Health System Issues: Return on Investment for Solutions - Term Paper Example

?RUNNING HEAD: Health System Issues Health System Issues: Return on Investment for Solutions BY YOU YOUR SCHOOL INFO HERE HERE Health System Issues: Return on Investment for Solutions Introduction The health care system is currently facing considerable inflation and budgetary problems at the local and funding levels. Ongoing governmental interventions continue to alter the scheme of health care delivery, however at the individual clinic and hospital level, problems with providing excellence in patient care continue to exist. Errors in medicine delivery continue to cause liabilities for hospitals, something considerably important in an industry that is often the target of malpractice lawsuits. Additionally, the organizational structure of hospitals often maintain problems in relation to redundant work behaviors and job roles for nurses and physicians that deplete efficiency in the delivery of quality health care. Finally, immigrant populations without access to adequate health insurance often put a strain on the health care system due to their reluctance to seek preventative care. Coupled with stereotypes and prejudices against immigrant citizens within the health care system, quality of relationships are also impacted between nurses and physicians and the immigrant patient. In order to improve and/or resolve these health issues, it is proposed to develop and implement several strategies to ensure less liability, improve immigrant health care services, and streamline efficiency within the organizational structure. The study takes a return on investment approach through cost analysis to determine the likely benefits of implementing new systems and processes to improve health care delivery. Liability and Structural Deficiencies The Institute of Medicine identifies that nearly one million patients are injured by medicinal errors and 100,000 patients die as a result each year (Hook, Pearlstein, Samarth & Cusack, 2009). Errors occur as a result of improper physician ordering of medicines, illegible documentation, and actual dispensing as a result of human error. The costs of adverse drug scenarios cost the health care industry, as a whole, two billion dollars every year (Hook, et al.). Some hospitals and clinics have developed training education that improves physician handwriting and analysis, however these errors continue to be a liability problem for executive leadership and impose concerns over job security for some health care professionals. In relation to organizational structure, hospitals have a difficult time today streamlining job function to avoid redundancies. This is especially important when the costs of labor continue to skyrocket in today’s recession economy. It is necessary to facilitate quality health care to have a structure where job roles are clearly identified and each activity as it relates to physicians and nurses is not superfluous and excessively repeated. For instance, when inefficient workflow occurs, patients can be over-medicated or the supply chain costs can rise significantly when over-use of hospital tools and medicines occurs. In order to avoid liability in patient medication and also improve job role function for cost issues, it is proposed to implement what is referred to as the electronic medical administration record (EMAR), an information systems architecture that provides for a paperless environment and is designed to facilitate more efficient work activities. A recent study of a small sampling of nurses indicated that in order to provide effective care, it was vital to have “smart, portable, point-of-care solutions to capture and share data, as well as routine communication” (Murphy, 2010, p.406). The nurses identified for the study believed the best way to reduce demand on time management was to improve inefficiencies in workflow and improve communications between themselves and physician staff (Murphy). The EMAR provides a new, virtual system of medicine ordering and dosing instructions, provides instant access to location of vital staff members involved in patient care, and serves as a communications forum to avoid redundant work activities. The improvements provided by the electronic medical administration record also improve patient care by reducing liabilities for medicinal errors and cost reduction in labor, supply chain, and training. The EMAR provides an electronic forum for the exchange of patient electronic records related to their name, allergies, any special dietary needs required, diagnosis and current medicine needs and dosing while a resident in the hospital. Errors and liability is reduced as nurses are provided with pre-printed EMAR forms each month with all of the patient information provided at the touch of a button. The proposed EMAR system works with the functionality of a digital pen that contains an infrared camera and a microprocessor that allows the nurse and physician to digitally sign a variety of patient-related documents. The pen functions and looks like a standard writing pen, however when nursing rounds are complete they need only dock the pen at a technology port where data is instantaneously transmitted to the EMAR database (Anoto, 2009). Further, rather than having nurses scan the internal environment in search of physicians for medicine ordering and dosing instructions, the electronic database can be equipped with a GPS device that gives instant location access of vital care staff to improve communications and avoid redundancies in the process. The EMAR provides the ability to share vital patient information to other internal and external entities, thus improving workflow and communications efficiency with important stakeholders. Other hospitals, employers, patients, insurance payers and ambulatory staff can be equipped with EMAR to ensure quality of care both before being admitted and after release (Garets & Davis, 2006). In relation to ambulatory care, the EMAR record provides knowledge of the patient immediately en route related to their allergies and current medicines to ensure that no interactions occur while being transported for emergency care. Training is facilitated through the use of this electronic system for a more efficient ambulatory and rescue system. Kuehn (2010) identifies that professional development requires more support in order to improve the role of nurse educator that should occur in the form of mentoring and peer review. It has already been identified that patients are at risk for improper care and ongoing medicine dosing errors that sometime occur as a product of inefficient work structure and job role identification. It is proposed to develop a 360 degree feedback system of review and training to improve nurse education and give executive leadership a clearer window of the individualized performance capabilities of hospital staff as it relates to pre-set organizational goals and standards. The 360 degree feedback system represents a low-cost methodology of improving communications between work teams and individuals and also gives a broader view of total job role function to executive leadership and mid-tier management at the health care facility. This system involves construction of a survey to peer groups, subordinates, managers, and sometimes even clients/patients as a means to report on individual performance (Garman, Tyler, Darnall & Lerner, 2004). Respondents report on their own experiences with co-workers or subordinate work teams and then this data is routed to the human resources division for assessment and analysis. Questionnaires and interviews are also utilized, but they must be structured with clear language appropriate for the job role, something essential for success in using this feedback mechanism (Carmichael, 2009). Utilizing the EMAR database, the questionnaire templates can be uploaded into the system for immediate access so that human resource managers can update or upgrade these survey or questionnaire forms in real-time as the need is demanded. The 360 degree feedback mechanism works efficiently as it provides not only information about nursing or administrative staff, it provides an entire snapshot view of the entire organizational staff related to their efficiency in providing excellence in patient care. Because it can be incorporated into existing systems (or into EMAR as proposed), it represents little in terms of cost to the health care organization. Immigrant Care Lack of insurance with immigrant patients, who now represent a significant margin of patient volume in certain regions of the country, leads to rising costs in the health care system at the local and national level. Children of immigrant workers who are not provided health insurance in their workplace, as one example, are three times more likely to not seek preventative health care and will not see a physician until their health problems have worsened (King, 2007). Preventative care often has the ability to ensure the illness does not become a health crisis and thus reduces labor costs of immigrant care and also the costs associated with the supply chain. There are also liabilities attached to the hospital administration as those immigrant patients that do not maintain health insurance cannot be denied treatment and thus might never pay their bills after being released as residents or after seeking general care. Further, Hispanic immigrant workers are often provided high-risk jobs that require little skill and this immigrant group experiences a much higher volume of traumatic injury on the job; thirty-three percent more than the domestic U.S. worker (Molina, 2011). In these high-risk job roles, health care is often not provided as part of their employment agreement and their pay is too marginal to afford quality health insurance (Molina). Because of the status of Hispanic immigrant job roles, they often experience prolonged recovery times from traumatic injuries and require more intensive physician care. To improve this situation and avoid long-run costs of higher supply chain costs and labor, as well as further reducing cost liability, it is proposed to develop a system of transportation funded by the hospital as a means to motivate seeking of preventative care in immigrant populations. “Access to transportation can improve health care use, especially in non-urban settings” and some self-reports from farmworkers have offered that poor access to transportation serves as a barrier for seeking health care preventatively (Hoerster, Mayer, Gabbard, Kronick & Roesch, 2011, p.687). The authors indicate that the provision of transportation or the use of mobile clinics maintains the ability to improve the health status of immigrants and improves motivation to seek preventative health services. The long-run benefit of this proposed strategic plan is to ensure less demand on the supply chain for intensive treatment of immigrant workers and also build a higher sense of corporate social responsibility perceptions in the local community where the health facility operates. This improves liability, a quality investment considering the strategic imperatives of liability reduction in key operating and cost areas. Cost/Benefit Analysis The implementation of the EMAR represents a higher one-time cost for development and implementation. As with most information technology projects, it will require dedication of a workflow project team to identify key roles and how communications occur within the hospital facility. This team will serve as a champion for change and also as a taskforce to ensure that a structured workflow of all activities is developed to assist in building the IT architecture needed to support more efficiency and reduce medicine dosing and instructional errors as it relates to the patient. The costs of implementing both the EMAR and the GPS system are estimated at $1 million. However, in a single liability suit involving patient death or injury due to malpractice claims, this EMAR system maintains the ability to pay for itself immediately upon implementation if quantitative data indicates that errors have been reduced and liability claims against the health care facility have dropped. The calculation for return on investment for this project involves the following equation: ROI = Operating Income/Operating Assets The operating income for the hospital fluctuates based on demand, supply chain demand for medicine and other treatment tools, and patient volume. However, under the assumption that operating income exceeds $50 million, the EMAR serves as a $1 million asset that is tangible indefinitely until technology needs require replacement. It is expected that the EMAR implementation will be a vital tool until at least 2020. Thus, it is clear that the investment analysis identifies this as a riskless technology need that supersedes its one time cost of labor and technology support for development. The 360-degree feedback system will require a one-time, kick-off introduction to the utilization of the feedback tools that will require a very small labor investment in training and human resources support. Since these tools will be housed on the EMAR system, all physicians and nurses will already be privy to training on this system as part of the strategic implementation, thus another strategy with minimal risk and costs. The EMAR provides for a paperless environment and if this system is coordinated with the intranet already in place at the health care facility, it can be a self-service model to assist human resources in time management burdens. The benefits of this system are a reduction of employee turnover, improving job role efficiency and productivity, and as a reward/discipline system based on quantitative and qualitative feedback. In this case, this strategic implementation will require only a new compliance policy development and one-time training on access and utilization. Human resources will take the champion lead, thus requiring no new labor expenditures. The transportation system for immigrant care will consist of a transit terminal operated by ambulatory staff already trained in dispatch operations, thus another strategic implementation with no labor investment. Training will be provided on maintenance teams already in place for ambulatory services and dispatch to ensure accuracy and timeliness. This system can also be promoted, at low cost, in local newspapers for access to other struggling citizens that require preventative care but have no access to quality transportation. Implementation of two daily operating small passenger buses will be purchased at an estimated cost of $50,000. Currently, the budgetary demands related to supply chain for immigrant services exceeds this cost exponentially and also maintains liability due to governmental regulations that inhibit the ability to refuse treatment to those who do not maintain health insurance. Thus, there is always an element of risk that high-dollar services for care and treatment for those who could have sought preventative care and now do not intend to pay their hospital bills. It is a one-time purchase that will require additional labor support in the form of two employees who will operate the new transportation system from 9am until 5pm Monday-Friday. The administration believes that the implementation of this transportation system maintains the ability to improve competitive position in the community through more responsible CSR activities. The benefits are more patient volume for those selecting this health care facility for its innovations and support, thus improving revenues over time. Liabilities are reduced in the process of operating a transport system that can be further developed, over the next year during testing, into a mobile health facility to improve revenues with mobile care delivery. This will be piloted based on the demand and success of the new transport services. Conclusion As identified by both the literature and the cost/benefit analysis for return on investment, the implementation of the EMAR system maintains the most viable solution for improving patient care and reducing liability. Combining technology services and ensuring training is conducted all at once rather than as an ongoing burden to administration provides new knowledge exchanges and improves organizational efficiency to avoid redundant job role activities. The cost analysis of these proposed solutions has identified that blending these approaches using the same methodology has long-term benefits that far exceed the estimated $1.1 million dollar expenditure. Reduction of medicine errors, alone, has far-reaching, positive implications over the short- and long-run for malpractice suit reductions. Coupled with a more appropriate human resource system to measure productivity and efficiency, there is little risk for implementing the solutions. References Anoto. (2009). “Improving Medication Administration Records”, p.2. Retrieved July 3, 2011 from http://www.e-infomax.com/case_studies/InfoMax-DigiMAR%20Case%20Studies%20Final.20090526.pdf Carmichael, Mary. (2009). “An all-round Appraisal Success”, Human Resources, July, p.74. Garets, Dave & Davis, Mike. (2006). “Electronic medical records vs. electronic health records: yes, there is a difference”, p.6. Retrieved July 2, 2011 from http://www.himssanalytics.org/docs/WP_EMR_EHR.pdf Garman, A., Tyler, J., Darnall, J. & Lerner, W. (2004). “Development and Validation of a 360 Degree Feedback Instrument for Healthcare Administrators”, Journal of Healthcare Management, 49(5), pp.307-321. Hoerster, K., Mayer, J., Gabbard, S., Kronick, R. & Roesch, S. (2011). “Impact of Individual-Environmental-and Policy-Level Factors on Health Care Utilization among US Farmworkers”, American Journal of Public Health, 101(4), pp.685-692. Hook, J., Pearlstein, J., Samarth, A. & Cusack, C. (2009). “Using Barcode Medication Administration to Improve Quality and Safety”. Retrieved July 2, 2011 from http://healthit.ahrq.gov/images/dec08bcmareport/bcma_issue_paper.htm King, Meredith L. (2007). “Immigrants in the U.S. Health Care System. Five Myths that Misinform the American Public”. Retrieved July 3, 2011 from http://www.americanprogress.org/issues/2007/06/pdf/immigrant_health_report.pdf Kuehn, Mary Beth. (2010). “Creating a Healthy Work Environment for Nursing Facility”, Creative Nursing, 16(4), pp.193-197. Molina, Natalia. (2011). “Borders, Laborers, and Racialized Medicalization: Mexican Immigration and US Public Health Practices in the 20th Century”, American Journal of Public Health, 101(6), pp.1024-1031. Murphy, Judy. (2010). “Nursing and Technology: A Love/Hate Relationship”, Nursing Economics, 28(6), pp.405-408. Read More