Cooper Green Hospital and the Community Care Planning - Case Study Example

Case Study: Cooper Green Hospital Executive summary The new Community Care Plan (CCP) clinics introduced by Cooper Green Hospital in Birmingham, Alabama are failing. Membership is inadequate and the clinics are costing too much money. At the same time their funding is coming to an end. This analysis proposes that rather than abandoning the program or leaving it to a slow death, a vigorous expansion program be undertaken. At the same time a new two-pronged marketing strategy designed to garner institutional support for the program from key government and funding partners accompanied by a grassroots promotional campaign to increase awareness of the program among the target population of Jefferson Countys indigent must be rapidly introduced. Finally, the expansion of the program has to be driven by an individual other than Dr Max Michael the originator of the program. He he has neither the promotional, organizational or social skills needed to develop a team that can effectively realize the cost benefits to service providers and time and convenience benefits to CCP members. *Key issues This case presents a series of key issues that, traced backwards, draw out the essential issues. The presenting issue is a lack of revenue: Start-up funds are terminating and the program is not yet self-supporting. The program is not yet self-supporting because it does not have enough paying participants. Therefore, the program needs more members, paying more membership fees to become self-supporting (or, ideally, profitable). The key issue in this case is promotional. One might be tempted to say marketing, but promotional is more accurate. Individuals to not need to be persuaded to buy membership in the Cooper Green Hospitals Community Care Plan (CCP) clinics. The problem is actually much more fundamental. They need to be made aware that the option exists. The case indicates that potential members have not made a choice not to join a CCP but rather, for the most part, were never aware that they had the option, of what the option entailed, an of what the potential benefits were. It is in this sense that the key issue is promotional. The symptoms are financial losses and low membership but the key issue is promotional: The target client group is largely unaware of the availability of the service. They lack the information necessary to say yes to CCP clinic membership. A lack of promotion is also evident on an entirely different level. The employees seem to enjoy working in the CCP environment and be motivated. However, the same cannot be said about their bureaucratic and political masters. The CCP program offers quicker, less expensive and more-effective care to the residents of Birmingham and Jefferson County. The program should have advocates at all levels of government, particularly Medicaid and Jefferson County. This broad-based institutional support is not evident in the case and, again, it is attributable to poor promotion: No bureaucrat and no politician would oppose quicker, less expensive and more-effective healthcare. The lack of support is only because a passionate advocate has not sold them on the benefits. Promotion, on two distinct levels is the key issue underlying the problems at CGHs CCP clinics program. Neither institutional allies nor potential members are aware of the unique benefits the program offers. *Situational analysis: External Environment In this case the situational analysis is very straightforward. The program is struggling. It has no competition for its target group (one of the advantages of an indigent client base!). Coverage of the area (Jefferson County) is adequate as the maps and charts in the case demonstrate. That said non of CGHs geographically proximate facilities target CGHs client group – the poor and indigent- and, therefore, they do not constitute direct competition. *Situational Analysis: Internal Environment The CCP program is extremely cost-effective. It saves consumers the hellish experience of a long emergency department wait and offers earlier, more effective intervention saving the healthcare systems resources and maintaining the consumers health rather than intervening, late, in a crisis. Even the employees enjoy the experience. The latter is an important point as, overall, CGH has many problems with organizational culture and employee commitment. Many of the employees of CGH see themselves as bureaucrats rather than service providers and their commitment to customer service is limited to say the least. Internally, the CCP program is supported by employees, provides cost-effective health care for the poorest segments of the population in the county and has the potential to be profitable for the hospital. *Situational Analysis: Directional Strategies Briefly, the situation is unusual. A cost-effective program that offers consumers quality of life and convenience benefits, and operates without any competition is failing despite high-employee morale and reported job satisfaction. Moreover, it is a program that is a perfect fit for the hospitals mission, “to provide access to preventive and routine medical services to the population traditionally served by Cooper Green Hospital: the poor and uninsured of Jefferson County.” *Strategy formulation The case early on succinctly outlines the three possible strategies through Dr. Michael internal dialogue: “Push forward with expansion plans for the hospitals Community Care Plan (CCP) clinics.” “Maintain the clinics that exist.” “Fold the program all together.” An argument for each strategic alternative can be made. Proponents of the termination of the program will argue that it will staunch the flow of red ink. While CCPs may have seemed like a great idea in theory five years of hard work has demonstrated that they will not work on the ground. Advocates of the status quo will argue that the five year pilot clinics project should find alternative funding sources. They would argue that the CCPs are an integral element of CGHs range of programs although they had not been as successful as projected. Boosters committed to the project such as its initiator Dr. Michael might favor expansion. They would agree that the that the CCPs CCPs are an integral element of CGHs range of programs. They would also argue that the CCPs need to reach a critical mass before they will become profitable (or even cost neutral) and that expansion is the key to turning around the financials. *Recommendation Dr. Michael would be correct that expansion is the correct strategy. However, it could also be argued that he case demonstrates that Dr. Michael is not the correct man to lead this expansion. Under him the program is still struggling after five years. One clinic was so poorly located it had to be closed after gang and criminal incidents. Significantly, “few people knew about the CCP and even fewer had joined.” He has not been an effective advocate for the program. Finally, he seems to have had trouble developing a team. The potential cost benefits of this program should have county officials on board and hospital funding agencies supportive. The union should be excited to see new employment opportunities possible (and better working conditions as CCPs absorb some of the burden from emergency rooms). Finally, the media and public should see the initiative as a wonderful example of fiscal responsibility (cost reductions) and humanistic, patient-centered care being delivered to the most socioeconomically disadvantaged segment of the population. The case provides no evidence that Dr. Michael has been able to develop this popular positive awareness of the plan. Casting no aspersions on Dr. Michael he is not the right man to oversee this aggressive expansion and promotional effort. *Implementation strategies Establish a broad-based expansion steering committee not chaired by Dr. Michael, with extensive stakeholder connections and awareness. In tune local connections with local community and neighborhood groups might have prevented locating a clinic in a location subsequently deemed unsafe. Neighborhood groups can spread the message verbally to targeted populations. Analyze geographic options: Intensive expansion of new clinics in a target area or extensive expansion throughout the hospitals catchment area? This is the first decision the committee must make. All levels of government can be brought onside by the economic argument, it is a cost effective way to care for the residents of Jefferson County, regardless of their ability to pay. Every agency distributing income support, disability and educational benefits in the areas serviced by the CCPs must be actively promoting the clinics to their recipients. In an ideal, and not impossible situation, their membership fees could be deducted, with the recipients approval, directly from their benefit check. Cooperation and coordination with Medicaid is essential for all of the above reasons, also. Therefore, representatives of government must be included in the steering committee Literature has been ineffective in spreading the word. Distributed through the CCPs, only users receive it, and it is rarely deemed relevant or appropriate. Program literature needs do be rapidly revamped to meet the needs of the target populations. It then has to be delivered to the target population through community groups, housing authorities and other organizations in the catchment area communities. Local media, billboards and a host of other promotional avenues also need to be considered. A marketing firm familiar with the target population and accustomed to working with community organizers needs to be engaged to (quickly) come up with an effective strategy for grassroots marketing of the program paired with complicated, financial presentations to government agencies and funding partners. A sophisticated marketing organization with these specific capabilities will earn its consulting fees through increased enrollment. Also, and painfully obviously, this material needs to be distributed in the emergency rooms of CGH and to all discharges living in the catchment area of CCPs. A person who has just lost a days pay and spent eight hours in an emergency waiting room will be open to the message that a faster and less inconvenient alternative is available through membership in a CCP clinic. There is no evidence that case subject Martha James received any information about or encouragement to join a CCP during her emergency room odyssey. This despite the fact that Dr Michael dealt with her personally. (His unawareness of the golden opportunity to sell his program that Martha James presented is further evidence of Dr. Michaels promotional and social ineptitude.) After her bad experience she would have been attentive to a message about a faster, more convenient CCP. *Benchmarks for success and contingency plans Direct, objective and easily measured financials are the bottom line for this expansion plan. The clinics have to become self-supporting. This means that each has to achieve a membership level of 1,000. This is a minimum as the physical expansion of the number of clinics, coupled with the re-engineering of the awareness and promotional campaign, will add costs. Therefore, it is reasonable to posit that each clinic must have 1,200 members to break even. A second set of benchmarks could be developed quite inexpensively and to the highest standards and most intense rigor through cooperation with University of Alabama. The CCP pilot is a unique project. As such the University of Alabama, School of Public Health (http://www.soph.uab.edu/) would be a perfect research partner. The School of Public Health specializes in health behavior – “Students learn state-of the-art techniques and methods for health program evaluation” and health care organization and policy – “rigorous training in research methods and evidence-based public health practice suitable for careers in public health leadership, or academic settings.” (http://www.soph.uab.edu/departments) The CCP would provide grist for gradate student research while CGH would benefit from the scrutiny and move into the future informed by the results. Importantly, qualitative research into client satisfaction and motivation, circumstances of joining and other issues not addressed by membership or financial figures could be collected. Sources University of Alabama, School of Public Health. n.d. http://www.soph.uab.edu/. Retrieved 16 August 2010. University of Alabama, School of Public Health. “Departments”. n.d. http://www.soph.uab.edu/departments. Retrieved 16 August 2010. Read More