In this case, the patient was a 26-year-old man with an inborn disorder the absence of the fifth toe on his right foot. Annual checking was recommended for this outpatient. At the moment of evaluation, no pain or walking challenges were reported. The examination proved that the right foot looks smaller compared to a normal foot. However, in general, the patient felt well, and the only recommendation was to continue annual checking and observing changes if any.
Pathology
Oligodactyly is an inborn (congenital) disorder when one of the toes or fingers are absent.
According to Mulyana and Sulaeman (2016), this condition is characterized by psychological challenges.
According to Kantaputra and Carlson (2019), this condition is defined as split-hand-foot malformation (SHFM).
An inborn disorder when a person has fewer than five toes on a foot is known as oligodactyly. This physical malformation is not a frequent condition, still, many people around the globe suffer from it. For example, Mulyana and Sulaeman (2016) admitted that oligodactyly is not just a disease with physical problems but an illness that is characterized by psychological conditions and challenges human relationships and interactions. Kantaputra and Carlson (2019) gave another definition to the absence of a toe or a finger, saying it as split-hand/foot malformation (SHFM) that affected the central rays of hands or feet. In general, the absence of one toe that does not result in walking disabilities is not a serious health problem but a psychological issue.
Imaging Techniques and Treatment
Images:
X-rays (AP projection, 50-55 kVp, 2-4 mAs).
Treatment:
Physical therapy to strengthen foot muscles;
Surgery to use a prosthetic limb replacement.
To control physical changes and prevent complications, X-rays are recommended with such characteristics like AP projection, 50-55 kVp, and 2-4 mAs. In this case, the patient is assessed annually to predict the development of negative psychological changes and control the physical growth of the foot, as well as its functions and abilities of the patient. Regarding the fact that no pain disturbs the patient, physical therapy is recommended to strengthen the muscles of the foot. Another option is a surgery that is offered for patients who are ready for a prosthetic limb replacement. This procedure is not cheap, and not many people may allow it without involving additional funding.
References
Kantaputra, P. N., & Carlson, B. M. (2019). Genetic regulatory pathways of splithand/foot malformation. Clinical Genetics, 95(1), 132-139.
Mulyana, D., & Sulaeman. (2016). People with lobster-claw syndrome: A study of oligodactyly sufferers and their communication experiences in the village of Ulutaue, South Sulawesi, Indonesia. Mediterranean Journal of Social Sciences, 7(1), 136-144.
Change in clinical practice encompasses incremental improvement in care quality or personnel capacities by training change agents, reconfigurating clinical processes, and adopting new models of care. A renewed focus on quality and safety, an aging population, novel payment methods, and the development of innovative treatments provide an impetus for transforming healthcare. Therefore, meeting patient needs, improving outcomes, and attaining better value for patients are the key factors driving change.
Purpose of Consultation and Overview of the Consultation Process
An objective assessment of a facilitys processes and systems identifies areas that need to change. The purpose of the consultation was to determine an improvement needed within the organization (Direct Care and Treatment/Community Based Services (DCT/CBS) of Minnesota Department of Human Services (MDHS) and give a consultative change recommendation. External metrics, including patient outcomes and community needs, will inform the recommendation.
A nurse leader serving as the Health Service Director in the CBS division of the DCT was selected and interviewed to generate data for the analysis. The face-to-face interview focused on a broad range of topics, including her role in the organization and its goals and quality improvement efforts. Among other issues discussed were DCTs mission, strength, weakness, opportunities for improvement, and initiatives to enhance patient safety. Additional data on the staff population, leadership structure, and services provided were collected from the organizations website. Key community needs were also identified through the same process.
Organizational Analysis
Description of Organization
MDHS operates institutional services for persons living with disabilities using the community-oriented model. MDHS is a public health department that seeks to address diverse health needs across Minnesota through its many divisions and programs. MDHS has three main offices in the Twin Cities metro area but has seven other campuses in Bemidji, Duluth, Fergus Falls, Mankato, Marshall, Rochester, and St. Cloud ( 2018-2020 Agencywide Strategic Plan, 2018). These offices house the different MDHS divisions, bureaus, and programs, including the DCT/CBS.
The MDHS includes many department and county agencies involved in healthcare and social services. The estimated number of employees is 3,600 working in different divisions and programs (Minnesota Department of Human Services, 2020). The number of patient encounters is not indicated, but the agency serves all the Minnesota population. The CBS program targets persons with disabilities in the community (approximately 593,700 people) through its distinct service lines focusing on foster care, family support, residential treatment, and vocational training. The estimated number of patient encounters is not indicated on the organizational website, probably because of the multiple service lines available. The CBS comprises seventeen vocational sites, four crisis homes, nine mobile support groups, and about 120 foster care facilities ( DHS-Operated Community-Based Services, 2018). Thus, the number of patients or communities served is quite large.
The leadership structure of MDHS recognizes four bureaus organized according to different functional lines. They involve the health protection, improvement, systems, and operations headed by assistant commissioners (Minnesota Department of Human Services, 2020). This executive leadership also includes the MDHS commissioner and his deputy, who provide oversight on all health-related issues in the state. The bureaus comprise eight divisions that are headed by directors that report directly to the assistant commissioners.
Details of the MDHS service area, such as size, age, and demographics, could not be found on its website. They may be privileged information that is not available to the public. The MDHS provides a broad range of services, including individual and family health (vaccinations and birth records), behavioral treatment, insurance, and preventive care (Minnesota Department of Human Services, 2020). Specifically, the MDHS-operated DCT/CBS program contains three service lines: community support services, intensive therapeutic homes, and residential and vocational services.
Primary Needs of Population
The MDHS, through its DCT/CBS program, serves the entire state of Minnesota. The overall size of the area served is 225,181 kilometers that comprise 87 counties and 852 incorporated cities (Minnesota State Demographic Center, 2020). Thus, MDHS serves metropolitan and rural communities throughout this area through its diverse programs. The states demographics include 83.3% White, 6.2% African American, 4.8% Asian, 1.1% Native American, and 0.04% Pacific Islander (Minnesota Department of Health [MDH], 2019). The elderly population is relatively high in Minnesota, presenting another public health challenge. Over a third of the people in metropolitan areas and about 6% of those in rural locations are above 50 years, and 11% of the states population includes persons with disabilities (Minnesota State Demographic Center, 2020). The unique needs of each population group call for tailored interventions and programs.
The primary health risks present in the population relate to ethnicity, poverty, age, substance use, and poor diet that lead to a high incidence of non-communicable diseases and disability. The minority groups African Americans, Asians, Native Americans, and Pacific Islanders are likely to have poor outcomes in education, socioeconomic status, and health compared to Whites (MDH, 2019). These health disparities lead to a high burden for overweight and related diseases such as cancer, diabetes, and mental illness in these communities. Minnesota obesity rate stands at 30.1% compared to a national average of 30.9%, with the low-income and minority groups experiencing the highest risk ( Obesity Quick Facts, 2020). These communities live in poor neighborhoods with a high concentration of unhealthy food options and limited physical exercise opportunities.
The high elderly population is also another public health concern in Minnesota. Aging is a risk factor for fall-related injuries and disability in the state (Burns & Kakara, 2018). This communitys health risks impact MDHS spending in healthcare programs with a health budget for obesity standing at $3.2 billion annually ( Obesity Quick Facts, 2020). The high demand for preventive care, mental health, and treatment and support for developmental challenges and chemical dependency increase care costs, strain healthcare resources and providers, and limit outreach services.
Nurse Leader Interview Summary
Role of the Nurse Leader
An interview with the Health Service Director was conducted for this analysis. She revealed that her role within DCT/CBS is similar to that of the Director of Nursing or Nursing Supervisor at a facility. The director has significant formal influence within DCT/CBS derived from her primary responsibilities. She supervises all staff and develops evidence-based policies and procedures that guide practitioners in providing healthcare. Her role aligns well with The Essentials of Masters Education in Nursing. Specifically, Essential IX recognizes nursing practice at the masters level as interventions that influence health outcomes for individuals, populations, and systems (American Association of Colleges of Nursing, 2011, p. 5). The integration of knowledge into practice, which is required at this level, is seen in her development and implementation of evidence-based policies and procedures. She is also responsible for designing organizational systems that meet priority population health needs supported by DCT/CBS using community resources, espoused in Essential IX.
The breadth of the directors influence also extends to quality improvement (QI) efforts initiated under the DCT/CBS program. She ensures that all QI projects meet practice standards and include evidence-based practices informed by patient/community-oriented care. As a nurse leader, the director is well-versed with issues shaping current healthcare systems; hence, she collaborates to develop a long-term strategic plan that includes specific goals related to strategic planning and implementation. Some of these include creating safe, respective, and positive environments for staff, fostering a person-centered culture at the organization, building a shared vision with community providers to increase resources and support for people served by CBS, and merging different service-line policies (MSOCS, CSS, MLB, and MITH) into a unified system.
The director exerts some informal influence on the internal stakeholders of CBS and DCT. She encourages staff and management within the two programs and related service lines and the individuals supported to start training meant to promote patient safety. She collaboratively developed supportive measures for personnel training and health technology such as electronic records in community settings, motivational interviewing, and medication administration.
Organizations Characteristics
Current Strengths
At the MDHS and DCT/CBS program, people are highly valued. The staff members are motivated to learn and improve their skills and competencies in their roles continually. The organizations workforce is at the core of the delivery of diverse services, including foster care for persons with a disability, family healthcare, residential care for people exhibiting risky behaviors, rehabilitation, and vocational training (Minnesota Department of Human Services, 2020). Thus, the team is supported to explore, research, and pilot health innovations and evidence-based practices in these areas. Training opportunities on leadership, project management, and lean sigma six programs are also available for staff.
Current Weaknesses
The organization depends heavily on community providers to manage healthcare needs. As a result, project targets are rarely met because these stakeholders have capacity or resource challenges. For example, the preventive screening project in Minnesota has done tests lower than the national average because of relying on community providers to recognize the need for the screen instead of communicating to them that it is required.
Evidence-Based Practice Activities
The organization integrates evidence-based practice into its care delivery systems, policies, procedures, and day-to-day practices. Before updating or implementing a new policy, it is benchmarked, and a best practice determined to ensure that it is proven to work. Staff education about the National Patient Safety Goals is done when implementing evidence-based protocols or procedures. Examples include doing three checks before medication administration to reduce errors and an updated suicide policy that reflects community risks. The director also develops evidence-based policies and procedures for staff to deliver to the communities served.
Quality Improvement Projects
At the MDHS, quality improvement has occurred at the level of staff training to improve the skills needed to deliver the organizations goals, among them creating a patient-centered culture and serving as a safety net provider. A 5-hour classroom Medication Administration Refresher and a one-hour Computer Based Training are offered to direct care staff to minimize medication errors. Another quality improvement project is system-wide satisfaction surveys and tools that monitor outcomes related to the quality of life, implemented evidence-based practices, and treatments. An electronic health record (AVATAR) has been piloted in residential care homes to tests its efficacy in community settings. The SBAR tool has also been adopted to improve communication within the larger DCT organization, while cognitive-behavioral training has replaced seclusion and restraint in mental health care.
Recommendation for Organization Change
Recommendation
A redesigned preventive healthcare is recommended to preserve and protect the health of Minnesotans. Using the plan-do-study-act model, the initial focus should be on educating populations to avoid health risk factors, adopt healthy lifestyles, and provide early screening and treatment. Nurses at the MDHS agencies and programs will then collaborate with providers as the first point of contact in a patient-centered approach to promote the communitys health through evidence-based interventions and health-seeking behavior. The providers will prioritize early disease detection (screening) and identify high-risk individuals guided by MDHS for a referral to the CBS program. Once identified, the nursing staff at the organization will work with them in community settings (their homes and foster care facilities) to decrease health risks, address social determinants, and modify specific lifestyles based on the baseline data. The recommended nurse-led preventive health model will focus on conditions with a high incidence in the community such as obesity, heart disease, cancer, mental illness, and diabetes.
Rationale
A key organizational weakness identified through the interview is over-dependence on community providers to manage most healthcare needs, resulting in suboptimal health outcomes. Stronger preventive care is needed, given the high prevalence of preventable non-communicable diseases. According to the Obesity Quick Facts, (2020), currently, 30.1% of Minnesota adults are obese, 9% have been diagnosed with diabetes, and the rate of psychiatric admissions stands at 7.0 per 1,000 people. Insurance coverage is low, which limits access to care.
A collaborative approach in which DCT/CBS provides guidance on risk factors to screen for and addresses preclinical diseases will help examine the gaps. It will ensure regular in-home screenings performed by community health nurses who will also serve as educators providing useful health information to promote positive behaviors (Burns & Kakara, 2018). The unique needs of the population will also be addressed through this change. They include cancer, diabetes, mental illness, age-related injuries and disabilities, and obesity attributed to unhealthy food and physical environments for minorities ( Obesity Quick Facts, 2020). Clinical outcomes can be improved by engaging community health providers under the MDHS/DCT/CBS program to conduct regular tests to identify high-risk individuals, educate the population on risk factors and symptoms, and strengthen the emergency response.
Evaluation of Change Effectiveness
The Centers for Medicare and Medicaid Services meaningful measures will be the national benchmark for evaluating the organizational change. They cover areas critical to better patient outcomes, including the promotion of prevention and treatment of chronic disease. The specific measures for assessing the effectiveness of the change will include the percentage of the population that receive influenza immunization, and cancer, diabetes, and substance use screenings conducted, follow-ups after hospitalization for psychiatric conditions, obesity rates, and 30-day heart failure readmissions over time ( Meaningful Measures Hub, 2019). Patient experience of preventive care health promotion, screening, and education will also be measured. The Hospital Consumer Assessment of Healthcare Provider and Systems (HCAPS) tool will be used for this purpose ( Hospital CAHPS, 2020). This national, standardized survey instrument will help evaluate the communitys post-implementation perceptions and satisfaction with the preventive health project.
Conclusion
Nurse leadership is critical not only in clinical settings but also in policy development and implementation. It impacts the safety and quality of care delivered and the integration of evidence-based protocols and procedures into practice. From the interview with a nurse leader who has a strategic role at the MDHSs DCT/CBS program, preventive health in Minnesota needs improvement to address the populations risk factors within a systems framework. The consultative change recommendation provided aims to improve the prevention of non-communicable diseases and related outcomes in this community.
DispatchHealth is a fast-growing medical company offering healthcare delivery by providing on-demand urgent care and medical treatment for different groups of citizens in their homes. The mission of the organization is to perform the most effective and innovative in-home medical care worldwide. The patient receives qualified specialist advice, the necessary recommendations, and appointments without leaving home. Besides, due to a psychologically comfortable and confidential home conversation, patients have the opportunity to ask the doctor any questions they are interested in and receive competent answers with a guarantee of confidentiality.
Moreover, one of the purposes of offering on-demand medical treatment is diminishing additional emergency room appointments and hospitalizations and lessening healthcare system costs. The organization was created in 2013 by Dr. Mark Prather and Kevin Riddleberger. The DispatchHealth co-founders aim to establish the unified, available, advanced care delivery by providing reliable medical care in the home while reducing additional expenses. DispatchHealth has a novel business structure, including a management organization, a business, and a clinical leadership team.
The medical company DispatchHealth is managed by a group of professional and experienced managers with extensive experience in various areas. The team consists of several positions, performed by co-owners Mirjam Nilsson and Jens Martensson, the surgeon August Berggren, sales Ian Karlsson and Chief Financial Officer Victoria Nilsson. There are also several leadership team positions such as Chief Growth Officer, Chief Provider Strategy and Solutions Officer, VP of Enterprise Optimization, and VP of Strategy (DispatchHealth, n.d.). The Market Leadership Team incorporates a VP of Growth, 3 Regional Market Directors, and a group of 7 Market Directors (DispatchHealth, n.d.). The company provides diagnostic, therapeutic, and preventive care in most medical specialties following modern sciences latest achievements. The Clinical Leadership Team is equipped with a VP of Medical Affairs/Medical Director, VP of Medical Affairs, Advanced Care, SVP Operations, Senior BP, Advanced Practice, and a host of Nurse Practitioners strategically positioned across the country (DispatchHealth, n.d.). The company employs doctors professionals with vast practical experience in the treatment of various diseases.
Services
In the multidisciplinary medical center DispatchHealth, medical services at home are provided by doctors who are qualified in various fields of medicine and are ready to conduct a wide range of medical procedures and examinations at home convenient for the patient. Both adults and childrens doctors work and go home in the clinic. The center specialists carry out the necessary medical procedures and manipulations: the setting of droppers, injections, and dressings, physiotherapy procedures at home (What We Treat, n.d.). In case of acute respiratory illness, fever, limited mobility with neurological pain, increased blood pressure, allergic reactions, calling a doctor at home is the most convenient way to get aid (What We Treat, n.d.). The service is available to everyone. By ordering the service in the app or by phone, the patient can expect a doctors visit as soon as possible.
Funding and Target Audience
The organizations funding comes from different lend investors and enterprises. These are Optimum Ventures, Echo Health Ventures, Venture Round Alta Partners, Questa Capital Management (DispatchHealth, n.d.). Dispatch Health has raised a total of $203.2M in funding over four rounds (DispatchHealth, n.d.). According to Melton (2020a), this type of medical organization attracts investors, considering home care as a tool to regulate growing healthcare spendings. Melton (2020b) claims that DispatchHealth visits will typically cost patients with insurance $50 or less, patients without insurance spend an average of $200-$300, nearly ten times less than the average ER visit, which the Healthcare Cost Institute estimates to be around $2,000. Target Audience varies in accordance with claims and patients diseases. 22% of requests are pediatric, 45% of patients seek general treatment, 38% are older adults, and about 8% of requests appear due to urgent cases.
SWOT Analysis
Strengths are accessibility and variety of treatments. The first is characterized by mobile urgent care service for home calls. It provides 18 states and 28 cities locations and serves babies and pediatric patients, family medicine, and geriatric patients, whereas the response time is 1-2 hours (Galiana & Haseltine, 2019). Another positive point is the cost covered by commercial or private insurances. It also considers Medicare with or without Secondary Insurance (Galiana & Haseltine, 2019). Concerning weaknesses, these are the arrival time, which ranges between 1-2 hours, depending on the schedule (DispatchHealth, n.d.). The number of responders is limited; it permits only two people per visit. There is no specialization, imaging, and telehealth option for increased access. It also cannot carry to the ER in case of an emergency. Opportunities are added imaging services that will shorten waiting at imaging offices and reduce ER visits, responding specialists, specializing in various domains, and transport services, enhancing accessibility and quality medical care for patients (DispatchHealth, n.d.). Major competitors are Anywhere Urgent Care, Remedy Urgent Care, Chicken Soup Urgent Care. Dispatch Health has much competition for specialty care that requires imaging, telemedicine services, and transport services.
Marketing Strategies
A significant increase in revenue is achieved through the organization of the entire marketing cycle in the organization, in-depth analysis of the competitive environment, the introduction of modern promotion technologies, and efficiency analysis. Concerning partnership, DispatchHealth obtains close associations with various medical institutes, including hospitals, larger payers, senior living communities, provider groups, and emergency services (EMS) (DispatchHealth, n.d.). Dispatch Health presents a website and mobile application to perform easy interaction with clients, optimizing doctors work, ensuring control, and improving service. The company actively uses social media to publish health-related news and innovation to help the patient stay current with the medical field situation. DispatchHealth educates the population and reveals some important points concerning the findings in the healthcare domain. Citizens are engaged due to useful and relevant information regarding health found on the companys website.
Future Marketing Strategies
With regard to future marketing strategy implementation, the main points are branding, building competition, referral system, social media, and surveys. It is essential to develop a regular healthcare brand to distinguish the organization from others. For boosting patients awareness and interest in the company, it is vital to submit special reasons, for instance, corresponding or lower costs of treatment services. The referral system allows the organization to expand the market through business connections. The active use of social media stays a decisive factor in the companys marketing. Moreover, it is needed to perform studies investigating the DispatchHealth services to define their quality.
DispatchHealth is intended to implement a programmed notification service as it can decrease open appointments. Besides, the functions, such as pay-per-click ads and advertising Healthcare Marketing, are the crucial marketing aspects that allow performing more overall visibility online due to the paid advertisements promotion. Furthermore, it is useful to utilize a customer relationship management system (CRM). Google Analytics manages trade ranking in different search engines. The company plans to follow its pay-per-click campaigns by adding Google AdWords and using a HIPAA-compliant call tracking system. Moreover, HubSpot, in particular, helps increase sales, optimize marketing, and improve customer service. These factors are achieved by storing information about customers, the history of relationships with them, improving the relevant business processes, and subsequent analysis of the results.
Final Recommendations
The final recommendations include the creation of transportation services to provide adequate medical care in time. It is suggested to sign contracts with ambulance dispatch assistance to transport patients to ER if needed. Imaging services are essential in terms of full disease image; this leads to the necessity to expand such aids due to obtaining portable X-ray machines. Finally, due to the globalizing and growing multicultural society, it is essential to enhance communication by developing bilingual staff and interpreting assistance. Tele-medicine technologies diminish optional in-home visits while expanding the service area to remote and rural areas.
Galiana, J., & Haseltine, W. A. (2019). Emergency medicine and hospital care in the home and community. In Aging Well (pp. 91-115). Palgrave Macmillan, Singapore.
This paper aims to discuss the increased use and success of e-prescribing in the state of California, as well as examine the benefits of using an electronic prescription system. Electronic prescribing is a technology-based generation of a medical prescription that implies its digital transmission to the pharmacy without using handwritten notes or phone calls. Over recent years, e-prescribing has gained considerable attention from policymakers, both state- and nationwide. The testing projects conducted in Florida, Massachusetts, and several other states showed a high level of interest in such a prescribing method from healthcare practitioners, pharmacy workers, and patients. More states started to implement it into their healthcare services system. Some of them require e-prescribing only for certain controlled substances, and some require it for all types of medications. However, e-prescribing will eventually become a part of daily healthcare practices since Medicare will start to demand submitting all Part D scripts in a digital form (Caiola, 2019).
Speaking of California, all the practitioners will be required to utilize e-prescription since January 1, 2022. Nonetheless, it is recommended to start submitting electronic prescriptions right now to test the e-prescribing software and make this change gradual and easy for all stakeholders. Each year in California, the number of electronic prescriptions among the non-electronic ones increases. Several years ago, the overall use of e-prescription was relatively low, including its utilization cases by small or solo providers along with independent pharmacies. Now, with the upcoming law of compulsory utilization, California experiences a rise in e-prescribing a range of medications and not only controlled substances. Certain barriers are now standing in the way of fully implementing e-prescribing into the healthcare system of California. They include costs of introducing new technology into medical facilities, fees associated with using the corresponding networks, as well as disruption of workflows. These aspects need to be gradually removed, which requires detailed investigation and careful planning to make the process less harmful for both providers and their patients.
Meanwhile, the benefits of e-prescribing are proved to positively influence all stakeholders involved in the process. The main advantage of the system is, of course, increased patient safety, which is the central objective of healthcare overall (Zadeh et al., 2016). The common errors associated with handwritten prescriptions include incorrect dosages, therapy duplication, selecting unavailable or inaccurate medicine, as well as order misinterpretation due to incomprehensible writing. If these errors are detected in the early stages of prescription processing, the delayed therapy might harm the patient that needs immediate care. In the worst scenario, the errors might not be identified whatsoever, which may result in serious health issues and even a fatal outcome. E-prescribing minimizes the possibility of a prescription mistake, as it uses strict guidelines and does not include a human factor. Moreover, the system warns a prescriber about potential allergic reactions and suggests the best medicine alternatives. Not to mention cost-effective outcomes for the patients, with the ability to save money when prescribed drugs electronically.
E-prescribing also benefits healthcare providers in the way it saves their time on writing prescriptions by hand and gives quick and easy access to the patients history. Prescribers can be certain that their possibles mistakes will be corrected, which gives them peace of mind (Zadeh et al., 2016). The same applies to the community pharmacies that obtain an opportunity to improve the prescription process and minimize the time spent on controlling and double-checking the entering orders. Moreover, e-prescribing gives advantages to employers, pharmaceutical, and insurance companies. Pharmaceutical companies see an opportunity to obtain data on prescribing habits of healthcare providers and work with them directly, using new technologies. Insurance companies can have less amount of claim losses as patients get clear, correct prescriptions. Finally, healthcare employers benefit from reduced medical costs and healthier employees. Thus, e-prescribing in California is destined to advance due to the present legislation and evident benefits of the electronic prescription system.
References
Caiola, S. (2019). Here Are Californias New Laws To Address The States Opioid Crisis. California State University, Sacramento. Web.
Zadeh, P. E., & Tremblay, M. C. (2016). A review of the literature and proposed classification on e-prescribing: Functions, assimilation stages, benefits, concerns, and risks. Research in Social and Administrative Pharmacy, 12(1), 1-19.
Edirippulige, S., & Armfield, N. (2016). Education and training to support the use of clinical telehealth: A review of the literature. Journal of Telemedicine And Telecare, 23(2), 273-282.
Despite the considerable investments and policy changes, the adoption of telehealth is still limited. Edirippulige and Armfield (2016) contend that since the application of telehealth engenders a change in practice, it should be supported by the appropriate skills development for the current and future practitioners. The authors argue that the application of the various components of cognitive learning mitigates the healthcare practitioners single largest dilemma of the future competencies required to work in a technology-infused environment. The article implies that physicians training programs commence by changing the thoughts and perceptions of the professionals, and support the development of new understandings and insights. Edirippulige and Armfield (2016) assert that the systematic organization and delivery of information and knowledge on telehealth progressively equip physicians with domain-specific problem solving skills. This article is insightful and relevant due to its distinctive focus and emphasis on information processing, curiosity stimulation, and relevance to healthcare professionals goals.
Additionally, telehealth trainers recognize that physicians are not passive information recipients but actively participate in the construction of their understanding. Edirippulige and Armfields (2016) publication postulate that positioning practitioners at the center of the training stimulate learning and skills acquisition. For instance, the authors argue that the participation of trainees in live lectures, integrating them in the development of the national telehealth plan, and role playing in clinical interactions using telehealth is critical. Therefore, this article provides invaluable perspectives on systematic change management approach and skills development in telehealth among physicians.
Kissi, J., Dai, B., Dogbe, C. S. K., Banahene, J., & Ernest, O. (2019). Predictive factors of physicians satisfaction with telemedicine services acceptance. Health Informatics Journal, 26(3), 1866-1880.
The adoption and subsequent success of telemedicine are predicated on the satisfaction derived by the users. According to Kissi et al. (2019), the perceived use of ease and usefulness are fundamental considerations and determinants which enhance the acceptability and adoption of telehealth technology by physicians. The article illustrates the critical significance of building on physicians previous experience when designing training programs. According to Kissi et al. (2019), integrating prior knowledge stimulates positive expectations and establishes an inherent zeal to apply the acquired knowledge. This perspective recognizes the need to address various key internal factors within the physicians, such as perceptions regarding how the new technology will enhance their effectiveness and technologically prepare them for the future. Additionally, the training should consider alignment with the existing clinical workflow and not impose additional tasks.
Moreover, trainers should foster curiosity and strategically organize the learning experiences to ensure they are meaningful. For instance, tutors often neglect the emotional aspect of learning, which impedes effective learning by leaving specific attributes of the subject unattended. Kissi et al. (2019) accentuate that telemedicine extends the traditional medical experience beyond the typical hospital jurisdictions, translating to greater satisfaction and effectiveness of the routine functions and tasks, such as diagnosis and consultation. This article offers useful dimensions through which training programs can be designed to foster acceptance and proactive learning by making the physicians understand the novel concept of telehealth and how it maximizes their occupational satisfaction.
Albarrak, A. I., Mohammed, R., Almarshoud, N., Almujalli, L., Aljaeed, R., Altuwaijiri, S., & Albohairy, T. (2019). Assessment of physicians knowledge, perception, and willingness of telemedicine in Riyadh region, Saudi Arabia. Journal of Infection and Public Health, (2019), 1-8.
Telehealth visits have been widely embraced and used to enhance accessibility and quality of care. Albarrak et al. (2019) note that despite the acquisition of advanced communication equipment among physicians, their deployment in telehealth remains relatively low. However, the article illustrates that the medical workers vastly prefer telehealth virtual visits compared to office attendance. A study conducted in Riyadh region demonstrated an overall positive perception and attitude towards telehealth among care providers. The findings of the cross-sectional survey revealed a 90% acceptability of telehealth as a viable strategy for providing medical care to patients (Albartrak et al., 2019). Additionally, the respondents acknowledged the potential of telemedicine in saving time and money, the willingness to integrate it within the existing system, and its extensive clinical usefulness. This article is critical as it offers useful insights on the growing predilection of telehealth appointment settings over the conventional environment. Moreover, the physicians acquisition of advanced communication devices pinpoints their eagerness to adopt and utilize telehealth in their operations.
Waseh, S., & Dicker, A. (2019). Telemedicine training in undergraduate medical education: Mixed-methods review. JMIR Medical Education, 5(1), e12515.
Over the past few decades, the adoption and application of telemedicine have grown exponentially, significantly transforming the contemporary healthcare trends. Waseh and Dicker (2019) note the remarkable integration of telemedicine competencies in the education programs for healthcare professionals. This article recognizes the indispensability of aligning the current education and training with this emerging pattern to effectively leverage its effectiveness and improve quality of care. Tele-assessments, ethics in telehealth, clinical rotations, and telemedicine-based lessons are all critical in supporting telehealth. This publication demonstrates the significance of implementing telemedicine curricula across the medical training and education programs as the foundations of developing familiarity and increasing comfort when applying telemedical approaches. According to Waseh and Dicker (2019), continued exposure with telehealth equips physicians with the technical and professional know-how to support the provision of care when distance separates the medic and the patient. Therefore, the article explicitly outlines the critical components necessary to support the comprehensive rollout of telemedicine.
The purpose of the Strategic National Stockpile (SNS) is to ensure adequate supply of medication and medical equipment during public health emergencies (PHEs) on a local and state level. PHEs are events when the immediate supply of medicines and devices may be extremely short or not possible for a number of reasons. In this case, the Strategic National Stockpile serves as a short-term buffer that helps with public health emergencies ( About the Strategic National Stockpile, 2020). Before the Covid-19 outbreak, the main focus of the SNS was local and regional emergencies such as natural and manmade disasters. However, the ongoing pandemic continues to expose the faults of the SNS system in place and shows its vulnerability in the face of a global threat. SNS 2.0, the next generation of the SNS, has set five priorities:
replenishing the SNS;
refining SNS strategy and structure;
establishing a distributor working model;
expanding the supply chain control tower; and
expanding domestic manufacturing.
The Structure and Responsibilities of the Strategic National Stockpile
At present, the Strategic National Stockpile hires more than 200 federal and contract employees ( About the Strategic National Stockpile, 2020). The SNS comprises several branches of different specialities that together ensure that the needed medicines and devices are in stock and can be delivered to the right place at the right time ( About the Strategic National Stockpile, 2020). The Information and Planning Branch is responsible for coordination of activities for stockpile and its partners. Information and Planning specialists train and support public health and emergency staff, check the stockpiles preparedness, and manage crisis response activities in the event of an emergency. Those working in The Management and Business Operations Branch oversee budgeting, policy, legislation, and strategic planning. It is the Operational Logistics Branch that replenishes the SNS with antibiotics, medical supplies, equipment, antidotes, antitoxins, antivirals, vaccines, and other pharmaceuticals. The Science Branch reviews the medical assets and researches to identify the needs of populations and the adequate response. Lastly, the relationships between the SNS and its partners are built through the Strategic Logistics Branch. The scope of the SNSs responsibilities includes medical countermeasures that are dispensed through points of dispensing (PODs).
The Purpose of Points of Dispensing
Medical countermeasures, abbreviated as MCMs, include vaccines, antiviral drugs, antibiotics, antitoxins, and chemical antidotes (Centers for Disease Control and Prevention, 2020). Their purpose is to prevent, mitigate, or provide a response to a public health emergency, be it one that occurs naturally or is manmade. MCMs get to the communities in need through PODs, points of dispensing. It is critical to dispense MCMs rapidly, which is why the local public health departments simultaneously use two types of PODs open and closed. Large public locations arenas, schools, and universities often have open PODs at their disposal. Managed by local health departments, they are used to deliver MCMs to all recipients.
In contrast, closed PODs are operated by partner organizations, and only their populations get access to the medicines and devices. Closed PODs ensure the continued functioning of a facility and a lesser burden on open PODs. Regardless of type, PODs serve common goals:
Make sure that recipients will not have severe reaction to dispensed MCMs;
Educating populations on the use and benefits of taking medicine and mitigating public health emergencies;
Dispensing MCMs on time;
Keeping track of MCMs used and replenished (Centers for Disease Control and Prevention, 2020).
The Planning and Implementation of PODs: Preplanning, Staffing and Just-in-Time
If an organization wishes to become a closed POD partner, it should contact its local public health department. The local public health agency can help set up a POD by informing about planning resources, giving recommendations, providing assistance, and encouraging resource sharing to tackle shortages (Centers for Disease Control and Prevention, 2020). Staffing is one of the tasks that determine the success of POD management. According to the dispensing standards established by Centers for Disease Control and Prevention (2008), each organization needs to estimate the throughput of a POD, or in other words, the number of people that are likely to visit for prophylaxis.
It should be noted that residents are not assigned to particular PODs. Further, the CDC does not impose any particular staffing configuration but rather gives organizations the freedom to use a mix of combination of timed drills and computer simulation modeling software. Such an approach ensures that an organization covers its unique needs and is consistent with the so-called Just-in-Time (JIT) method. JIT promotes the provision of resources in the time when they are needed, as opposed to preparing them in advance. With regard to training, the approach includes creating a learning culture and using responsive technology to accommodate learners acquiring new knowledge anywhere and anytime.
The Planning and Implementation of PODs: 12-Hour Push Package and SLP
A 12-hour push package is the first line of support from the Strategic National Stockpile in the event a threat is not immediately identified. The contents of push packages include a wide range of medicines and medical supplies. Weighing up to 50 tons and color coded for easy identification, they are pre-packed and ready for rapid transportation to any location in the United States in less than 12 hours. Strategically located warehouses store many 12-hour push packages, and each is ready for immediate deployment. Because of in-advance planning and the ease of transportation, authorities can empower themselves when responding to a threat.
Although the adoption of telehealth is relatively low, the integration of cognitive learning theory and physicians insights into the design and development of healthcare informatics can stimulate the transition from traditional to computer-based practice.
Introduction
Despite the transformative potential of technological advances in healthcare service delivery, the adoption and usage of telehealth and other computer-aided innovations by physicians remain significantly low. Telehealth, a subsystem of healthcare informatics, combines medical, computer, and information sciences to enhance the management, delivery, and quality of health services offered by improving staff effectiveness and efficiency, and reducing associated costs. However, these benefits have not been realized due to low healthcare workers acceptance and uptake. Although the adoption of telehealth is relatively low, the integration of cognitive learning theory and physicians insights into the design and development of healthcare informatics can stimulate the transition from traditional to computer-based practice.
Background
Telehealth is the application of telecommunications and electronic information technologies, such as mobile devices and computers, to support the delivery of remote clinical care and other health-related services, such as teleconsultation, telemonitoring, and telediagnosis. Kissi et al. (2019) argue that converging information science, medicine, and technology was intended to augment personnel shortages in healthcare, increase service accessibility, and minimize costs. However, the realization of these benefits has been subverted by the physicians dismal uptake and the reluctant transition from traditional to telehealth practice due to negative perceptions in the ease of use and functionality.
Transitioning from the conventional to telehealth practice is dependent on the perceptions of healthcare professionals regarding the satisfaction levels, practicality, and efficacy derived from the technology. According to Kissi et al. (2019), some concerns can be addressed effectively by involving physicians in the design, development, and training as an approach to stimulate the reflection of how technology enhances their practice. For instance, despite the acquisition of technologically advanced communication equipment by doctors, their application and utilization are limited. This indicates that although physicians acknowledge the importance of technology in their practice, they lack enough motivation to deploy them in practice. An assessment by Albarrak et al. (2019) revealed that despite the physicians preference of telehealth to physical attendances, the willingness to use is limited. This can be attributed to the presence of some challenges or the inadequacy of the systems, which discourage their adoption and usage. Therefore, the integration of cognitive learning concepts in telehealths various stages could capitalize on the healthcare workers eagerness demonstrated by the acquired equipment and arouse the desire to the full transition to telehealth practice.
Benefits of Cognitive Learning Theory in Supporting Transition to Telehealth
Cognitive learning theory emphasizes the acquisition of transformative knowledge through active involvement by building on past consciousness and comprehension. As a result, the model provides many benefits, including the development of problem-solving skills and enhanced confidence levels. Waseh and Dicker (2015) posit that the incorporation of telemedicine-based lessons in regular medical curricula offers invaluable competencies, critical in tackling emerging challenges and applying the acquired knowledge confidently. Introducing telehealth concepts in the existing education and training programs increases the learners familiarity through constant exposure, and fosters their eagerness of applying the obtained knowledge (Edirippulige & Armfield, 2016). This implies that appropriate skills development and coaching are critical in transforming the perceptions and thoughts of practitioners before they enter into the technology-driven industry.
Effectively leveraging the rapidly evolving technology requires a robust connection with the already acquired knowledge as the foundation of developing familiarity and boosting confidence levels when applying telemedicine (Waseh & Dicker, 2015). Physicians acceptance of technology can be fostered by increasing their familiarity, which enhances the technologys ease of use and functionality. Therefore, adopting cognitive learning approaches ultimately supports the physicians transitioning from the traditional operational model to telehealth practice.
Additionally, the healthcare workers obtain useful problem-solving skills which they can apply to navigate challenging tasks or scenarios. As an emerging, dynamic, and continually evolving technology, telehealth has various inherent challenges and shortcomings, such as patient resistance. However, skills acquired through the cognitive learning theory equip the physicians with skills, expertise, and ability to resolve difficulties as they occur. As a result, the practitioners willingness to transition to telehealth is stimulated by their ability to overcome obstacles, thereby supporting the transition to telehealth practice.
Conclusion
Despite the extensive investments, advancements, and policy changes to support telehealth, its uptake and adoption are limited. However, the various challenges impeding the physicians transitioning from the traditional operational model to telehealth practice can be mitigated by utilizing the cognitive learning theory across the latters phases of design, development, and training. The participation and involvement of the healthcare workers in these stages equip them with the essential knowledge and expertise to support application and the resolution of emerging challenges. The active role-playing stimulates buy-in, resolves any negative perceptions, and reinforces the intrinsic benefits of technologically-driven practice. Additionally, cognitive learning theory accentuates the need to redesign the current training programs as an approach to address the emotional aspect of trainees, and the subsequent transitioning to telehealth practice. Therefore, this model is effective in supporting the doctors shift to telehealth.
According to the U.S. Bureau of Labor Statistics, there are 7330 surgeons, 4340 anesthesiologists, 24320 surgical technologists, and 8550 CRNAs in the Northeastern United States. Subsequently, the size of this studys population is 44,540 health professionals engaging in surgical procedures. The states representing the population include Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Delaware, Virginia, West Virginia, Maryland, and Washington, D.C.
Sampling Method
Convenience sampling was used as a sampling method for two reasons. Firstly, these respondents are the ones who have first-hand experience with advanced technological surgical equipment and were willing to participate in the study. Secondly, it has been studied that small samples are suitable for qualitative studies because the sample represents a particular and in-depth perspective of the topic (Etikan et al., 2016).
Examples of Journals
The American Journal of Surgery, Journal of Surgical Education, Journal of Surgery, Journal of the American Medical Association.
Introducing Medical Virtual Reality
Another venue for educating health professionals in the sphere of advanced technological surgical equipment is the medical virtual reality. One of the problems concerning the transition of a medical student to a health practitioner is the lack of sufficient surgical practice. It can be managed by the implementation of virtual technologies in the medical field. Javaid and Haleem (2020) suggest that introducing medical virtual reality can provide students as well as surgeons with scenarios, preparing them for the actual work. Not only does it signify the use of sophisticated medical equipment, but it also follows the ideas of the theory of andragogy in adult learning.
A Paragraph of Study that Has Used Andragogical Framework
Dasgupta (2020) discusses the use of andragogical approach in medicine. Particularly, problem-based learning is presented as an expression of Andragogy in medical education. The researcher writes about students being presented with real-life cases and is expected to decipher them by their understanding and reasoning abilities (p. 11). The subsequent implication is that it is possible to simulate such scenarios with medical virtual reality. As a result, Dasgupta applies andragogical framework in his study, while leaving the possibility of adapting it to the modern technological realities.
Alternative Study Designs
As the purpose of the study is to evaluate the perception of the medical personnel of their skills, training, and competencies, two other study designs might be valid exploratory and cross-sectional (Omair, 2015). An exploratory design is appropriate for fields, which are not thoroughly investigated. It also utilizes a small sample size, however, the descriptive format fits better because numerous sources on the studied subject exist, and it is more appropriate to reference the actual knowledge rather than the unknown phenomena. Another alternative is the cross-sectional type, which would allow surveying data from groups based on the existing differences, like access to advanced medical equipment. At the same time, it would require a large sample size, which is not viable for this study, thus justifying the qualitative descriptive design.
Instrument for Data Collection
As most of the data were textual, it was necessary to structure the interaction with respondents in a question and answer fashion. The primary instrument for collecting data was questionnaires with the option to expand the answer behind the framework set by questions. The interviews would have also been helpful, however, the respondents ability to think and write down their thoughts in a cohesive manner is more valuable, thus making questionnaires a better choice (Belisario et al., 2015).
Shortcomings and Drawbacks of In-Service Training
The key factor in the diminished effectiveness of in-service training strategies is inappropriate methodology and curriculum. Another reason, as perceived by the participants, is the lack of follow-up activities and insufficient motivation. Dorri et al.s research (2016) supports the finding that the skills are not properly formed, if the in-service training is not followed by a recurring program, which is repeated in at least three months. The importance of motivational factors is underlined by the results of the study by Chaghari et al. (2017). They also argue that the effectiveness of the professional training is low, if the staff is not provided with motivation, like the additional credentials for the experience with advanced equipment.
Shortcomings and Drawbacks of On-the-Job Training
The findings demonstrated that the frequently observed drawbacks and shortcomings in the implementation of on-the-job training for operating room staff include ineffective trainers, team disturbances, rushed training, and low productivity. The conclusion that low productivity is the drawback of this learning style is partially confirmed by the previous research by Rassin et al. (2015). They argue that the effectiveness of On-the-Job training depends on the level of health professionals knowledge and their willingness to expand their boundaries. Another finding that rushed training is a setback of on-the-job learning corresponds to the study by Teagle et al. (2017), who conclude that personnel should be given adequate time to acquire skills and develop confidence.
Participants Experience and Confidence
Irrespective of the identified difficulties pertaining to the effectiveness and feasibility of training interventions, the majority of participants admitted the usefulness and overall positive effect of training on their skill levels in technological use. These findings are further corroborated by the earlier study by Niermeyer et al. (2019). The researchers drew a direct link between a practitioners exposure to technology and their level of confidence in it.
Recommendations and Results
The study has disclosed several important implications of training for health professionals. Firstly, the finding that skills should be solidified with follow-up activities means that more research is needed to develop programs of in-service training. Secondly, the lack of motivation is a key issue in achieving results. The subsequent recommendation is that the hospital administrations ought to put more effort into explaining the necessity of training, or by providing financial incentives to the personnel.
The deficiencies of on-the-job training also determine the recommendations to the superiors of those practitioners, which require immediate learning. Firstly, the studys emphasis on low productivity and training hurry as disadvantages of on-the-job learning implies that hospitals should provide more opportunities for personnel to familiarize themselves with the new equipment. For instance, training can be included into the working hours. Alternatively, the administration can correct their hiring policy by selecting only those practitioners that already have the necessary experience.
Finally, the finding that learning to work with technology has a beneficial effect on practitioners leads to two recommendations. The first is that the administration should provide the conditions for personnel to acquire the necessary skills. The second is that medical education should include practice with sophisticated equipment in the curricula. Although not immediately apparent, the positive effect will be apparent when the medical graduates will apply for jobs with surgical equipment, and they will already be familiar with the technology.
References
Belisario, J. S. M., Jamsek, J., Huckvale, K., ODonoghue, J., Morrison, C. P., & Car, J. (2015). Comparison of selfadministered survey questionnaire responses collected using mobile apps versus other methods. Cochrane Database of Systematic Reviews, (7). 1-99. Web.
Chaghari, M., Saffari, M., Ebadi, A., & Ameryoun, A. (2017). Empowering education: A new model for in-service training of nursing staff. Journal of Advances in Medical Education & Professionalism, 5(1), 26.
Dasgupta, A. (2020). Problem based learning: Its application in medical education. Journal of The West Bengal University of Health Sciences. 1(2), 11-18.
Dorri, S., Akbari, M., & Sedeh, M. D. (2016). Kirkpatrick evaluation model for in-service training on cardiopulmonary resuscitation. Iranian Journal of Nursing and Midwifery Research, 21(5), 493-497.
Niermeyer, W. L., Philips, R. H., Essig Jr, G. F., & Moberly, A. C. (2019). Diagnostic accuracy and confidence for otoscopy: Are medical students receiving sufficient training?. The Laryngoscope, 129(8), 1891-1897.
Omair, A. (2015). Selecting the appropriate study design for your research: Descriptive study designs. Journal of Health Specialties, 3(3), 153-156. Web.
Rassin, M., Kurzweil, Y., & Maoz, Y. (2015). Identification of the learning styles and on-the-job learning methods implemented by nurses for promoting their professional knowledge and skills. International Journal of Nursing Education Scholarship, 12(1), 75-81.
Communities need to function optimally to allow all members to complete their tasks successfully and record meaningful social mobilities. Politicians, policymakers, and leaders should collaborate and implement appropriate programs that can meet the demands of the greatest majority. Societies tend to encounter various challenges and gaps that can affect the recorded outcomes. The proposed change in the selected community revolves around the introduction of new practices and guidelines to promote healthy behaviors. This paper gives a detailed description of the intended initiative.
Context for the Change
Community organizers and social workers apply their skills efficiently to identify and address most of the challenges affecting the people they serve. Some of the common problems include juvenile delinquency, racism, discrimination, inequality, poverty, poor health outcomes, and unemployment (Northouse, 2018). The professionals work with local communities to identify some of the challenges affecting the experiences of the greatest majority. The acquired knowledge becomes the best principle or framework for providing sustainable services and support systems that are customized in accordance with the demands of the targeted people.
In the selected community, most of the people are facing various health problems, such as obesity, overweight, and diabetes. These conditions are attributable to poor lifestyles and behaviors, lack of proper information, and failure to exercise. Past studies have offered convincing information regarding the nature of this problem in the United States. For instance, Mansaray (2019) observed that around 70 million individuals in the country were obese. The number of overweight citizens stood at around 99 million (Northouse, 2018). This problem affects both men and women. Chandler and Kirsch (2017) believe that such health problems are critical risk factors for various illnesses, such as coronary artery disease, cancers, stroke, and type 2 diabetes (Northouse, 2018). Unless the relevant professionals implement proper strategies and solutions, these problems can result in increased mortality and affect the overall performance of a regions economy.
Change Agents
The identified predicaments are capable of disorienting the health experiences and outcomes of many patients. The best solution entails the introduction of a new change whereby different stakeholders will collaborate and guide more people to engage in proper health behaviors (Mansaray, 2019). The proposed program seeks to educate more people in the community about the importance of maintaining or checking their body mass indexes (BMIs). The beneficiaries will also acquire new insights for engaging in exercises frequently and eating healthy.
The relevant change agents who can ensure that positive results are recorded include community organizers, nutritionists, social workers, and human services professionals. These actors will identify specific individuals to be part of the required team. Such a team will then appoint a leader whose role is to coordinate the conducted activities, mentor followers, communicate efficiently to followers, and solve emerging issues (Northouse, 2018). Community members will also appoint representatives and coordinators who will liaise with the team and provide timely information.
Opportunities and Constraints
The current scenario presents several opportunities and constraints that might have significant implications on the anticipated results. For instance, the appointed leader stands a chance to apply the concepts and theories of management studied in class to change the current situation (Chandler & Kirsch, 2017). Such an approach will present new opportunities for guiding the team members, solving recorded challenges, and providing personalized support (Chandler & Kirsch, 2017). The involved professionals have a proper understanding of the major processes and strategies required to implement organizational change. These attributes will ensure that the change is successful.
The targeted beneficiaries are aware of some of the best practices for managing obesity and getting rid of some of the opportunistic conditions. This reality means that the involved participants will complete the change within a short period. The willingness of more people to improve their health experiences and conditions is a new opportunity for the intended transformation (Wakumbe, 2016). This aspect will encourage the beneficiaries to be involved and become part of the proposed transformation.
However, some constraints might affect the nature and effectiveness of the intended process. First, some of the change agents and citizens might be unsupportive. Different theories indicate that resistance is one of the major obstacles many leaders encounter want trying to introduce new practices. Second, the involved team might be unable to acquire the relevant materials and resources to support and sustain the entire project (Wakumbe, 2016). However, the presence of competent leader will minimize the potential impact of these constraints and eventually ensure that meaningful gains are realized in the identified community.
Leader Actions and Processes
The success of any change process depends on the actions and involvements of the leaders. The first initiative that the professionals will have to consider is that of an effective theory. For instance, Kurt Lewins model is an outstanding framework that many people have applied in their communities and organizational settings to achieve the intended goals (Mansaray, 2019). The leaders behind the suggested community change will need to consider the best theory to manage the intended actions, prepare the beneficiaries, and solve challenges that might emerge. A good change will also create room for supporting the process and making it part of the selected community.
Second, the people in charge of the project will have to apply the most appropriate skills and attributes. For instance, Mansaray (2019) encourages leaders to communicate effectively, solve emerging challenges and differences, listen attentively, and provide the relevant empowerment. This analysis explains why there is a need for the team to create a positive culture that will resonate with the unique demands of the targeted beneficiaries. Such actions will improve the level of involvement and ensure that positive results are recorded. Third, the leader tasked with the initiative will ensure that the followers receive timely resources and equipment to support the entire process (Chandler & Kirsch, 2017). Such individuals will solve most of the emerging issues and complete their tasks in a timely manner.
Various processes will be essential to support the intended change and ensure that it meets the demands of the beneficiaries. For instance, the professionals will have to conduct several campaigns that will educate most of the people about the importance of the intended change. The individuals will also engage in one-on-one sessions that will allow most of the community members to receive personalized information (Chandler & Kirsch, 2017). The recruited social workers and other participants will provide additional instructions and guidelines to ensure that obese persons receive the intended medical support.
The idea of continuous learning will become an effective initiative for allowing community members to acquire additional insights for managing their BMIs. The leader will also monitor the effectiveness of the implemented activities frequently to ensure that they deliver the intended outcomes in a timely manner (Mansaray, 2019). These processes will make the proposed change initiative successful and capable of delivering admirable results in the community. Consequently, most of the beneficiaries will record positive health outcomes.
Logic Model
Table 1. Logic Model
Program Name:Community Change Initiative to Address the Health Challenges of Obesity
Program Goals:Sensitize more people about obesity and overweight, learn more about the risks associated with the two, and encourage them to change their health behaviors and diets.
Resources:Educational materials, papers and pens, funds for transportation, and pamphlets
Estimated Budget:20,000 US dollars
Outputs
Outcomes
Activities
Audience
Short-term
Mid-term
Long-term
Planning phase
Identified professionals
Analyze the aspects of the change
Team selection
Professionals
Form team
Mock project
Involved team members
Experiment initiatives for the proposed change
Engage in continuous monitoring and amendments
Launch project
Community members
Learn more about obesity/overweight
BMI monitoring
BMI monitoring
Educate community members
Community members
Engage in exercise
Routine exercise
Lifetime exercises
Completion and follow-up
Community members
More people start to take their diets seriously
People combine acquired ideas
A lifestyle transformation
Conclusion
The above discussion has described a community change initiative that is capable of supporting the demands of more obese and overweight citizens. The relevant health professionals, social workers, and policymakers will need to collaborate and appoint a competent leader to support the entire initiative. The involvement of all the key stakeholders will monitor the proposed change and ensure that it delivers desirable results. The outlined logic model will guide the entire process, encourage more people to be involved, and eventually make it possible for more community members to overcome the challenges of obesity.
The Strategic National Stockpile (SNS) was formed in 2003 under the Department of Homeland Security (Esbitt, 2003). SNS uses Cities Readiness Initiative (CRI) to access large cities (Carbon County Montana Public Health, 2014). Point of Dispensing (PODs) is a post-incident strategy to provide life-sustaining supplies such as medicine, food, water, shelter, and the general public within 72 hours after the disaster (Khan& Richter, 2012).
This research paper explores existing state plans for mass prophylaxis using Points of Dispensing (PODs) during widespread national health emergencies such as disease outbreak and bioterrorism attacks, among others. There are two primary plans based on PODs that can be used during local mass prophylaxis in a public health emergency or during a terrorist attack. The plans are the Local Health Department (LHD) and the Field Operations Guide (FOG) (Khan & Richter, 2012; Oregon Public Health Division, 2012). This paper will discuss the two plans in detail to explain how they work. Each of the plans has its advantages and shortcomings. In an emergency, it is, therefore, imperative to analyze and determine the best model to be incorporated as the alternative of the main one used.
Local Health Department
Local Health Department POD is commonly used in a large metropolitan area because, as Khan and Richter (2012) allude, the challenges that this model is likely to encounter in a sparsely populated areas are quite different from the ones it would face in an urban setting which is densely populated. In offering mass prophylaxis to the general public in case of a health crisis or a terrorist attack, this plan is used to supply affected groups medical necessities. Although this model has numerous disadvantages as per Khan and Richter (2012), the Centers for Disease Control and Prevention and the Department of Health and Health Services still give credit to it as the cornerstone of availing support in times of prophylaxis.
The CDC Division of the Strategic National Stockpile (DSNS) requires dispensing points to fulfill about three tests out of the possible seven. According to Khan and Richter (2012), out of the seven experiments, four are directly related to POD activation, set-up, and throughput and complete one functional or full-scale exercise for each Cities Readiness Initiative Metropolitan Statistical Area (MSA) that tests key components of mass prophylaxis plans (p. 2). These tests should be carried out by the Public Health Emergency Preparedness Grant year normally between August 10 of each year and August 9 of the following year. CDC recommends that dispensing sites should be places that the residents are familiar with, are accessible, and populous. These places could be community centers, schools and playing grounds among others (Khan & Richter, 2012). The dispensing sites come with advantages such as adequate space, proper security, and good climate. They should not be health centers as this will inhibit the medical personnel there from carrying out their duties in so far as the pandemic is concerned.
This model is scalable; it can readjust itself to accommodate more residents. On the other hand, this POD model has its shortcomings too. For example people with disabilities queue together with the rest of the population, which is terrible on the part of these people living with disabilities. Another drawback of this plan is that there could be inadequate sites to put up dispensing sites, and since mass prophylaxis should take place in places of essential services to the population, it becomes challenging. According to Khan and Richter (2012), it is time-consuming to put together the logistics in this operation. This could be disadvantageous in the already desperate situation that characterizes the general public.
Field Operations Guide
Field Operations Guide (FOG) is the other POD model adopted in the Oregon state to develop highly scalable dispensing points that meet the requirements of the Centers for Disease Control and Prevention and the Division for the Strategic National Stockpile (Oregon Public Health Division, 2012).
This POD plan uses a response tool known as Incident Command System to coordinate medical supplies mass dispensing. In this plan, mass prophylaxis is done in two PODs: medical PODs and non-medical PODs. Medical PODs involve screening the victims for medical conditions such as allergies and ulcers, among other medical conditions that would affect the kind of medication administered to these individuals. However, in non-medical PODs, individuals self-screen themselves to establish whether or not they should be administered with the prescription.
Figure 1: Example of a Standardized POD (Oregon Public Health Division, 2012).
Discussion
Having studied how the two POD plans operate, it can be seen that they are similar and also different in specific ways. Both POD plans are targeted towards offering rapid prophylaxis to the masses during times of emergency. While LHD is quite flexible and scalable, FOG seems to be relatively rigid in times of emergency. These could be detrimental to the process of dispensing supplies in a large-scale emergency. FOG is centralized in the sense that it receives directives from the Incident Command System. This can be time-consuming and counter-productive. FOG is state-specific, while the traditional LHD can be used in any part of the US in times of medical emergency. With these striking differences, a traditional LHD model of dispensing is the most preferable in a crisis. In as much as LHD is the best, it has its fair share of disadvantages, and it is, therefore, prudent to bring in alternative models. FOG PODs are kind of closed PODs in that the general population cannot be allowed to access them. In this way FOG attends to less people as compared to LHD (open PODs). At the time of writing Oregon Public Health Division (2012), there were fewer FOG dispensing sites as compared to LHD sites. The open PODs are way more complex and require more funds and planning to assess their readiness
Having a national standard for POD implementation using the traditional LHD POD plan will compound the problems that this model encounter even when dispensing at lower jurisdictions. A major issue that is likely to arise is shortage of staff to aid in the administration of medication countermeasures. This will mean that several dispensing sites should be identified all over the nation. Several memoranda of association with site owners will be signed and it is not guaranteed that every site owner will approve of this. The chain of command will also widen so that information from the top-most authority will have to go through several officers in the POD framework before reaching workers at the ground. This work therefore, does not support the idea of having a national standard of implementing PODs.
Conclusion
It is agreeable that LHD cannot fully handle the entire population in the stipulated time because of its challenges. The problems include inadequate staff, lack of security, a large population to offer medical help, unavailability of dispensing points, and other issues. In a practical situation, these challenges can be overcome by resorting to alternative models like dispensing in schools, homes and business premises among others. FOG, which is another prophylaxis approach, is state-specific. For example, this research considered the Oregon POD FOG. It is a standardized POD model that is destined to be effective in handling small populations. Medical emergencies or any disaster that comes with a widespread crisis is an unfortunate situation that should be met with much preparedness from state authorities to reduce helplessness among the general public if a disaster strikes.
Esbitt, D. (2003). The Strategic National Stockpile: Roles and responsibilities of health care professionals for receiving the stockpile assets. Disaster Management & Response, 1(3), 68-70.
Khan, S., & Richter, A. (2012). Dispensing mass prophylaxis? The search for the perfect solution. Homeland Security Affairs, 8(1), 31-42.
