Sanitary and Safe Working Conditions in Hospitals - Essay Example

Heart Failure Readmissions

Orlando Rivera

Chamberlain College of Nursing

NR712: Topics in Healthcare Systems Leadership

October 2016

Problem Area of Impact

Hospital readmissions due to congestive heart diseases or surgery related complications such as valvar disease, myocardial infarction, and arrhythmias impact significantly on the microsystem. Individual hospitals that performed the procedure on the patient shoulder the burden of treating complications arising after the surgery (Nohria & Desai, 2015). The individual hospitals are the microsystem in this analysis, while the health department financiers and the federal government assume the mesosystem and macro systems respectively. The different systems are affected differently, depending on their levels of engagement. Individual hospitals bear the greatest brunt as they directly incur the expenses of treating the readmitted patients. The health department financiers suffer the financial strain of funding the post-surgery treatment. The federal government on its part bears the overall stress of providing adequate funding for the scheme. The government also takes blame and criticism in instances of a shortfall. Significant input deserves to be made to the individual hospitals to invent ingenious methods of treatment that reduce the chances of readmission. Patients with conditions that may facilitate the development of further complications should be put on proper medication before and after the surgery to alleviate the levels of difficulties (Kiersma, Plake, & Darbishire, 2011). With proper preventive and treatment options, individual hospitals, adequate resource mobilization from the financiers, and appropriate policy and financial planning from the federal government, the three systems will adequately address the challenge of readmissions after heart surgeries.

A three-pronged strategy will be the most appropriate in addressing the challenge, by involving all the concerned stakeholders in the elaborate scheme. Focusing all the efforts on a single system will cripple the efforts of the other entities, leading to failure of the corrective procedures. Involving all the systems will promote a convergence of norms, practices, and standards in combating the challenge.

Strategies and Techniques

Financial constraints present the greatest burden of the discovery of an adequate remedy to the situation. It is against this backdrop that the corrective procedures and mechanisms will major on the most efficient financial management systems can adopt in handling the issue. On an overhaul scale, the concerned stakeholders need to conduct an economic appraisal of the entire medical scheme to identify potential pitfalls and bottlenecks that make readmissions prevalent and expensive to treat. Thus far, financial reallocation, staffing matrices, and the introduction of a culture of safety are the most optimal methods of taking care of the runaway situation.

Financial Reallocation

Monetary redistribution involves identifying the areas and population sets that are more susceptible to conditions that may warrant readmissions and channel more funds to those sectors. According to the Center for Disease Control (CDC), individuals aged above 65 years are more vulnerable to surgery complications such as valvar disease, myocardial infarction, and arrhythmias that necessitate readmission (Merley, 2014). The funding system can accordingly be adjusted based on the number of medical issues handled according to age sets. If it is apparent that given areas attract more elderly patients than others, it is imperative to dedicate more resources to those areas (World Health Organization, WHO Patient Safety, 2011). It is noteworthy that even though there is a strain on financial resources, some of the money allocated to given centers may not be exhausted while other areas fast deplete their share.

Staffing Matrices

Some of the post-treatment conditions arise out of unprofessional conduct by the staff and management of the hospitals (O’Brien, Paima, & Abaga, 2015). In some cases, laxity medical superintendents may fail to identify a medical condition in the patient such as diabetes or hypertension that may cause complications later. As a consequence, patients end up developing complications that warrant readmission. Inadequate staffing matrices that may lead to some medical officers overworking, a factor that contributes to the readmissions challenge (Desai, 2012). As a standard of operation, the health facilities must work on a proper staffing matrix that allows nurses and doctors adequate rest, enhance higher levels of professionalism, and promote efficiency in the workplace.

Safety Culture and Collaborations

A safety culture takes into account sanitary and secure working conditions that will promote efficient operation. In essence, a safety culture involves a plethora of actions that the hospital management can take into account to ensure that patients are comfortable in the course of their treatment (Okuyama, Martowirono, & Bijnen, 2011). Proper diagnosis and follow-up are the key measures that the hospital system can put in place to reduce the chances of readmissions. The safety culture also involves collaboration with care facilities for the elderly who may be persuaded to take up the challenge of taking care of the patients once discharged (Konstam & Upshaw, 2016). Based on their history with the patients, it will be easier to handle the issue and remove the burden and expenses from hospitals.

In essence, no single action will adequately solve the issue of readmission and the attendant financial constraints. However, a combination of the highlighted techniques and strategies, spread across all the systems, will be a good starting point in addressing the challenge. In the implementation of these optimal goals, all the stakeholders must be involved for coherence and better coordination.

Implementation Plan

In effecting the strategies mentioned above and techniques, all the stakeholders in the medical treatment must be involved. The key stakeholders are the individual hospitals, financiers, the federal government, and the general public. Despite their overall participation in the plan, the stakeholders play slightly varied roles and come into play at different scenes to achieve a collective goal. The financiers and the federal government must agree on a sufficient sum allocated towards the cause. Such an amount comes from a statistical and actuarial analysis of the number of cases presented every year, varying levels of prevalence, and any other emerging trends. Medical facilities must play a crucial role in adopting the safety culture and driving efforts to alleviate the suffering of patients in their care (Merley, 2014). The hospital management must ensure that all the working areas are sanitary. Besides, the health centers must work on an elaborate staffing matrix that enables adequate rest for the staff to optimize their performance (Gimenes & Faleiros, 2014). The general public too has a role to play in enhancing smooth operations. Through public information and sensitization, the public can benefit from information on the dangers of non-disclosure of information upon admission and the risks of withholding such information.

As currently constituted, the medical treatment scheme in the hospitals involves admission, treatment, and readmission. Medicare through the Centers for Medicare and Medicaid Services (CMS) meets the costs readmitted patients, except those whose complications arise within 24 hours of discharge or surgery. In the latter instance, the individual hospital satisfies the costs of such post-operative care as the incident is deemed to fall within their responsibility. Ideally, the hospitals lodge a bill of costs with the CMS for reimbursement of the expenses incurred.

The plan as presently constituted skips important details on safety culture and financial reporting. As the case is, the CMS pays on a need basis, currently constraints in proper financial allocation and planning. The gap existing on statistical and actuarial determination of claims make it difficult for the organization to adequately meet the needs of the patients and sometimes, the shortfall leads to instances of conflict with the respective hospital management systems. The flowchart below illustrates the claim process by the hospitals and the gaps that new systems seeks to fill.

CMS

Hospitals

Readmitted Patients

The new steps to address the challenge of funding to the hospitals undertaking readmission will take about 12 months to actualize fully. The first three months will be dedicated to statistical and actuarial determination and analysis to work out criteria for funds disbursement. Based on the results obtained, it will take another two months to work out a suitable formula for funds disbursement that takes into account the different levels of need by the respective hospitals. In the remaining six months, the stakeholders will test the workability of the plan, by assessing the number of readmission cases and determine if there is agreement with adopted strategy. Overly, the project seeks to reduce the financial constraints experienced in financing the readmissions in heart surgeries.

Your Role as a DNP-Prepared Leader

As a lead strategist, it will be my overall responsibility to see the coming to fruition of the program. In effecting change, I must be determined, persuasive, and visionary. A determination is critical in moving the agenda. At times, it may be difficult to approach different entities and try to persuade them to adopt a new idea. Often, one may meet resistance or criticism. Resistance kills the morale, and it may set one back some steps. It is important to persevere and see through the constraints that may exist.

A leader ought to be visionary. From my standpoint, I must be able to see the eventual result of the program. I should be able to forecast on what is likely to happen when I take some steps in the implementation process. The vision helps me to stay on track with the process and avoid any mishaps in the implementation of the new plan. The concept is also important in rallying my team members behind the course. It will also be considerably easier to sway the other stakeholders with a well formulated and defined vision.

Owing to the new the new territories that the program will chart, I will need to convince several stakeholders on the workability of the plan for it to sail through. Good persuasion skills will come in handy in situations where I am likely to encounter resistance, in particular on the development of a statistical and actuarial scheme to determine the amount of money allocated to the hospitals at any given time. Negotiations will also be crucial in dealing with stakeholders from the systems who may be opposed to the new plan. At times, it may require me to compromise on some stands to achieve consensus on various issues. However, the negotiations must not propose measures that will cause a deviation from the overall goal.

At all levels, I must impact on the members and influence them to adopt the new plan. While the scheme may look uninteresting at first, I will use various persuasion and motivational gimmicks such as devising a rewarding system for players who come up with awesome ideas on how the program can be rolled out. The desire to be gifted will rejuvenate the spirits in the other team players and motivate them to keep on the course. Occasionally, I will brainstorm the members to ensure that the project ideas remain implanted in their minds. Through these mechanisms, I will make sure that the spirits of the team players will continue to stay awake to the overall goal.

Measurable Outcomes

Various parameters such as customer satisfaction, clinical outcomes, and patient engagement scores indicate the overall success of the program upon implementation. Customer satisfaction derives from the declining number of negative reviews or the increased number of positive reviews. Satisfied customers often communicate their feedback through an evaluation system of increased number of referrals (Nohria & Desai, 2015). Depending on the number of positive reviews and increased number of patients visiting the facility, without the influence of other factors such as disease outbreak, is an indication of success. Also, based on the nurse and patient engagement scores, I will be able to determine whether the new program has any positive impacts (Hernandez & DeVore, 2015). Declining levels of conflicts or antagonism between nurses and patients indicates improved relations or at least, better working conditions.

Upon the implementation of the program, the patients will expect better treatment at the hospital. Besides, the patients will receive treatment promptly as there will be no qualms about non-reimbursement from the CMS. Overly, the program will improve relations at the medical centres and promote efficient service. Improved service delivery will translate to better reviews and increased referrals. As suggested by (Nohria & Desai, 2015), improved medical attention is the only sure way of revamping the health sector. Also, the move will improve the relations between the various stakeholders in the industry.