The world has become a global village because of advanced transport and communication technologies which have eliminated the geographic boundary. Global health is becoming an issue of concern to the global village, especially the communicable diseases. For this reason, there has been a united effort from the international society to fight various diseases.
Various international organizations have been working closely to find solutions to several health problems that affect both the developed and developing nations. Organizations such as the World Health Organization, Center for Disease Control and Prevention, and many other nonprofit making organizations have focused on research on global health issues.
On the other hand, institutions such as the World Bank, International Monetary Fund, United Nations, and other financial organizations have been playing a pivotal role in financing research and development in the healthcare sector. In this research, the focus is to analyze the global health policies and healthcare financing as a way through which the international society seeks to eliminate diseases in the society.
Global Health Policy
According to Buse, Mays and Walt (2012), it has become apparent that in the current globalized society, the spread of communicable diseases from one country to another is very easy. A clear case in point is the ongoing Ebola cases that started in Sierra Leon, Liberia and a few other West African countries.
When it started, the world was oblivious of the fact that it could spread to other parts of the world due to the movement of people from one country to another. However, the disease has now spread to other continents, most notable in North America. Several cases of Ebola patients have been reported in the United States.
This shows that geographical factor is no longer a barrier to the spread of the communicable diseases. It is because of this fact that the international society has proposed a number of global health policies to help manage these diseases.
The World Health Organization has been working with governments in various parts of the world to establish effective research and disease control institutes to help in early detection and management of outbreaks of various communicable and non-communicable diseases.
Given its mandate by the United Nations, World Health Organization has a policy agreement with various countries, especially the developing nations which still suffer from poor infrastructural development, which allows the organization to partner with the nongovernmental organizations to establish research centers (Alexander, 2014).
The governments are expected to support such initiatives in various ways. The ultimate aim of this policy is to have strong institutions that are able to detect disease outbreaks early enough, and manage them effectively in order to avoid mass casualties. The Liberian Ebola outbreak would have been controlled easily were it that there were proper structures in place.
This is a relatively new policy that is yet to gain good foundations in the targeted countries. However, there is a commitment by the responsible stakeholders, especially after the scare that was witnessed in the affected West African countries.
Center for Disease Control and Prevention has been making parallel programs for research and disease control in the United States and many other countries in the world. The organization has made policy agreements with various governments to work in these countries and support the medical research processes and disease management. The organization is fully funded by the government of the United States of America.
Outside the United States, this organization has a limited mandate beyond research and policy development. This organization has been working with other government sponsored organizations in various countries to conduct research and to formulate policies based on the local environment.
The ability of these policies to address various problems under different contexts will be compared in order to determine a united front to be used when addressing some of the global health issues.
The United Nations and World Health Organization have been making a concerted effort to eliminate the discriminative policies that some countries have put in place for people who plan to make international travels. According to Milstead (2013), a number of countries have restrictive policies which bar people suffering from specific diseases from visiting their countries.
This has affected the ability of patients in the developed countries to seek medical help from advanced institutions. These two institutions, working together with human rights groups, have been working together to develop policies that will lift such bans in order to make hospitals in the developed countries accessible to the international community.
Healthcare Financing Role
Healthcare financing role is an important task that defines the level of progress that can be made towards achievement of specific goals. According to Teitelbaum and Wilensky (2013), in the past, financing of healthcare was considered the responsibility of the national governments. However, the severity of some of the diseases like Ebola has changed this perception.
Currently, the role of financing healthcare services has been assumed by a number of stakeholders. Nationally, the governments still remain the largest financiers of healthcare services. In the United States, the government has made concerted efforts to subsidize the healthcare services in order to ensure that there is a universal health care for all. In the global context, many institutions are now sponsoring healthcare programs.
The World Bank and International Monetary Fund is the largest financier of these programs on a global context (Annemans, 2008). The government of the United States is also another major global financier of healthcare programs, especially in the developing countries.
The United Kingdom, France, and the United States have also partnered in a program meant to distribute antiretroviral drugs among the citizens in the developing nations to help manage HIV/AIDs. These drugs are now available freely to the registered victims to help them lead normal lives.
Other non-governmental organizations have also been actively involved in sponsoring research and direct medical care, especially in African countries. These organizations get funding from donors, mainly large organizations that do this as part of their corporate social responsibility to fund their activities.
These organizations have been active in war-torn countries such as Somalia, Democratic Republic, and parts of Nigeria. These organizations have also been in Haiti and Pakistan to help address the health concerns.
Conclusion
The world is fast becoming a global village as technology in transport has eliminated the geographic boundary that existed before. This has created a scenario where communicable diseases can spread easily from one country to another. In order to address this problem, the international community has developed programs that would help fight various diseases in order to inhibit their spread.
Various institutions such as the World Health Program and Center for Disease Control and Prevention have been working closely to advance research into this field to find a common way of containing this disease.
References
Alexander, N. (2014). Faces of the Ebola response. World Health Organization. Web.
Annemans, L. (2008). Health Economics for Non-economists: An Introduction to the Concepts, Methods and Pitfalls of Health Economic Evaluations. New York: Academia Pr Scientific Publishers.
Buse, K., Mays, N., & Walt, G. (2012). Making health policy. Maidenhead: McGraw Hill/Open University Press.
Milstead, J. A. (2013). Health policy and politics: A nurse’s guide. Burlington, MA: Jones & Bartlett Learning.
Teitelbaum, J. B., &Wilensky, S. E. (2013). Essentials of health policy and law. Sudbury, Mass: Jones & Bartlett Learning.
My place of work is a military college for health sciences. The college constitutes a part of Saudi’s armed forces medical services in the ministry of defence. The college receives funds from the ministry of defence. Therefore, its budget must be developed in accordance with the national funds that are allocated to the department of defence.
The college’s hierarchical structure of management begins with the College Director (must be a military officer), College Dean (a military person), College Deputy Dean, and then the Heads of Department (Nursing, RT, and Paramedic). The current paper proposes a healthcare initiative and conducts a situational analysis of the college with the objective of establishing the appropriate recommendations on how the college can improve its capacity to achieve its mandates.
This goal is accomplished through the development of a simulation programme to enhance situational awareness and critical decision making/communication skills to prepare new graduates for the medicine field. One of the major mandates of any organisational managers is to establish a means of identifying incidents that are likely to pose health threats to its works.
Similarly, the government has a responsibility of responding appropriately to health threats to ensure that the nation maintains the collective health of its populace. The government establishes various institutions that have the responsibilities of delivering quality care to all people. However, in some cases, special care units may be established to provide healthcare to some selected groups of people, including children and military hospitals.
People who work in such institutions are graduates from different healthcare training institutions. Currently, I work in one of such training institutions in Saudi Arabia. Therefore, I have a noble role to play in ensuring quality care in Saudi Arabia. I have to ensure that the graduates are well prepared to achieve the Saudi Arabian government’s objective of delivering quality care to all citizens.
The Rationale for the Choice
Workplaces require requisite care plans to ensure accessibility to quality care for all workers. Such accessibility can lower people’s exposure to risks that may impair their health. In fact, one of the fundamental human privileges is the right to access good healthcare. To achieve this fundamental human right, virtually all nations have established various programmes and public health campaigns to ensure that people recognise the need for being risk-free from preventable and curable ailments.
Health care initiatives should aim at improving the outcomes of the healthcare needs of the target population. Therefore, the rationale for a care plan should be based on the existing problem. In case of my organisation, such needs should respond to the personal factors and internal or external drivers within the administration.
The college graduates 1200 students and 250 graduates every year in areas such as Nursing, Respiratory Therapy, and Paramedics. The Saudi’s ministry of higher education has approved the college’s curriculum. Although its top-ranking leaders are military people, the graduates are non-military. However, they are given an opportunity to join the armed forces upon their completion of the training in their respective areas of specialisation.
To accomplish this agenda, they are required to make official applications. When students graduate as non-military professionals, they are given the flexibility to work in any healthcare organisation, including those in the public and private sector. The above flexibility comes with some disadvantages for the students who may wish to join the military upon the completion of their training.
In fact, even though the institution is a military college, the students’ curriculum does not include any Battlefield Medicine courses or training. This observation means that people who join the military as medical care professionals have inadequate skills in Battlefield Medicine and training. This situation is amplified by the fact that the college experiences challenges of shortage of instructors and educations.
It only has two hospitals. It does not have any medical simulation centre. These problems form the rationale for the development of a simulation programme to enhance situational awareness and critical decision making/communication skills to prepare new graduates for Battlefield Medicine. In the college, I serve as the clinical education coordinator.
My job description entails planning, arranging, allocating, and monitoring the clinical training for the students. Considering that I am also taking my Master’s Degree in medical and health care simulation, the healthcare initiative falls squarely within my responsibilities as the education and training coordinator.
PESTEL Analysis
PESTEL situation analysis approach is considered vital here since it indicates the likely forces that may influence the success of the new programme externally. These factors are beyond the control of the college. Therefore, understanding their implications on the new programme is crucial in determining whether to design the programme, notwithstanding its implementation.
Several factors influence the decisions of leaders of any organisation. From the PESTEL organisational analysis approach, these factors have a political, financial, collective, technical, ecological, and legal bearing (Gerry, Kevan, & Whittington 2005). For the case of the college, the political environment influences the operations of a healthcare organisation via the willingness of the current political regime to alter its policies towards health care (Kavilanz 2011).
Indeed, the college suffers the lack of and/or inadequacy of training facilities and resources. Considering that the new programme requires the pledge of high financial and human resources, especially where technology-enhanced simulations are to be incorporated, the participation of the political regime in decision-making is critical to the success of the new health initiative.
Political stability constitutes a central aspect that defines the importance of the new health care initiative. Indeed, the programme is appropriate because of political instabilities that arise from the war in the Middle East region, particularly in Yemen. War presents challenging situations to medical practitioners.
Therefore, according to Bruch and Gerber (2011), it is crucial for students at the college to learn how to access various situations in war-torn zones for them to develop the capacity to administer health care to the military personnel and communities within these areas in a risk-aware manner.
Since exposing students directly to high-risk situations may be dangerous, the remedy for preparing them for the field via the military medical training is through the simulation of similar situations such as those that would be encountered in the real work environment.
The management of the college must also comply with environmental regulations, tariffs, and employment laws that have been established in Saudi Arabia. From the perspective of economic factors, Saudi Arabia depends largely on oil to fund its budget (Yizraeli 2000). Hence, any turbulence in the economy arising from the interference of the oil mining may adversely influence the budget of the college.
Therefore, monetary allocation to purchase specialised simulation equipment has to suffer. This situation is particularly wanting considering instabilities in neighbouring nations such as Yemen, which may affect the exportation of oil and oil-related products across the gulf coast. However, war in Yemen also proves the importance of offering special training to the military medics, especially where care must be provided in a battlefield.
This training can reduce the fatality rates for people who are injured on the battlefield. Social factors act as an immense success factor to the college. The college brings together people from different backgrounds. Therefore, commitment to respecting individual differences has always been a major area of concern.
For this purpose, the institution has established an organisational culture that ensures that all people accomplish their educational goals with cultural, religious, or any other diversity-related conflict. Technology has been critical to ensuring that students share knowledge and/or exchange information on the current evidence-based practices in their career. However, lack of technology-based simulations programmes has limited the exposure of students to battlefield medical experiences
Among the other components of PESTEL situational analysis, technology constitutes an essential factor in improving training at the college. Scholarly literature on the education of care providers suggests that education and training are critical to ensuring patient safety. For healthcare provider education, advocates of the simulation approach to training such as Ziv et al. (2003) say that the modality offers an opportunity for learners to rehearse their professional skills in a non-detrimental environment.
Reznick and MacRae (2006) add that the incorporation of simulation in training on healthcare provides an opportunity for the students to participate in deliberate and structured practice while at the same time getting instant and timely feedback on their performance. This plan gives them an opportunity to improve on their areas of weakness.
In the programmes that are deployed in the simulation process of training students at the college in preparation for Battlefield Medicine, incorporating education technologies is incredible. Educational technologies can enormously foster better learning through simulation models. For instance, although it is possible to depict flawlessly how throbs occur and/or how they cause resonance using a regulation fork, it is complex to express what ideally development is and/or how particles can work when they are exposed to different circumstances.
In the same way, it would be enormously hard for a teacher to demonstrate the danger that is brought about by mixing two specific chemicals. However, amid these difficulties, with educational technologies, such experiments can be accomplished precisely and comprehensively in classroom settings with the help of digital simulations.
Lipsitz and Reisner (2010, p. 91) say, ‘digital simulations and models can help teachers to explain concepts that are too big or too small, or processes that happen too quickly or too slowly to demonstrate in a physical classroom’. Indeed, technology application in an educational setting fosters learning. Concord Consortium Company’s technology provides a working illustration to support this claim.
This company is a non-profit-making firm whose mandate is to develop science, math, and engineering educational technologies. Indeed, the company has developed software that is open source to all teachers. Teachers can deploy the software to aid them in the modelling of concepts.
One of the most conspicuous successes of the company is the development of molecular workbench software. This software helps science teachers to replicate issues such as compound attachment, gas rules, and even fluid technicalities among others. The overall impact is that although these topics may present abstract ideas, especially to new students, visual simulations make their teaching much easier. Hence, teachers’ work becomes both effective and efficient in terms of the delivery of the goals.
Research is also in the process of coming up with software that can be used to experiment evolution through virtual greenhouses. Moreover, to make learning physics more effective, various software tools have been developed to can aid students to appreciate the physics behind the efficiency of energy utilisation through the employment of model houses and simulations of the manner in which matter interacts with the electron clouds.
These examples explain how technology can be deployed to make education effective via the creation of digital models and simulations (Mishra & Koehler 2006). The college is incredibly concerned about its environmental impacts, especially based on the evident inappropriate disposal of materials that wrap the consumables that are used by students while in its premises.
The organisation is established and authorised to train health care personnel by the ministry of higher education. Therefore, it is also bound by various legal provisions that regulate its manner of conducting educational training of medical practitioners in the Saudi Arabia in accordance with the acceptable international standards.
Critical Analysis
The simulation expertise has immensely enabled many instructors to stretch far outside the text-focused and linear education methods by helping them to commit learners proactively to other means of scholarship. Consequently, while many nations, especially in the developed world, ask whether they need to use more simulation technologies in their education systems, other nations want to know how technologies can be used to improve training in health care settings.
Technology is one of the mechanisms that can be used to improve training and development at the college where I work. However, for it to be effective, it needs to reflect the manner in which the students learn in the settings of education. It can help in the realisation of the effective educational interventions since it possesses elements of educational psychology and more importantly profiles that closely match the organisational and school social psychology (Woolfolk, Winnie, & Perry 2008).
Hence, educational technologies need to be effective in improving education even to people who have special needs that arise from their physical and mental disabilities at the college. The proposed care plan relies on technology. This situation introduces a scholarly question on the efficacy of potential technologies that can be deployed in the implementation of care plans.
Quantitative meta-analysts such as Cook, Erwin, and Triola (2010) and Cook et al. (2012) investigate virtual patients and technological simulation modalities for their efficacy. Indeed, their findings may be essential in the case of my workplace that is in the process of implementing the healthcare initiative programme. Cook, Erwin, and Triola (2010, p. 1589) define virtual patient simulations as ‘computer-based interactive cases in which learners emulate the role of healthcare providers to obtain a history, conduct a physical exam, and/or make diagnostic and therapeutic decisions’.
On the other hand, technology-based simulations require learning institutions to possess educational devices that can facilitate learners’ physical interactions with situations that reflect clinical care environments and variables. The devices need to be used for the assessment and teaching purposes. These approaches involve the deployment of frameworks, manikins, practical certainty apparatus and structures, and cadaver.
Virtual patient simulations do not require the college to possess specialised healthcare paraphernalia. However, technology-enhanced simulation techniques demand them. Does simulation-based training work in healthcare settings? More than 600 separate studies that have brought together above 36,500 subjects have endeavoured to respond to the above question.
They accomplish this role by comparing training approaches that involve simulation and the ones that do not consider any intervention. According to Cook et al. (2011) and Cook et al. (2013), technology-focused and virtual patients in simulation approaches have statistically significant advantages in training aspects such as the attainment of skills and knowledge as measured by CPU scores, experiment setting, ranking of trainers, and the development of behaviours that are similar to those in real-life patient-care environments.
In case of effects that involve patients directly, including the event of critical problems, transience, and people who stay in the healthcare facilities, the merits of simulations are essential, despite their little significance (Zendejas et al. 2013). This observation implies that the incorporation of simulation in training students in preparation for Battlefield Medicine can work well in comparison with the current situation that involves no instructions.
An important question is whether it is appropriate to replace the current teaching methods with technologically enhanced teaching methods. Arguably, at the college, the traditional teaching models are ineffective. Educational technologies can make such models effective. However, many people may want to know how this goal can be attained.
The Concord Consortium exemplifies a good example of how this outcome can be achieved. The company developed software that enables students to understand the concepts of genetics through the ‘breeding of dragon’ concept. With the help of the software, teachers can give their students problems that closely relate to performance assessments.
When a student is requested to develop a dragon, teachers can follow stepwise what the students did to achieve the results. To this extent, incorporating simulation programmes is critical to increasing both situational awareness and student preparedness in the Battlefield Medicine. Any endeavour to improve training at the college has always been a challenging one considering the problems of inadequate tutors and training facilities.
This situation has been a major problem in many nations, not just in Saudi Arabia. For this reason, test scores are conducted together with comparisons of the perceived performance of a nation’s education against other nations. This case has resulted in pushing education to the forefronts of the state level politics. In this context, improvement of education ranks right behind the concerns of health care reforms within any nation, including Saudi Arabia.
Given the intense need to increase the quality of training and preparedness to deal with Battlefield Medicine, the deployment of educational simulation technologies is inevitable at the college if the need to address challenge such as providing health care to people in battlefield such as the current war in Yemen will have to be sufficiently addressed.
However, it is crucial to note that technology does not act in a similar manner with physical mechanisms for improving training in preparing the graduates for Battlefield Medicine. For instance, while smaller classes are preferred for effective learning, using technology to enhance education cannot act in such a similar manner.
Force-field Analysis
Force-field analysis is a strategy for evaluating a decision based on forces that oppose and/or are in support of the decision. To determine whether to proceed with the decision, scores of the force that support or oppose the decision are determined. When compared to the opposing ones, higher scores of supporting forces mean that the decision is appropriate.
Alternately, leaders can focus on seeking strategies for increasing the weaknesses of the opposing forces while at the same time strengthening those that are in support of the decision to ensure that the change is successful (Lewin 2015). The design and implementation of the simulation programmes that can help to increase situational awareness and preparedness of the students for the Battlefield Medicine will involve a change in the manner, which the college has been conducting its training. Change may involve proactive and reactive approaches.
In my place of work, the change arises due to the need of altering the way of preparing students for their future career to prevent the occurrence of a crisis. Crises occur when the volatility of the Middle East region increases such that the need to have medical practitioners who are experienced in the Battlefield Medicine exceeds the ability of the college to train them at once. The transactional or planned change constitutes a key force that drives the necessity of the health care initiative.
In the battlefield, situational awareness is vital compared to gathering tools, weapons, and equipment to face the enemy. Indeed, knowing the enemy’s strategy helps in the development of counter strategy and/or the making of key decisions on the appropriate equipment and weapons to use to defeat the attacker. To this extent, the simulation of battlefield conditions can help to develop the expertise and capacity to evaluate and determine the appropriate strategy for offering medical services in the battlefield.
Considering the increasing instability in the Middle East, especially with the emerging and continuous war in Yemen, the force of situational awareness surpasses any opposing force such as high monetary requirement to provide specialised equipment for technology-enhanced simulations.
Key Findings
As the educational coordinator of the college, I have the responsibility of developing the proposed healthcare initiative. Although students do not graduate as military officers and that this policy cannot change to promote the flexibility of career selection, it is becoming almost inevitable to treat patients in warring conditions. This claim holds considering the example of the war in Yemen in which people, including civilians, are injured.
They need medical attention while in the war-torn areas. This setting may subject the medical practitioners to dangers. Therefore, knowledge and skills in the situational analysis are crucial. This learning cannot be conducted in a real war environment since such a strategy can expose untrained students to high risks and hence the rationale for the need to conduct situational training while preparing the students for Battlefield Medicine.
In the development of the programme and its implementation, effective leadership during change is necessary. Leadership plays the function of identifying any potential crisis and then setting the vision and goals for ensuring that organisations change their business models so that they do not experience the crisis (Bruch & Gerber 201).
Indeed, the new programme will involve increasing budgetary allocation to the department of defence to fund it. This case suggests that effective communication of how and why the funds are required is critical since increasing funds that are allocated to the ministry of defence implies a reduction of monetary allocation to fund other public goods and services. Therefore, to create and sustain stakeholders’ confidence, effective communication is necessary.
Only the educational training coordinator in conjunction with other college top leaders can play this role. Leadership will also help in reducing any hindrance to the success of the project by linking the Saudi Arabian visions of maintaining a healthy and productive citizenry and the need to offer medical services in war-prone environments.
Recommendations
The Middle East region is susceptible to political risks that are presented by the evident instabilities in nations such as Syria, Iraq, Iran, and the conflict between Israel and Palestine. Today, Yemen is also involved in the war. During a military confrontation, whether between two nations or with terror groups, injuries and casualties are inevitable. Hence, offering medical aid in a battlefield environment is unavoidable.
However, the workers who offer the aid need to be secure and aware of the potentiality of the enemies harming them (workers) while executing their work. The best way to train them on how to avoid the danger is through the simulation of the real work environments. To this extent, the proposed healthcare initiative involving the development of a simulation programme to enhance situational awareness and critical decision making/communication skills to prepare new graduates for Battlefield Medicine is highly recommended.
The college should consider implementing the programme through technology-enhanced simulation approaches and/or through virtual patient simulations. Both strategies are recommended since they offer students an opportunity to train on Battlefield Medicine before their exposure to the actual environment. This plan helps to develop the appropriate behaviours that can prevent any exposure to high-risk cases during their work in unstable environments.
References
Bruch, H & Gerber, P 2011, ‘Strategic change decisions: Doing the right change right’, Journal of Change Management, vol. 11, no. 5, pp. 1-99.
Cook, D, Brydges, R, Hamstra, R, Zendejas, B, Szostek, H, Wang, T, Erwin, J & Hatala, R 2012, ‘Comparative effectiveness of technology-enhanced simulation versus other instructional methods: a systematic review and meta-analysis’, Simulation Healthcare, vol. 7, no. 2, pp. 308-320.
Cook, D, Erwin, J & Triola, M 2010, ‘Computerised virtual patients in health professions education: a systematic review and meta-analysis’, Acad Med, vol. 85, no. 11, pp. 1589-1602.
Cook, D, Hatala, R, Bryges, R, Zendejas, B, Szostek, H, Wang, T, Erwin, J & Hamstra, J 2011, ‘Technology–Enhanced Simulation for Health Professions Education: A Systematic Review and Meta-Analysis’, JAMA, vol. 306, no. 5, pp. 978-988.
Cook, D, Hamstra J, Brydges R, Zendejas, B, Szostek, H, Wang, T, Erwin, J & Hamstra, J 2013, ‘Comparative effectiveness of instructional design features in simulation-based education: systematic review and meta-analysis’, Med Teach, vol.35 no.5, pp 844-875.
Gerry, J., Kevan, S & Whittington, R 2005, Exploring corporate strategy: text and cases, Prentice Hall, London.
Kavilanz, P 2011, ‘Healthcare reform stands: how it impacts employers’, Journal of Health Politics, vol.13, no. 2, pp. 113-119.
Lipsitz, L & Reisner, T 2010, The Computer and Education, Educational Technology, Englewood.
Mishra, P & Koehler, J 2006, ‘Technological pedagogical content tent knowledge: a framework for integrating technology in teacher knowledge’ Teachers College Record, vol. 108, no.6, pp. 1017-1054.
Reznick, K & MacRae, H 2006, ‘Teaching surgical skills-changes in the wind’, N Engl J Med, vol. 355, no. 12, pp. 2664-2669.
Woolfolk, A, Winnie, P & Perry, N 2008, Educational Psychology, Pearson Publishers, Canada.
Yizraeli, S 2000, ‘how important is Saudi Oil?’, The Middle East Quarterly, vol.7, no.1, pp 57-64.
Zendejas, B, Brydges R, Wang, T & Cook, A 2013, ‘Patient Outcomes in Simulation-Based Medical Education: A Systematic Review’, Journal of General International Medicine, vol. 1, no. 3, pp. 312-339.
Ziv, A, Wolpe, R, Small, D & Glick, S 2003, ‘Simulation-based medical education: an ethical imperative’, Academic Medicine, vol. 78, no. 8, pp. 783-788.
Health care professionals handle various ethical dilemmas in their course of duty. A case study will show the challenges that health care professionals face in their duty. The case study involves a Jehovah Witness patient who is suffering from a life-threatening medical condition. A black Hispanic pregnant lady in her early twenties is involved in an accident, and she is taken to the Emergency Room (ER).
She had signs and effects of interior bleeding and was encouraged to have a blood transfusion and surgery to save her and her baby. She declined both the blood transfusion and surgery. Her refusal of blood transfusion was because of her teachings and religious inclination towards the Bible. The ethical question raised is whether to respect the lady’s independent decision and go against the set standards of care or to ignore and save her and the baby.
Application of the principles of global health ethics to the dilemma
To address the dilemma presented, there has to be the application of the principle of respect, autonomy, non-maleficence, justice, and beneficence. By applying the virtue ethics, the health care professionals concentrated on the independence of the patient and her right to go by what she believed was the best option for her despite the impending outcomes. The lady was old and of sound mind to make a good decision of not accepting the surgery nor the blood transfusion. Using the principles of health care, the professionals went by the wishes of the patient’s independence of believing her religious teachings. The health care professionals followed the principle of beneficence, which advocates the well-being of individual decisions.
The wellbeing of the patient was more of a spiritual than physiological. The practitioners also followed the principle of non-maleficence. They never inflicted pain or harm on the patient intentionally but opted to respect her wishes. If they violated the beliefs the patient held, then that would amount to causing harm.
The principle of trust and respect was also at play when the professionals acted truthfully to the patient and gave her room to make her own independent decision.
Application of the principles in a different country with different ethical values
Different countries have different ways of dealing with ethical dilemmas. Some countries have laid down guidelines that relate to the treatment of people who are believers of Jehovah Witness. Graham (2011) argues that “in Australasia, specific guidelines for treating pregnant women that focus on stabilizing the patient by using traditional and new treatment modalities to meet patient needs, particularly for Jehovah’s Witnesses or other patients who decline blood transfusions” (p. 104).
The approach towards this case could have been different in countries that have risk management laws. The patient signs a declaration that shields the caregivers and hospital from any litigation arising from their decision to treat a patient without her consent. According to Graham (2011), “to support this protocol, the Society for the Advancement of Blood Management maintains a database of hospitals that provide blood-conserving services in the United States as well as in Canada, Chile, Korea, and South Africa”(p. 79).
Contribution of the principles of global health ethics to positive social change
The principle of health ethics promotes social change by ensuring professionals operate in a just society. This involves respecting the rights and decisions of others, like in the case above. This ensures a just co-existence between parties. The principle of non – maleficence contributes to positive social change by ensuring that a particular procedure will not harm the patient. The principle of autonomy is also important in ensuring positive change that can reduce tension.
According to Christine (2012), “this tension takes center stage in some analyses of the ethics of public health, as when public health policies are placed on autonomy-limiting continua and the fourth and fifth justifications dominate the analysis” (p. 68). The principles should be part of the health care curriculum. Health care educators should include this principles to critical thinking decisions to help amateur and experienced practitioners handle cases like above.
References
Christine, S. (2012). Health Inequalities and Global Justice. Edinburgh: Edinburgh University Press.
Graham, H. (2011). Understanding Health Inequalities. Maidenhead: McGraw-Hill.
In 2014, the US is set revolutionize its healthcare industry. On the 1st of August, the country is expected to make major changes in its healthcare information management system. The change will be marked by the introduction of International Classification of Diseases, Tenth Revision (ICD-10).
The new system will replace the existing ninth revision. All healthcare service providers are expected to have implemented the framework, failure to which they will be denied license to practice. No further grace periods and extensions will be provided.
As a result, the focus of stakeholders in this industry has shifted to healthcare information management specialists. The specialists are charged with the responsibility of spearheading the implementation of the new system.
The ICD-9 code is used in the country’s healthcare system for a number of purposes. For example, it is used to report inpatient procedures and medical diagnoses. The framework provides support for electronic transaction. However, ICD-9 is set to be replaced by ICD-10.
The latter is an improved version of the former. The new system will be introduced on the 1st of October, 2014. It is set to bring about significant changes to the management of healthcare information.
Specialists working in the Healthcare Information Management (HIM) sector anticipate the changes to ‘revolutionalize’ the health industry. There are other developments that are anticipated in the industry as a result of the new system.
They include the introduction of the Health Insurance Portability and Accountability Act [HIPAA] (Sean, 2012).
With the implementation of ICD-10, the HIPAA standard will be upgraded from the traditionally used 4010/4010A version to a more advanced 5010 edition (Centers for Medicare & Medicaid Services [CMS], 2013a).
The new changes are likely to improve the provision of healthcare services, especially with regards to revenue collection and payment procedures.
In this paper, the author is going to look at some of the issues revolving around ICD-9 and the new version, ICD-10. The aim of this paper is to review the future and place of this new system in the American healthcare system.
It is a fact that implementation of the new mechanism is bound to face a number of challenges. Some of them include lack of capacity among healthcare organizations, as well as possible resistance from various stakeholders.
The impacts of such hurdles on the efficiency of the new system will also be reviewed. A total of 35 journal articles were accessed from Google Scholar, Medicaid, and Mediplus databases.
An exclusion and inclusion criterion brought down the number of these journal articles to 13. A thematic analysis methodology was used to review the content of these articles in relation to the topic.
Literature Review
Major issues associated with the adoption of ICD-10 are brought about by the dynamics of the healthcare industry (Dimick, 2010a). Dimick (2010a) arrived at this conclusion owing to the fact that only slightly over half of the organizations operating in the industry have commenced transition to ICD-10 by April 2010.
Dimick used the findings of a survey carried out by the American Health Information Management Association (AHIMA) on April and August 2010.
In this survey, 53 percent of the respondents stated that the organizations they worked in had already laid down plans to implement ICD-10. On their part, 46 percent of the participants had no idea when the process would begin.
Coding experts have expressed concerns that delaying the implementation process will make it hard to beat the set deadline. According to the August survey, inpatient hospitals have been on the forefront in the adoption of ICD-10.
In the study, 62 percent of the respondents stated that their hospitals had already started to implement the system. The study conducted in April revealed significant support for the new system. For example, 56% of the inpatient hospitals had already started using ICD-10.
However, 38 percent of the hospitals had not implemented the system. Out of these, 18 percent stated that they commence in the coming six months, while 41 percent had no idea when the implementation would start (Dimick, 2010a).
The findings made in the August survey showed that progress had been made within a span of four months. Some of the major milestones that had been achieved included upgrading to HIPAA 5010. The system is the new version of the transaction standard to be used with ICD-10.
Additional milestones involved the determination of the organizational structure. Other organizations had already started setting up steering committees to spearhead the transition process. By August 2010, 22 percent of the respondents stated that their organizations were halfway towards full implementation of ICD-10.
However, only 14 percent had indicated the same progress in April (Dimick, 2010b). Failure to meet the 1st August deadline could result in dire consequences, such as denial of services in the healthcare industry. The Centers for Medicare and Medicaid Services (CMS) has stated that no further extensions will be provided.
Implementation of ICD-10 is a complex process that requires the joint efforts of all stakeholders in the healthcare industry. The HIM specialists play a significant role in the implementation of ICD-10. Upgrading the current systems forms the basis of implementing the new coding regime.
The greatest task lies in the software and hardware upgrades. Some components need to be modified or changed to accommodate the new system.
They include office settings, servers, and computers. Additional hardware, such as cables, may also be required. The organizations are expected to consult the vendors with regards to the additional technology needed (Sullivan, 2010).
The implementation of the new coding system will require the joint effort of all healthcare professionals (Averill & Bowman, 2012). The professionals involved in coding, as well as those who perform diagnostic functions, play a significant role in the success of ICD-10.
It is important to note that new codes are made from the existing medical records. As such, the individuals carrying out diagnostic procedures must record their findings in a manner that can be easily interpreted by the HIM specialists.
Such recording will make it easier for the information to be translated into codes. In addition, those carrying out diagnostics must be in a position to interpret the codes generated (Cartwright, 2013).
In most cases, ICD-10 is rolled out over several years. For this reason, the process is characterized by multiple projects that vary depending on the time the implementation is scheduled to occur.
Mini budgets are prepared to cater for each year’s expenses and contingencies. Training coding professionals on ICD-10- CM/PCS should be carried out at least six months before implementation. HIM departments need to set aside resources for education opportunities (Heubusch, 2010).
HIM professionals should receive training on a number of areas, which include project management, application development, and operations reengineering (Bowen, 2010).
AHIMA recommended the last ICD-9-CM update to be made at the beginning of October 2012, which is the end of the Fiscal Year (FY). No updates should be made to ICD-10-CM/PCS for 2013 and 2014 FYs. Planned revisions should only begin in 2015 FY, which commences on the 1st of August, 2014.
Methodology
Databases and Search Terms
Information used to complete the research was obtained from a number of databases. They included Medicaid, Medicare, and Google Scholar. The three were selected as a result of the variety of journals published in them. The first two (Medicaid and Medicare) contain articles that are relevant to the healthcare sector.
The last one (Google Scholar) is characterized by articles covering a wide range of topics. The journals found in these sources are mostly academic and professional. For studies to be published in the journals found in these archives, they have to undergo scrutiny from professionals in the field.
Such scrutiny is meant to ensure that the findings reflected in these articles have been arrived at following a systematic research.
The online libraries are also reviewed on a regular basis to ensure that they contain up-to-date information. As a result, the information found in these sources is relevant to emerging issues in the healthcare industry.
The three databases identified above were considered to be the most appropriate in providing information concerning the implementation of ICD-10. To obtain the articles related to the topic, a number search terms were used. The search words included ICD-9 and ICD-10.
However, the terms generated articles that contained generalized information. As such, more specific key words had to be used. The researcher keyed in the following keywords:
ICD-9 + failures,
ICD-10 + success,
ICD-10 + implementation,
ICD-10 + efficiency.
Inclusion and Exclusion Criteria
At the end of the search process, the researcher came up with a total of 35 journal articles. To complete the research, only 13 sources were needed. The researcher had to adopt an exclusion and inclusion criterion to come up with the final list of sources. The inclusion criteria involved a careful assessment of the articles.
To begin with, the sources selected had to be published in reputable journals. Since the data needed for the research was professional in nature, peer-reviewed journals were selected. In addition, the articles had to be relevant to the topic of the study.
Sources that contained the key terms ICD-10 and ICD-9 were preferred over those that did not. The affiliation of the authors also determined whether an article would be used in the research or not.
The sources authored by scholars associated with agencies and organizations that actively participated in the implementation of ICD-10 were selected. Such organizations included, among others, Centers for Medicare and Medicaid Services.
Articles to be used in the research also had to be recent to provide up-to-date information. Since the study revolved around the American healthcare system, articles to be used had to provide information specific to the country.
The exclusion criteria used in the research was aimed at cutting down the number of articles used from the initial 35 to 13. To begin with, sources providing information about another country other than the USA were excluded. Only data relevant to the American healthcare system was required.
Articles that were more than 5 years old were also excluded from the research. The sources were not used regardless of their relevancy to the topic. As already indicated, up-to-date information was needed to reflect the developments in the field.
As such, recent sources were selected to provide the researcher with information on the progress made in the implementation of ICD-10. Articles from unprofessional sources were also excluded from the research. The researcher was only interested in professional data sources. That is why peer reviewed articles were used.
Data Analysis
The matrix method was used to analyze the data obtained from the sources. Using the matrix analysis, the researcher took into consideration specific themes that needed to be addressed. The researcher was particularly interested with the nature of ICD-9, ICD-10’s predecessor.
The author introduced ICD-9 to inform the audience of the changes they should expect with the new system in the healthcare industry. The researcher also focused on ICD-10 as the ‘much awaited’ system.
Reasons why the new approach should be anticipated were also analyzed. In addition, the researcher focused on the implementation process, the challenges to be anticipated, as well as the agencies and persons required to spearhead the process of putting in place ICD-10.
Results
ICD-10: An Ambitious Program by the Government
From the articles analyzed, it was found that the implementation of ICD-10-CM/PCS will be one of the most expensive activities that the US healthcare industry has undertaken in the recent past (Heubusch, 2010).
For example, a study carried out in 2003 by Robert E. Nolan, a consultancy firm that had been contracted by the Blue Shield and Blue Cross Association, revealed the costs that will be incurred in rolling out the new system.
It was found that it would cost the country between $5.5 and $13.5 billion to implement ICD-10. A further productivity loss of between $752 million and $1.4 billion is also expected.
However, the cost is expected to be higher since the study did not consider the impacts the system will have on nursing homes, suppliers of durable clinical-equipment, clinical laboratories, claims clearinghouses, and third-party administrators in the industry.
The scope of the study was limited to healthcare organizations in general. The individuals carrying it out ignored the fact that the impacts of the new system will go beyond the conventional healthcare firm.
Another study carried out in 2004 by the Rand Corporation for the National Committee on Vital and Health Statistics provided similar estimates.
The study revealed that the cost of adopting ICD-10 will range from $475 million to $1.53 billion. The study also estimated that the benefits associated with the implementation will range between $700 million and $7.7 billion (Bowen, 2010).
ICD-10: The Future of the American Healthcare System
The shift from ICD-9 to ICD-10 will help improve the efficiency of the healthcare system. The improvement will be achieved through the introduction of enhanced data collection tools (Heubusch, 2010).
The enhancements in healthcare services following the introduction of the new system are expected to be realized through the provision of specific information.
Such information will narrow the scope of the healthcare issue under study. The system will also provide medical practitioners with improved diagnosis information to help them deal with diseases affecting the population.
However, for the system to be effective, healthcare centers and organizations must familiarize themselves with the new set of codes. To achieve this, individuals working in these institutions must be adequately trained (Heubusch, 2010).
Education on clinical documentation also needs to be provided to prepare the health practitioners for future challenges likely to be encountered in the coding process.
Through such training programs, the persons responsible for coding will be equipped with the knowledge required to translate the information contained in the medical records. The organizations are expected to develop tools to assess the impacts of the new system.
The tools will help the health institutions to determine the efficiency of the new arrangement. In addition, such mechanisms will be used to determine the ease of recording new information and the efficiency of the system with regards to retrieval of data.
It is noted that healthcare institutions deal with a large volume of data, some of which is confidential. It is important to enhance the safety of such information when archiving it. The aim is to ensure that the information can be retrieved easily, but only by authorized personnel.
The tools develop in line with the new system will a critical role in achieving this objective. They will help the personnel to analyze the security measures undertaken to protect information from unauthorized personnel, as well as its compatibility with the previously used framework (Buckholtz, 2010).
To this end, it is important to ensure that the data is not lost in the process of transiting from the old framework to the new system. The healthcare organizations are also expected to put in place mechanisms to help in prioritizing and mapping out health issues, as well as in training (Sean, 2012).
ICD-10 and Clinical Modification/Procedure Coding System (ICD-10-CM/PCS)
The changes expected in the United States of America’s HIM are necessitated by the need to improve the country’s capability in handling of medical records (Department of Health and Human Services Centers for Medicare & Medicaid Services, 2013).
The new framework that is set to be introduced in 2014 (ICD-10 and Clinical Modification/Procedure Coding System [ICD-10-CM/PCS]), has two major elements. The nature of the two facets sets this arrangement apart from the previously applied system.
The first is the ICD-10 and Clinical Modification (ICD-10-CM). The element is used for diagnosis coding. It is applied in all settings in the United States of America’s healthcare system. Its code comprises of 3 to 7 digits, compared to the traditional ICD-9-CM that uses 3-5 digit codes (Heubusch, 2010).
However, the format of the codes is similar. The second facet is ICD-10 and Procedure Coding System (ICD-10-PCS). It is concerned with the procedures used in inpatient coding. It is only applicable within a hospital setting. ICD-10-PCS uses a 7 alphanumerical digit code.
The coding is central to that of ICD-9-PCS, which uses 3 or 4 digits. As a result, the new system will help to code for a wide range of inpatient issues in the USA compared to its predecessor. The improved capability is one of the strengths associated with this system.
The need for ICD-10 is made apparent from the fact that ICD-9 provides limited information concerning the inpatient procedures carried out in a hospital. The 9th version also provides inadequate data with regards to the health condition of patients. ICD-9 is 30 years old.
It is regarded by many people as an outdated system. It is also inconsistent with the current healthcare procedures in the country. Most of the classifications used in the current system are fully utilized. As a result, it is difficult to code for emerging health issues.
Preparations to switch to the new system began a number of years ago. However, adapting to the new coding environment is likely to pose a challenge to the HIM specialists. It is important to note that many countries have already switched to ICD-10.
However, the US continues to use the old system with regards to morbidity and mortality. The country is different from other developed nations. It is the only one that continues to use ICD-9. Today, over 100 nations are using the new system to complete a number of processes.
For example, it is used to report death cases. Nordic countries were the earliest adopters of ICD-10. They started a 4 year implementation program in 1994. United Kingdom adopted the system in 1995.
ICD-10 has 22 chapters (Heubusch, 2010). Today, service providers in USA use ICD-10 to record mortality data only. They continue to use ICD-9 to record morbidity, Medicaid, and Medicare claims.
Both ICD-10-CM and ICD-10-PCS have not been used before in the USA. Their use will commence on October 1st, 2014, when ICD-10 is expected to be launched.
Implementation of ICD-10 and the Challenges Involved
It is the responsibility of the Department of Health and Health Services (HHS) to oversee the implementation of ICD-10. The implementation deadline has been extended a number of times in the past. For example, the system was to be implemented in 2011.
However, the deadline could not be met due to a number of problems associated with the system. One of the problems associated with its implementation is the fact that its codes are approximately 10 times more than those used in ICD-9 (Heubusch, 2010).
ICD-10 has a huge number of codes. According to Heubusch (2010), the ciphers are approximately 140,000 in total. The American Association of Professional Coders (AAPC) has highlighted this issue. According to this organization, one code can be used to represent a condition and its associated symptoms.
The adoption of ICD-10 also requires transition to HIPAA version 5010. In addition, medical claims made in the past will be converted to ICD-10. Failure to convert these claims will lead to their rejection. As a result, the transition process is expected to affect the diagnosis of persons who were previously covered under HIPAA.
As the deadline approaches, the realization of ICD-10 is likely to be the most important objective in healthcare facilities across the country. Focus is now shifting to HIM specialists who are expected to showcase their level of expertise in guiding the process (Heubusch, 2010).
The ability of the USA healthcare system to effectively implement ICD-10 within the stipulated deadline relies on these professionals. The new system requires a precise electronic medical documentation framework.
For this reason, healthcare organizations need to analyze the transition gaps that exist within their current ICD-9 system to understand what needs to be done to implement ICD-10.
It is important for HIM specialists to work closely with the system vendors to ensure that the available data is not lost during the transition. The vendors should ascertain that their products are ready to avoid delaying the implementation process further. The dealers are also required to use applications of recognizable standards.
They are expected to assist health practitioners when the need arises. The new system should also be tested to understand the issues associated with it prior to the launch. The practice will help the HIM specialists to deal with major problems before the implementation.
Testing prior to the launch of the new system will also ensure that the implementation process will not be further delayed as the new issues are being attended to. It is also important to identify the additional vendor-related costs that may be incurred following the adoption of the new system.
The aim of this is to ensure that the organizations are adequately prepared for any new issues that may arise (CMS, 2013b). HIM specialists are required to identify any adoption and conversion procedures that may simplify the implementation process.
Simplifying the adoption process would help cut on the cost of implementation. Fewer resources would also be required. All employees expected to participate in the process should be adequately trained (Dowling & Wisdom, 2010).
Conclusion
The implementation of ICD-10 is a tough task. It cannot be achieved within a short duration of time. Years of planning are required for the system to be effective. For this reason, the proposed shift from ICD-9 to ICD-10 is anticipated to be a major challenge in information technology (Bowen, 2010).
With a deadline already in place, players in the industry have no option but to make the changes within the stipulated timeline.
Medical facilities that are yet to implement ICD-10 should realize that they have very little time to complete the process (Heubusch, 2010). HIM specialists are required to be conscious when implementing the changes. Mistakes may lead to a crisis in the healthcare industry.
References
Averill, R., & Bowman, S. (2012). Don’t delay implementation of ICD-10. Health Affairs, 31(7), 1650-1650.
Bowen, R. (2010). The reality of ICD-10: The ICD-10 transition can be a success, as long as work starts now. Journal of AHIMA, 81(9), 10.
Buckholtz, R. (2010). ICD-9 transition to ICD-10 diagnostic coding. Otolaryngology – Head and Neck Surgery, 143(5), 716-716.
Cartwright, D. (2013). ICD-9-CM to ICD-10-CM codes: What? Why? How?. Advances in Wound Care, 2(10), 588-592.
Since the beginning of the 1990s, Acibadem Healthcare Group has been in place to deliver high-quality care using the latest innovations and technology (MedRetrieat par. 1). Acibadem Healthcare Group currently occupies a leading place in the Turkish healthcare sector due to its advanced equipment (Trilogy, GammaKnife, CyberKnife, Truebeam STx, Rapidarc), highly-qualified staff, and bold and innovative projects (“About Acibadem” par. 1; MedRetrieat par. 1; “Technology” par. 3). Acibadem Healthcare Group can be considered as one of the moving forces in the Turkish healthcare that is focused on the ongoing development and improvement of the service excellence.
Hospitals of the Group such as Acibadem International Hospital specialize on the provision of health care services specifically for the patients who arrive in Turkey as medical tourists; the hospital is staffed with the professionals who can speak many foreign languages such as Russian, English, Spanish, Kyrgys, and the languages of the Balkans (“International Hospital, Istanbul, Turkey” par. 1). Besides, Acibadem hospitals have been accredited by the JCI (Joint Commission International) global standards for the sector of healthcare (Turkey Health Advisor par. 1). In addition, Acibadem Labmed now has ISO 15189 accreditation level which makes it one of the most influential labs in the region (Turkey Health Advisor par. 1). The Group does not only provide a wide range of high-quality services but also delivers the excellent patient experience and a high level of the client satisfaction.
Acibadem Healthcare Group currently includes 17 hospitals and 13 outpatient centers; the combined size of all the facilities of the Group equals 402000 square meters; it hires 13000 professionals (the number of physicians is 2500) (Acibadem Healthcare Group 7; Patients Beyond Borders par. 1). Moreover, the number of beds in the hospitals is 2146, and there are 98 ORs; further, according to the data of 2013, Acibadem Healthcare Group could accommodate 408660 inpatients (with 110000 surgical patients) and provide care to over 3 million outpatients; it also conducted about 6 and a half million lab tests and over 650000 of radiology tests (Acibadem Healthcare Group 7). Acibadem network spreads to 8 different countries such as Singapore, Brunei, Malaysia, India, and Macedonia among others (“Why Acibadem?” par. 2).
To compare healthcare sectors of the United States of America and Turkey, it is important to identify the overall public health indicators in these countries. For instance, according to the data of 2007, life expectancy at birth in the USA (78.1) is higher than that in Turkey (73.2); however, throughout over three decades since 1970, this number has changed significantly for Turkey (from under 50 years old) and remained almost unchanged for the USA (from over 70 years old) (OECD 6). Life expectancy at 65 is twice higher in the USA population (OECD 16). Infancy deaths are 3.5 times more frequent in Turkey than in the USA (If It Were My Home par. 1). Also, the number of practicing physicians in the USA is 2.4 per 1000 people, while in Turkey it is 1.5, which indicates that the Turkish healthcare is understaffed and the population – underserved (OECD 11). The overall healthcare expenditures are more than twice as high in the USA as they are in Turkey (Anderson and Squires 3). At the same time, the residents of Turkey are almost 84% less likely to become exposed to HIV/ AIDS during the course of their life (If It Were My Home par. 1).
Greenland Healthcare Clinic offers a range of home-based health care services coupled with community based social services to the people of South Carolina. It has been revealed through market research that the region is in dire need of not only the quality healthcare, but also the need for better social services. And as such, it is our belief that by employing well educated and competent staff coupled with organized management, we can become one of the best healthcare agencies in South Carolina. Greenland Healthcare Clinic will be created as a Charleston Limited Liability company based in Charleston County. The office will be based on Main Street in Charleston, Southeastern State of South Carolina.
Greenland Healthcare Clinics’ services will mainly target the individuals who will require the home-based healthcare service providers at their convenience. Our agency will be licensed by the state of Columbia. Currently, there are only two home healthcare clinics in South Carolina which do not offer services to all our target regions. Greenland Healthcare Clinics is integrated as a partnership.
The core founder of Greenland Healthcare clinic, Clement Nitzch, is a renowned health administrator coupled with his social work skills with enormous expertise in social services. The partnership will also incorporate, a non-managing partner, Gustavo Brandao, who will assist with the start-up funding. Greenland Healthcare Clinic will be managed by the clinical directors Veronica Tadivo and Roberto Rodriguez. All the Greenland Healthcare Services will be set in accordance with the existing Medicare Insurance regulations of Columbia.
Company Description
Greenland Healthcare Clinic is an upcoming Home-based healthcare and social service agency. The premise will be based in the heart of South Carolina and will provide the following services: Skilled Nursing, Social Work, Personal Injury Case Management, Nursing Aide and Speech therapy (Home Health Care Services Business plan, 2013).
Market Analysis
The Greenland Healthcare Clinic customer base will be largely drawn from the patients referred by healthcare facilities, physicians and other healthcare professionals. The patients seeking personal Injury Case Management will be basically those who get injured either at work place or those involved in other forms of accident within an organizational structure. The referrals will basically emanate from attorneys in search of case management services for their clients (Home Health Care Service Business Plan, 2013).
Due to the fact that a good number of people living in Charleston, South Carolina are elderly, it therefore prudent for them to stay at home most of the time and get treatment from a nearby healthcare provider, this will avoid continuous movement sometimes for longer distances in search of healthcare services. Greenland’s primary market segment will therefore include those patients who are in their old age; thereby requiring home care services (Washburn Small Business Development Center, 2013)
Organization and Management
Greenland Healthcare clinics’ starting team will consist of a Clinical Director, an Administrative Director and five other employees. Due to the fact that Clement Nitzch is a licensed social worker, he will therefore provide all social health services for the start up stage of the plan, coupled with that, he will also provide most of the administrative directions within the premise. Veronica Tadivo being a registered nurse, she will provide the nursing services and supervising the nursing staff during the initial stages of the business (U.S. Small Business Administration, 2013).
References
Home Health Care Service Business Plan (2013). Executive Summary. Web.
U.S. Small Business Administration, (2013). How to Write a Business Plan. Web.
Washburn Small Business Development Center. (n.d.). Business planning to profits. Web.
CIO and CTO: Fundamental Responsibilities and Key Characteristics
In healthcare, the Chief Information Officer, or the CIO, supervises the work of the IT department. Additionally, the company CIO addresses the issues related to the technology purchasing decisions, as well as the needs related to technology that the staff members may have. Planning and enhancement of the communication processes between the members of the IT department is another role of the company CIO. For instance, choosing the information collected with the help of IT devices from the patient so that the treatment strategy could be defined is one of the possible tasks that a CIO may need to accomplish in the healthcare setting.
The Chief Technology Officer (CTO), in their turn, is preoccupied with designing the corporate policies related to the use of the corresponding diagnostic and treatment technology. Although the CTO may also perform the functions similar to those of the CIO, such as the supervision processes, these are the business-related opportunities and risks rather than the patient-related ones that a CTO manages. For example, in the context of a healthcare service, a CTO may monitor the trends in the contemporary healthcare technology area so that the company could deploy updated techniques and use up-to-date equipment to tend to the patients’ needs.
Although there is a very fine line between a CTO and a CIO, they tend to focus on different areas of the company’s operations. Furthermore, each addresses the needs of the company’s stakeholders from a different perspective (a healthcare one vs. a technological one). However, at the end of the day, both strive to increase customer satisfaction rates.
Recommendations for CIO and CTO: Increasing Patient Satisfaction
The focus on the interoperability of the company’s departments is the most valuable advice that one can give a CIO. While being seemingly self-explanatory, the significance of informational connectivity between the departments of a healthcare service often slips the managers’ minds. As a result, the pace of the company’s operations is slackened down significantly, and the threats of data misinterpretation emerge. The inter-system sharing of the patient’s records, in its turn, is bound to help reduce the number of mistakes to zero, making a range of healthcare processes such as bedside handover simpler and faster. Therefore, enhancing and improving the communication processes occurring in the healthcare organization should be viewed as the primary focus of the CIO. To attain the identified goal, one should consider the specifics of organizational behavior and interpersonal communication in the facility; unless appropriate communication, negotiation, decision-making, and conflict management techniques are utilized in the process, the information management is going to be flawed.
For the CTO, it might be a reasonable thing to be very honest and clear about the technology strategy to the essential company stakeholders, including not only patients but also the investors and the employees. Although including the latter in the list of the people that need to be informed about the corporate technological strategies might seem an obvious choice, it is often overlooked The consequences of the negligence are dire – without a proper understanding of the course that the firm is taking with its IT framework, the employees may misinterpret their roles and responsibilities, therefore, leading to a drop in the healthcare services. The patients, in their turn, also have to be aware of the technological advances that the company has to offer.
Improving Healthcare Processes and Increasing Quality Levels: Tools
Project Roadmap: Key Milestones
Using the project roadmap is the first step toward enhancing the efficacy of healthcare services as the tool in question helps get the priorities straight. Defining the key milestones of a specific process, it introduces order to the relevant processes, helping attain the corresponding goals in an efficient an expeditious manner. The roadmap functions as the tool for assigning healthcare service members roles and responsibilities based on the current priorities of the organization.
Apart from determining the milestones of a specific healthcare process or a project, a roadmap sets the quality indicators that permit an accurate measurement of the personnel’s performance. As a result, the evaluation of the changes in the services quality becomes a possibility.
Finally and, perhaps, most importantly, the project roadmap tool sets premises for a culture change in the context of an organization. In other words, it becomes the impetus for enhancing diversity and convincing the employees to adopt a patient-centered approach in order to cater to the unique needs of the target population (Ulltveit-Moe, 2014).
(i)Six Sigma Model: Quality Assurance
The principles of (i)Six Sigma suggested by Pyzdek and implying the promotion of a consistent quality improvement (Pyzdek & Keller, 2014) are viewed as an indispensable part of the contemporary business processes management in not only healthcare organizations but entrepreneurship, in general. Offering the DMAIC and DMADV frameworks as the foundation for implementing change, the tool serves as the means of promoting change on all levels of the company’s operations. Furthermore, the philosophy of Six Sigma implies that the employees’ attitude toward the idea of service quality should be altered together with the change in the firm’s operations. As a result, the staff members become geared toward a consistent quality improvement.
Data Privacy and Proper Use of Information: What Can Be Improved
Security Gap Analysis: Detecting the Loopholes
The very title of the strategy is quite self-explanatory; the process of data privacy enhancement is carried out by detecting the dents in the current framework and considering the ways of managing the located issues. The array of issues that the specified strategy embraces can be viewed as both the advantage of the approach and its problem. By conducting the gap analysis, one will be able to consider the human factor, the problems with the current organizational behavior model, the issues in the IT environment, etc. However, the analysis will take an impressive amount of time which the company may not have. Furthermore, the necessity to envelop a wide range of areas, such as the OB issues, the IT problems, etc., may have a negative effect on the accuracy of the analysis results (Tse, Schrader, Ghosh, Liao, & Lundie, 2015).
Investing in Information Management Systems
Representing a rather long-term approach, the idea of investing in the development of the future IMS is, in fact, quite sensible. By promoting the IT progress, organizations build the premises for the further enhancement of their IT security and the safety of the corporate data. The outcomes of the IT-related research and the findings thereof may become the basis for creating the IT strategies that will prevent companies from data leakage. Moreover, by developing information systems, firms enable their staff members to grasp the significance of proper information management; as a result, the employees do not make the mistakes that lead to an increase in data vulnerability (Rao, & Gilbertson, 2016).
Training Providers in Using Technology in Healthcare
Recreating the environment in which healthcare providers are most likely to operate when using their IT skills is the most important element of designing high-quality training. Herein lies the significance of simulations as the principal tool for training providers to use the corresponding information technology appropriately. By choosing a simulation as the essential training tool, one is likely to help healthcare providers get ready for the scenarios that they are most likely to face in reality.
It would be wrong to assume that creating patterns for addressing all possible scenarios is the key reason for applying simulations as the training tool. Instead, the identified approach is supposed to help healthcare providers develop critical thinking and resourcefulness required to manage unexpected problems and find original solutions to unique dilemmas that they may face in the context of the target environment. As a result, healthcare experts will have an opportunity to gain flexibility required to address a range of problems and be very creative in locating the solutions to the emergent issues.
Moreover, simulations can be viewed as a perfect means of training the necessary skills in a safe environment. Thus, the participants of the training process may control the process and focus on the issues that cause them the greatest concern. Pausing the training at the points where sensibility is required and speeding it up at the stages that have been drilled well enough allows the participants to work on the aspects that they need to.
Finally, the opportunities for saving some of the financial resources that simulations provide need to be brought up among the definitive reasons for choosing the approach in question. Using creativity, one will be able to design the necessary setting using the minimum of financial resources; as a result, the costs of the training are reduced significantly.
Effective IT Alignment and Strategic Planning Initiatives
BPM COT and IT Processes: Strategic Modeling
Designed specifically to align the essential IT processes with the ones that are related to business, BPM COT is the framework that allows creating a very lifelike simulation. By using the identified software, one is likely to design the model that represents the corporate processes in a very detailed and accurate manner. As a result, the IT elements can be aligned with the corporate ones in a manner as efficient as possible (Aligning IT to the strategic plan, 2013).
Goal Models as the Means of Aligning IT and Business Processes
The concept known as goal models may also serve the purpose of aligning the IT elements and the essential business processes. First, it assigns each member of the organization a particular role that they are supposed to follow, the IT Department being viewed as the implementer of the strategy designed by the Operations Manager in the case in point (Baïna, Ansias, Petit, & Castiaux, 2008). Therefore, whereas the business strategy is interpreted as a driver in the identified philosophy, the IT strategy is considered to be the factor that contributes to the enhancement of the business strategy success.
IT Governance and Its Effects on the Process of IT Alignment
The promotion of IT governance in the company can be viewed as another tool for aligning the IT processes and the ones related to the company’s operations management. By definition, the subject matter is the part and parcel of the enterprise governance, which incorporates a specific leadership strategy and a design of the organizational structure and processes. As a result of the approach mentioned above, CIOs become capable of using the principle of value delivery as the link between the operational management processes and the IT issues.
Pyzdek T., & Keller, P. (2014). The Six Sigma handbook (2nd ed.). New York, NY: McGraw-Hill.
Rao, L. K. F., & Gilbertson, J. R. (2016). Longitudinal engagement of pathology residents: A proposed approach for informatics training. American Journal of Clinical Pathology, 142(6), 748-754.
Tse, J., Schrader, D. E., Ghosh, D., Liao, T., & Lundie, D. (2015). A bibliometric analysis of privacy and ethics in IEEE security and privacy. Ethics and Information Technology, 17(2), 153-163.
Ulltveit-Moe, N. (2014). A roadmap towards improving managed security services from a privacy perspective. Ethics and Information Technology, 16(3), 227-240.
Crossing the Quality Chasm is a comprehensive report dwelling upon the quality of health care in the US, which calls for bridging the quality gap through a drastic redesign of the American health care system. The report provides principles for action that policymakers, health care managers, regulators, doctors, nurses, and other people responsible for patients’ well-being must follow in order to achieve the ultimate goal indicated in the document (Likosky, 2014). Moreover, the report not only criticizes the existing system and sets performance expectations for the century ahead but also suggests particular improvements in six dimensions: patient safety (reducing the possibility of harm), care effectiveness (preventing misuse or underuse of resources), patient-centeredness (improvement of customer service and taking into account patients’ preferences in care decisions), timeliness (reducing wait time), care efficiency (minimizing waste), and equity (eliminating racial and social inequality of health care) (Brilli, Allen, & Davis, 2014). Crossing the Quality Chasm analyzes the causes of the quality gap as well as limitations of the present-day system of health care to come out with a totally different framework for care. It claims that services should be performed at four levels: patient experience, care-giving microsystems, organizations that house and support them, and legal, financial, and educational environment – this would promote evidence-based practice and improve quality that is currently impeded by a lot of adverse factors (Inoue, 2016).
Analysis
The Agency for Healthcare Research and Quality’s 2015 National Healthcare Quality and Disparities Report is an official document recording the country’s progress in eliminating various disparities that currently exist in health care. The major assumptions include the following ones (Radwin, Castonguay, Keenan, & Hermann, 2016):
there has been a considerable improvement in providing access to health care services to people who did not have any kind of health insurance before;
the quality of health care continues to become better;
the overall treatment has been improved with the gradual removal of disparities;
patient safety has been increased, although gaps remain;
care coordination is not given priority;
care affordability is still low;
racial and social care discrepancies persist.
This important information will render assistance in advocating for a disadvantaged patients population as it clearly shows the areas of health care that do not seem to improve in terms of bridging gaps. Thus, it shows the directions of further development. Besides, the report will guide me in the provision of culturally competent care and help initiate programs and campaigns aimed at increasing affordability of health care service to people of low economic status (Austin, McGlynn, & Pronovost, 2016).
The Institute of Medicine’s 2010 and 2016 Future of Nursing Reports are highly significant for re-evaluating the role of an advanced practice nurse in the health care system. Both documents encourage nurses to be more active, efficient, and decisive in the complex health care system and take an active part in the decision-making process. Such reassessment of an advanced practice nurse’s position implies that I would be able to take a leadership role in improving care provision. The system still has a lot of weak points that have to be addressed. Many recommendations from the documents are already reflected in the unceasing process of advancing the profession that is capable of opening new horizons to its representatives. The evidence-based recommendations provided in the report will be very useful not only in providing high-quality care to patients but also in policy-making (Grossman & Valiga, 2016).
References
Austin, J. M., McGlynn, E. A., & Pronovost, P. J. (2016). Fostering transparency in outcomes, quality, safety, and costs. Jama, 316(16), 1661-1662.
Brilli, R. J., Allen, S., & Davis, J. T. (2014). Revisiting the quality chasm. Pediatrics, 133(5), 763-765.
Grossman, S., & Valiga, T. M. (2016). The new leadership challenge: Creating the future of nursing. Philadelphia, PA: FA Davis.
Inoue, M. (2016). Improving quality of care through primary care research. Journal of General and Family Medicine, 17(4), 267-269.
Likosky, D. S. (2014). Clinical microsystems: A critical framework for crossing the quality chasm. The Journal of Extra-Corporeal Technology, 46(1), 33-37.
Radwin, L. E., Castonguay, D., Keenan, C. B., & Hermann, C. (2016). An expanded theoretical framework of care coordination across transitions in care settings. Journal of Nursing Care Quality, 31(3), 269-274.
Some of the common professionals in healthcare sector include nurses, physicians and nurse practitioners. All of them play integral roles within their diverse disciplines. For instance, a nurse plays the role of a caregiver who attends to patients in a caring and passionate manner.
A nurse also facilitates smooth flow of communication between healthcare recipients and a medical doctor. In most cases, nurses teach patients on matters related to healthy lifestyles through client advocating and counseling sessions. The best mode for rewarding nurses lies in the provision of a well equipped nursing environment as well as decent pay.
The first medical officer to be consulted by healthcare recipients is usually a primary healthcare physician. The latter is best suited in issues related to managerial care and cost requirement of medical supplies in a healthcare unit. He/she is also quite familiar with a healthcare environment sue to accessibility and ease of delivery of communication. Better remuneration is a much needed base for rewarding physicians.
A nurse practitioner has an extended scope of clinical duties in various areas of practice. The latter has to be licensed by an accredited nursing body.
A nurse practitioner assesses healthcare recipients who may be either in-patients or out-patients. This kind of assessment entails diagnosis and general treatment of patients. Besides, a nurse practitioner also undertakes data synthesis and analysis of patients as part and parcel of assessment.
In terms of social identity, research studies have unanimously established that individuals have a certain tendency of seeking a sense of belonging in certain groups.
Hence, group identity can be used by all the above disciplines to inject change more effectively. Finally, the best way I can lead, organize and influence a healthcare team is by sticking to the vision of the team, enhancing personal integrity as well as being solution-oriented and proactive.
Many governments today have made it their duty to put in place mechanisms that would ensure their citizenry is provided with an effective and affordable healthcare service. Healthcare is an expensive undertaking that needs proper financial planning.
However, the sector, as the paper reveals, encounters a terrific deal of issues, which include staff and physician issues, cost-related issues, competition, and the drive for technology, just to mention but a few.
Further, as a chief finance officer, the paper gives me a chance to point out the strategies that I can put in place in a bid to curb the aforementioned issues in an attempt to make health care available to the majority without compromising its quality.
Healthcare finance issues
Staff and physician shortages affect the healthcare industry in so many ways. Staff and physicians who can be described here as health professionals are the backbone of the health industry without whom there will be no health industry thus doing away with healthcare.
A logistic regression analysis on staff to patient ratio indicates that more staff per patient in the health industry increases the satisfaction of service provided to patient, as well as by the individual healthcare giver. This increases the patients’ confidence in the healthcare system, which will therefore lead to the patient investing further in the healthcare sector.
Shortage of staff leads to burnout among staff members, as they are overworked therefore leading to a gradual compromise of the service provided (Zhu & Yu, 2012, p. 266). Such outcomes lead to patients losing their faith in the system thus leading to pullouts that will affect the financing of the whole program.
The drive for technology is another issue that affects the healthcare sector together with its financing in a positive and negative manner. Technology, as an industry, evolves every day. With it, it comes with better and efficient ways of solving problems. Improved technology in the diagnostic equipment leads to more accurate diagnostics and exact solutions to a problem.
This leads to increased faith in the healthcare system, which will lead to further investment in the system and thus leading to financial stability. At the same time, technology is extremely expensive, as it leads to escalated costs in the services being provided.
This influences negatively on the financial position of healthcare service providers, as they will also have to raise their premiums for them to stay afloat (Ganz, 2011, p. 111). Such financial implications influence the scope of services provided, as well as the numbers of people who can afford it thus making it both an enhancing factor as well as a limiting factor.
Increased competition is yet another issue that has had an impact in healthcare finance in different ways. Big companies with large capital bases have used their financial power to dominate the industry by developing exceptionally large networks of their businesses within the markets in which they operate.
This follows because their financial capacity and networks enable them to provide cheaper services, and an almost omnipresent presence makes them enjoy the benefits of the economies of scale. To dominate the market, the giant guns make takeover bids for the smaller providers.
The small providers also merge with other small providers to enhance their capacity. Stiff competition has also led to the closure of healthcare providers who cannot compete effectively with others (Cleverly & Cameron, 2011, p. 461). It has also led to healthcare providers seeking further financing through tools such as equity and borrowing to enable them raise enough funds for stability in the market.
Cost issues in the healthcare financing sector are one of the principal factors that affect the industry because the cost is heavily dependent on financing for it to move on. The basic drive of any investor is to make a profit, and if possible, in the shortest time possible. Therefore, when people invest in healthcare, they are there primarily for profits.
The demand for profit, as well as the need to provide a quality service, has to be balanced to come up with a winning situation for the investor and the clients. Reimbursement is a weighty and an urgent issue in healthcare management because healthcare firms provide services for which they are later compensated.
Therefore, reimbursement, as a major component in healthcare, determines whether a firm will be paid for a service that it has already provided, and cannot be retracted. It also determines whether the firm will recoup its money, as well as profits.
Reimbursement in healthcare is a complex issue, as it mostly involves a third party who makes the payment on behalf of the patient way after the patient has received the service. It also involves a complex billing system that varies from one provider to the other (Casto & Layman, 2006, p. 16). A poor reimbursement structure will lead to losses, which can be irrecoverable.
This makes financing healthcare a devilishly tricky matter for investors because any investor will only put his/her money in a system that guarantees positive returns. Therefore, reimbursement will dictate the financing of a healthcare program.
Strategies to Put in Place if I were a Chief Finance Officer (CFO)
As a chief finance officer of a healthcare system, I would come up with measures that would define the different cost areas in terms of service and administrative costs. The service cost would be the cost the firm incurs when it provides a given service to the client, and the administrative costs being the costs of running the firm. Other cost areas would be statutory costs, as well as costs related to credit obligations of the system.
Overhead costs, though coming under administrative costs, are at times higher than expected. Therefore, in my view, the cost should stand out as one of the major costs that the firm might face in the future. Firstly, in a bid to fund the costs, I would commission a research survey that would bring out the cost of providing different services by the different service providers.
I would use the health insurance sector as a potential body besides donors who have the health of others at the center of their minds to fund the costs.
Afterwards, I will come up with a cost that is fair compared to other providers and package it in such a way that it will be attractive to the insurance players at the same time being profitable to my firm. I would also price the services in a way that they would be able to cover the costs of the service that would have been provided. I would also apply for any exemptions and subsidies as provided for by the law.
I would allocate resources based on the following factors: the needs of the system, the availability of resources, and the demand for a given resource, as well as the different needs of the different distinctive groups, if any. Basic needs of the system will be allocated resources, as they are essential to the existence of the system. The demand for a given resource also makes it an integral bit of the system (Ganz, 2011, p. 113).
Therefore, the availability of a given resource will determine how much each group will receive based on the corresponding order. Special groups make a system look different from others thus standing out as a decisive factor too.
As a CFO, I would make a decision on individual capital items to discard or retain depending on the factors at hand. Fixed assets like buildings, which appreciate over time, would not be discarded as long as the geographical position of the asset is still relevant to the business.
Equipment will be discarded depending on the following factors: old machines, which have been broken down and are beyond repair, repairable machines, which are cheaper to replace than to repair, old machines, which are working but are obsolete in the industry, as well as equipment that can disposed before they lose value.
I would invest in human capital and technology, as well as assets that will be relevant to the future functioning of the firm. A competent and adequate work force is essential for the provision of services because healthcare is about service delivery, and, for a system to stand out, it has to have a unique touch, which should be different from the rest in the industry.
Healthcare, like many other industries, is dependent on technology for proper, accurate and speedy delivery of services to the clientele. Investment in assets in strategic areas and locations will also be a consideration.
As the CFO of a healthcare system, I would base my financial prognosis on the capital base of the firm, the budget of the firm, and the different sources of revenue that the firm has been using. The capital base of the firm will allow the firm to plan with a given amount at hand without factoring in outside revenue intervention.
Expected revenue will be based on the different services that the firm will be offering, as well as new services that could be introduced to increase the revenue base (Dechow & Larson, 2011, p. 39).
To prepare the health sector for the future, I would invest in research and development. The bit about research would enable the firm to predict expected trends in the market in a bid to come up with packages that would put it up-to-date in the industry.
I would also enter into partnerships with other players in the industry upon which my organization depends. This is a sure way of securing the market and taking control of the market. I would also negotiate for favorable credit terms from creditors as a way of strengthening the organization’s capital base.
Conclusion
In conclusion, healthcare financing is one of the trickiest components about the healthcare system management, as it is intricate and complicated in nature. Healthcare is a gigantic industry in many countries. It is still growing and extremely dynamic in nature. Many factors that are not or should not be seen as main drivers of this system tend to play a prominent role in dictating the direction the industry is taking
. Factors like technology and administrative systems, which should be secondary, have come up as main factors, which tend to dictate the direction and existence of the system. Planning and forecasting have also come up as significant factors due to their determinant nature of the future of the industry. Without planning and forecasting, the industry would simply come to a halt, as the financial industry is at times unpredictable.
Reference List
Casto, A., & Layman, E. (2006). Principles of Healthcare Reimbursement. Illinois: Ahima.
Cleverly, W., & Cameron, A. (2007). Essentials of Healthcare Finance. New York: Jones & Bartlett Learning.
Dechow, P., & Larson, P. (2011). Predicting material accounting misstatements. Contemporary accounting Research, 28(1), 17-82.
Ganz, R. (2011). The impact of healthcare reform on Innovation and New Technology. Gastrointestinal Endoscopy Clinics of North America, 22(1), 109-120.
Zhu, X., & Yu, L. (2012). Nurse staffing levels making a difference on patient Outcomes: A multi study in Chinese hospitals. Journal of Nursing Scholarships, 44(3), 266-273.