the area there are others who believe that it is best provided privately. A. 1.3. Successful Development of the Three Regional Centers within the Time Specified The development of these centers whether individually or together will require proper planning. These are three separate projects and some of them may need to be broken down into two or more projects. There is the risk that the development of the regional centers will costs more than the initial projections and so the appropriate project management tools need to be utilized where necessary. A. 1.4. Ability to Recruit and Retain Obtain Qualified Staff In order for Trinity Community Hospital to be successful it needs to be able to recruit and train and retain good staff. It therefore means that emphasis has to be placed on human resource development and performance management. The hospital may have to pay its specialist staff more in order to obtain and retain the best skills in the service areas in which it wants to grow. It will also need to develop the areas that are complementary to these services. Information suggests that patients prefer competing facilities because they are able to offer a more sophisticated cardia back-up capability. A. 1.5. Ability to Generate Income to Cover Costs There is the risk that Trinity Community Hospital may not be able to recover its investment and ongoing costs. The projected capital investment for the regional cancer center would be $8,000,000. This would cover oncology center with simulator, linear accelerator, infusion suite, as well as for the renovation of vacant space in MOB 1. The margin expected is $1,337,000. The capital investment on the regional orthopedic center is expected to cost $600,000 if it is constructed on the campus and $700,000 if purchased adjacent to campus. Additionally, the expansion of the radiology unit in order to accommodate a second MRI will cost $3,000,000. The expected profit in relation to the orthopedic center is $2,171,500. In order to develop the cardiovascular center the capital investment would amount to $4,500,000 for two cath labs and $500,000 for the cardiac rehab expansion. The profit expected from the cardiovascular center is $3,625,000. The total capital investment on all three centers is expected to be $16,700,000 with an expected profit margin of $7,133,500 as shown in the Appendix. There is no information on how the projected earnings were arrived at and so there is no certainty that this will materialize. In addition to the uncertainties regarding the earnings, there is the question of whether sufficient funds will be available to carry out these investments and to carry out ongoing projects. There is $25,000,000 in capital reserve but this is only $8,300,000 more than the amount required for the capital investment. Additional costs resulting from project overruns need to be factored in. If the funds are borrowed then this further exposes the hospital to financial risk. It means that they will have to have funds on a monthly basis to make both interest and principal payments. Over the past two years net profit has fallen from $23,075,000 to 4,355,000 and then to $1,495,000 in the current year. This indicates that over the past two years things took a turn for the worst resulting in a decline in profits by over 81% last year and 135% in the current year. Over the three year period revenues fell from $461,500,000 to 435,500,000 and then to $427,000,000 in the current year. This represents a 5.6% reduction in the previous year and a 2% reduction in the current year. This means that a slight reduction in income can result in huge losses for the hospital. This is an indication that the hospital needs to do more than invest in order to generate more income. It needs to manage the funds that it has in its position as well as coordinate and schedule patient care so as to maximize earnings. The planned investment may not return the anticipated income and net margin that has been projected. There are a number of other competing facilities and only the nursing is highly rated. The hospital has a competent dedicated nursing staff that is committed to outstanding patient care. This is the hospital’s greatest strength and it needs more than that to turn around its operations. The hospital will need to demonstrate to the public that it will be able to provide excellent medical care if it is to compete successfully with the other hospitals. A. 2. Addressing the Needs Identified The needs assessment indicates that there are a number of issues that need to be addressed. There are insufficient oncology services to support aging population. The existing facilities and resources are woefully inadequate to prevent, diagnose and treat cancer and the rate of growth is expected to be 34% over the next 5 years. The community already needs additional linear accelerators, chemo units, operating suites, and advanced imaging equipment. The existing resources (physicians and facilities) will be outstripped by demand. The risk is that the existing facilities, equipment and human resources will not be able to handle future growth which is expected to be as high as 350% in the area of outpatient services in the next five years with orthopedic and inpatient cases expected to increase by more than 46% and 30% respectively. As a result of the expected increase in demand for oncology and orthopedic services, there is also expected to be an increase in demand for cardiovascular services. The demand ranges from 21.6% in relation to the expected growth in coronary artery disease, 22% for diagnostic cath procedures and 25.6% for anglioplasties growth of 26% . The hospital board has knowledgeable people but they have divergent views and in some ways are seeking to satisfy their own self-interest. Even though there is a member of the board who is adept in managing disagreements he does not appear to be effective as there is not always agreement on program priorities. The health care facility has sought to address the situation with regards to shortage of oncologists. The recruitment of additional physicians is currently being carried out. Additionally, State planning data confirms the need and has indicated that it is a priority. In terms of the requirements for orthopedic services state planning data has indicated that it exists. Although, it is seen as a priority there is no indication that any recruitment has started in preparation for this the forecast increases. Additional physicians are also being recruited for the cardiology and cardiovascular surgery groups and state planning data indicates that there is a need for these services. The number of patients that have been visiting the hospital has been declining and the hospital is losing patients to competing facilities. If the health care facilities are not up to standard then there is the risk that little or no new business will be attracted to the area. There is a downward trend in the utilization of the hospital. Part B Health Planning Summary The mission of Trinity Community Hospital is to serve the community in such a way that every patient receives the support and care that they require. However, for this to be possible a number of things need to be put in place. The hospital management needs to ensure that the existing facilities are properly managed and utilized to its fullest. One of the current priorities is to ensure that the current resources are used efficiently and effectively. It therefore means that proper coordination and scheduling of resources are of paramount importance. Additionally, patient care needs to be managed with the use of a scheduling system to ensure that appointments are properly scheduled in keeping with the resources that are available. The hospital needs more focused board members who have the interest of the hospital at heart. If the hospital is to achieve its mission then it needs to be able to satisfy all the health care needs of the community that it serves. Members of the board with competing interests, for example, Dr. Joint should be asked to resign as they will never be able to agree on matters of priority. In the area of oncology services the healthcare facility needs to place more emphasis on cancer prevention and control. This will both improve the outcomes and reduce the cost of providing these services. Greater emphasis needs to be placed on educational programs that promote lifestyle modifications to include diet, exercise, nutrition shopping for healthier food products, and smoking cessation. In the area of orthopedic service recruitment should be fast tracked to avert a major crisis in this area. The hospitals need to start acquiring imaging equipment, surgical suites, and rehabilitation capacity. Patient care coordinators are critical in order to avoid unnecessary back logs which would make the situation far worst than anticipated. It is also important that educational programs be prioritized in order prevent or reduce the level of accidents and to promote healthy lifestyles. Trinity Community Hospital needs to place emphasis on ensuring that sufficient human resources are recruited in the requisite areas. Plans should be put in place to provide additional cath labs, surgical suites, and cardiac rehabilitation capacity. In order to prevent a back log patient care coordinators will be required to ensure that the scheduling of patient appointments and staff to deal with them are closely monitored. Additionally, more emphasis needs to be placed on reducing the growth in the need for cardiology services by educating the community in relation to cardiac risk factors, healthy living, and lifestyle modification. These services are critical if patients are to obtain the support and care needed. If the hospital is to be successful the downward trend in terms of the number of patients served and the revenue and profits generated needs to be seriously analyzed. A marketing campaign needs to be developed as this would be critical to the success of the hospital. It would make no sense to develop these facilities without having the flow of patients required for efficient utilization. A project management plan needs to be done for the development of each of the three regional centers. This will include budgeting of costs for comparison and control of actual costs as the projects progress, planning for the resources required, and scheduling of human resources. The application of the appropriate knowledge, processes, skills, tools, and project management techniques can have a significant impact on the success of these projects (PMI 2008, p. 4). Additionally, various scenarios need to be analyzed in order to determine what the profit or loss with be under favorable, adverse and most likely situations. According to Heizer and Render (2006, p.4) all organizations perform three functions they include marketing, production (provision of a service in this case), and finance/accounting. Marketing helps to generate the demand for the service that the hospital provides and the accounting will record the receipts and payments as well as the income and expenditure. The management of receivables will ensure that less of the hospital’s revenue end up as bad debts. It is only when the revenue is actually collected that the hospital will be able to pay its bills. This means that the trend of the increase in the number of days for collecting receivables needs to be reversed. References Heizer, J and Render, B. (2006). Operations Management. 8th ed. New Jersey: Pearson Prentice Hall Holton, G.A. (2004). Perspectives: Defining Risk. Financial Analyst Journal: 60(6), p. 19 – 25 Project Management Institute. (2008). A Guide to the Project Management Body of Knowledge. 4th ed. USA: Project Management Institute Appendix Capital Investment Required Over the Next Five Years Description Cost Margin Cancer Center 8,000,000 1,337,000 Orthopedic center 3,700,000 2,171,500 Cardiovascular center 5,000,000 3,625,000 Total 16,700,000 7,133,500 Read More