The document outlines an expansion proposal for a rehabilitation center. It discusses expanding services to better serve beneficiaries with disabilities or substance abuse issues through a patient-centric care model. This would involve streamlining services, improving quality, and cross-training staff. The proposal discusses assessing internal and external stakeholders, performing a SWOT analysis, and considering expansion costs, staffing needs, and competitive factors. It also addresses managing conflicts, ethical concerns, tracking quality improvements, and ensuring performance meets statistical goals as the facility expands its services and capacity.
3. Long Term Care Communication
Patient Centric Care Model
Technology Implementation
Performance Evaluation
Quality Assessment
4. Patient Centric Model
Streamline and Cost Reduction
Quality Improvement
Service at Point of Delivery
High-Volume and Low Risk Services
Cross-training
360° Feedback
5. Internal Stakeholders
Patient-Staff Relationships
Health Care Staff
Physicians
Nurses
Human Resources
Health Care Professionals
Managers and Administrators
8. Facility Expansion Strategy
Expansion Costs and Funding
Human Resources and Staffing
Salary and Placement
Capital Budget
Market Shares and Competition
Competitive Advantage
10. Manager’s Role in Conflict
Management
Assess Conflict
Identify Parties Involved
Analyze Issue
Evaluate Compromise or Resolve
Facilitate resolution meets organizational policy
11. Ethics
Tort Law
Contract Law
Medical Malpractice
Patient Self-determination
Power of Attorney and Guardianship
Beginning and End of Life Care
12. Financial and Human Resource
Sector
Budget
Equipment
Expansion / Renovation Costs
Hiring New Staff
Interview time and duration
Funding for new hire pay
Schedule and Deadline of Expansion
Training
Internal Applicants
14. Tracking Quality and Progress
Performance Statistical Evaluation
Statistical Process control
Rollout and Implementation
Continuous Quality Improvement
Six Sigma
Editor's Notes
Image from https://www.uhpa.org/campus-specific/educational-seminars-on-long-term-care/
Long Term Care is a dynamically expanding service with a dramatic increase in our aging baby boomers.
Long Term Care
* continues to grow due to an increasing rate of aging baby boomers
* 2030 67 million people over 65
number of people over the age of 85 also doubles due to higher life expectancy
We must engage in the high demand of services as an opportunity to expand our services in the community and improve care delivery and quality.
Patient value-based service is becoming more and more of a popular concept
Rehabilitation is a much needed service in a growing demographic of mental / physical disability, substance abuse and aging patient.
Health care expenditures in the US are very high due to higher demand in services and lack of funding or insurance especially for the elderly
Image from http://southbridgecarehomes.com/long-term-care/safe-caring-secure-long-term-care/
The Patient Centric Care Model demonstrates streamlining of care by efficient communication of teams and performance management. Continuous Quality Improvement is mobilized by monitoring staff performance and patient evaluation of services
Technological Implementation is also a competitive advantage for an efficient communication method of patient data/information, services provided, payee information, health history and many more. Quick easy diagnosis, prognosis times and physician and staff convenience
New medical technology that enhance care services, although expensive, they are a good investment for care quality and gain patient trust, secure long-term reimbursement.
Evaluating Staff performance and communicating accordingly between different levels of management and supervision, data can be delivered based on each department or units specialty and contribute to overall CQI
(Buchbinder 2012)
Image from http://www.aachonline.org/portals/36/Images/DocsAroundComputerRGB.jpg
Streamlining services will expand efficiency of services with team work fluidity and management of performance
Teams will be evaluated in performance by statistical goals being met or not
Teams will meet at least every two weeks to provide input with each others concerns, goals and coaching with emphasis in opportunities of improvement and progress.
Employees are rewarded for top performance and employees with opportunities to improve are placed in focus for more intrinsic reward/ motivation
Service at point of delivery enhances patient satisfaction and categorizing services when high volumes are ate hand by evaluating each priority patient
Differing departments/ units with unique specialties collaborate to provide broader perspective of improvement for overall organizational CQI
(Buchbinder 2012)
Patient-Staff relationships are the core of health care continuum and CQI
Physician-patient relationships
Availability
Relationships with Staff especially with Nurses
Pay and Efficiency of Services
Nurse Shortages
Nurses retire faster than the volume hired
Balancing nurse work hours
Job Burnouts
Overworked Nurses
Nurse-Patient Relationships
Human Resources
Determine time needed to acquire sufficient amount of staff and if budget friendly
Training of new staff adds to cost
Approval and Eligibility Evaluation
Hiring support care staff such as Respiratory Technicians, Surgical Technicians etc.
Managers and Administrators
Execute, Control and Monitoring Performance standards and quality improvement, reassures stakeholders of expectations, capital, market share, and revenue management, strategic planning for continuous organizational survivability
Evaluation of efficient pharmaceutical drugs and cost of surplus purchases
Return of Investment statistics
Adhere to government regulation and policies to standard expectations and performance of organization for Medicaid and Medicare Coverage
Manage documentation and electronic communication of patient insurers especially those provided by employers.
Consumer Advocacy Groups
payees assure safe, convenient, low-cost and high quality care provided by organizations that are funded.
insurers have also implemented pay-for-performance programs based on various quality and customer service measures.
Ensure organizational performance meets partner funding expectations such as partner hospitals and organizations.
Figure above from Buchbinder’s Intro to Health Care Management shows the essential components of strategic health care planning that constitutes the fluidity and efficiency of a plan.
SWOT Analysis
Market assessment
complex and time consuming
opportunities and threats
Five Forces Model
Power of the Healthcare Workforce supply and demand of healthcare providers
Power of Consumers and Payers focus on patient-centric model, community needs, payer expectations and desired results.
Technological Innovations Picture archive Communication System film imaging system reduce need for staff and increase in cost.
Regulatory Environment liability reforms and care quality measures as influenced by medicaid and medicaid as well as care acts and other payers.
Competitive Rivalry addressing competitive intelligence in monopolies and oligopolies and determine strategy to efficiently respond to organizational threats
Determining costs of new staff pay, training, equipment, renovation costs.
Approval of funding and capital budget
Determining quality equipment, staff and construction resources with a reasonable budget that won’t sacrifice quality.
Expected Revenue and current reimbursement rates
Determining areas with opportunity of improvement
Current statistical performances
Competitive advantages
Opportunities of advantage in the Market and Market Share / Value
Determine method of marketing and promotion of services
Overall cost internal and external improvements
Conflict in the health care setting may not only impact the productivity and morale of the disagreeing individuals (e.g., physicians, nurses, technicians, administrative staff members),4 but also negatively affect patients and their family members if they interact with a demoralized or dis- enfranchised team member.
Conflicts arise from
Differences whether large or small
Disagreement in values, motivations, perceptions, ideas or desires
Trivial differences, Strong emotional influence from a deep personal need
These needs could be to feel safe and secure, to feel respected and valued and for greater closeness and intimacy
- ameliorate potential impact on patient care and safety
low-intensity minor disagreements and high-intensity sabotage, litigation and all out war
Trades of agreement and facilitation of managers
(Simpao 2013)
Image from http://conflictconsultantsnetwork.com/wp-content/uploads/2013/10/healthcare.jpg?width=127
Managers must influence a positive example on how employees can resolve conflicts especially when there’s a conflict of interest or involving organizational quality or improvement. Assessing the conflict is essential so as to avoid presumptions and allow each involved party to have an equal opportunity to assess their concerns when not emotionally compromised.
Analyzing the issue and determining compromise or trade while facilitating that such exchanges meets organizational policy are essential
Simpao suggests there are 5 ways to resolve conflict
Competition
Avoidance
Compromise
Accommodation
Collaboration
To successfully resolve a conflict, you will need to learn and practice two core skills: the ability to quickly reduce stress in the moment and the ability to remain comfortable enough with your emotions to react in constructive ways even in the midst of an argument or a perceived attack.
• Understand what is really troubling other people
• Understand yourself, including what is really troubling you
• Stay motivated until the conflict is resolved
• Communicate clearly and effectively
• Attract and influence others
Tort Law regulates health care services an plays a very important role in conducting long-term care. Applying restrictions and policies are essential in running a fluid progress of expansion to avoid violation of government restrictions.
Tort and Medical Systems Reform
Negligence must be proven with root of causation
Intentional Tort (assault, battery, false imprisonment, defamation of character, privacy invasion
Infliction of Mental distress
Health Care Power of Attorney HCPA/ Guardianship
health care decision and full guardianship of patient
ethical dilemma in how much families should spend or should they utilize patients assets to pay for care
conflict between providers and guardian
Patient Self-Determination
Patients have ever right to decide whether to accept or deny care
Otherwise can be decided by guardian if patient is unable to decipher comprehensively e.g. paralyzed, coma, dementia etc.
(Buchbinder 2012)
End-of-Life Decisions
physician directives
living wills
HCPA
allows patient to decide on wish concerning ventilators assistive cardiovascular device, feeding tubes, pacemaker etc.
death with dignity
how a chronically ill person is treated are based on the values of the country.
(Austin and Wetle 2012)
Budget can affect the quality and availability of newly hired staff
Determining new equipment costs and reliable vendors will have time and monetary investment needs as well
Expansion and construction costs will depend on services acquired and vendors
Realty agreements and reassuring government regulations of health care facilities and long-term care
Hiring new staff will also add costs for training new staff with those who have experience since facility is originally short-term care
Staff time investment of training will need strategic planning of how each team can efficiently communicate progress with trainees and executing organizational expectations of performance and productivity.
Since the passing of Medicaid and Medicare
national health expenditures of GDP has increased by 6.3% 1960 to 16% in 2004 $6,289 per person. By 2009 GDP increased to 2.47 trillion or $8046 per person, 2013 3.02 trillion at $9505 per person. National Health Expenditures
(Austin & Wetle 2012)
More physicians are retiring than the count of physicians graduating
Outsourcing IMG’s are partially sufficient especially at MUC’s but not enough to serve the growing rate of aging baby boomers
Longer life expectancies from advancing medical technology and health improvements
Patient privacy and trusting a new facility can be a challenge
Demographic of the community must also be evaluated on the diversity of patients and cases to be served.
Future Directions in Health Care Delivery
rise of cost and demographics
expansion of medicaid and access to purchase of premiums can increase patient count
instead of having patients transferred from one facility to the other in order to balance staff shortage
(Buchbinder 2012)
Stakeholder Determinant of Quality Assessment
Technical Management clinical performance of HC providers
Interpersonal Relationship Management coproduction care by patients and providers
Amenities of Care patient in interest in individual well-being
Ethical Principles providers autonomic interest in societal and organizational well-being
health service quality is driven by both clinical and nonclinical processes
Effectiveness providing services based on knowledge to those that benefit and can refrain from this not likely to benefit
Efficiency avoid waste in equipment, supplies, ideas and energy
Execute Six Sigma
SIX SIGMA
resource intensive tool
best applied to important costly issues in key processes
employee structured process called DMAIC
Define
mapping future organizational states, delimiting work scope
Measure creation of metrics and application of determining progress
Analyze breakdown of understanding process (flowchart)
Improve specifies steps needed to achieve define step
Control ensuring improvements are continuous or permanent
(Buchbinder 2012)
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References
Buchbinder, S. B., & Shanks, N. H. (2012). INTRODUCTION TO HEALTH CARE MANAGEMENT. Jones and Bartlett Learning.
Simpao, A. F., M.D. (2013). Conflict management in the health care workplace. Physician Executive, 39(6), 54-6, 58. Retrieved from http://search.proquest.com/docview/1492870510?accountid=35812
Anttila, K., & Moss, T. (1999). Eight steps to effective health care communications. Compensation & Benefits Management, 15(2), 31-37. Retrieved from http://search.proquest.com/docview/206606093?accountid=458
Jerry D. VanVactor, (2012) "Strategic health care logistics planning in emergency management", Disaster Prevention and Management: An International Journal, Vol. 21 Iss: 3, pp.299 - 309
Austin, A., & Wetle, V. (2012). The United States health care system, combining business, health, and delivery. (2nd ed.). Upper Saddle River, NJ: Pearson Education.