For this assignment, I chose Denver city in Colorado. There are two reasons for this. First, I live in Denver. Thus, I am aware of the current local health care policies at the center of the many discourses within the city hall. Secondly, several health issues in Denver are also being discussed across various Colorado state departments.
Health Issues Discussed on the Web Page
The issues being discussed on the Denver Public Health page encapsulate the necessity to improve the health of the community through environmental assessment and improvement. These estimates are based on three factors: equity, prevention, and the importance of place. Other topics that are also being discussed on the website include access to care, injury prevention, tobacco use, prevention and rehabilitation, healthy eating, maternal health, and behavioral health (Denver Public Health, n.d).
Impact of the Department of Environmental Health
Each of the state departments plays a significant role in the health of Denver residents. However, for this paper, I selected the Department of Environmental Health (DEH), which is critical in the pursuit of better healthcare for the community. More importantly, the department is not limited to the environment but also involves other health-related issues that fall under its jurisdiction. Therefore, the Department of Environmental Health improves healthcare within the city precincts through:
Provision of HIV resources The Denver Office of HIV Resources, which falls within the Department of Environmental Health, invests federal funding for HIV-related care and any other related services. In turn, the resources have significantly reduced the levels of HIV in the city.
Formulation of practical food system policies Naturally, most cities have food issues, and this has an overall impact on the health of the local community. Lack of natural food, for instance, leads to high levels of consumption of junk food, which affects the health of the general populace. However, through this role, the DEH ensures that the local community has access to natural food through its various programs.
The DEH helps in combating tobacco addiction and offers rehabilitation facilities and counseling.
Environmental assessment activities carried out by the DEH is crucial in efforts to conserve the environment.
Finally, health vulnerability in Denver is an issue that needs to be regularly addressed. The Denver Department of Environmental Health helps in the evaluation of heatwaves and advises on how to tackle heat vulnerability (Department of Environmental Health, n.d).
It is important to acknowledge the fact that the DEH does not carry out the stated mandate and programs without external assistance. It collaborates with bodies such as the Denver Community Health Matters, Denver Public Health, and organizations such as Be Healthy Denver.
How Can a Citizen Be Involved?
The role of the community is undeniable in the implementation of policies and programs. Indeed, in order for local policies to work, residents have to be involved. Necessarily, it can be assumed that the driving force behind these undertakings is the community. Without the support of the local population, it would be impossible for these programs to be successful. Therefore, the local community can participate in improving health indicators in their neighborhoods by adhering to health standards, taking part in environmental conservation efforts, practicing healthy eating habits, and volunteering for crucial public health programs. All these will ensure a healthy lifestyle.
Coding is essential for complex systems containing numerous data sets. The Healthcare industry is one such system. The American Medical Association (AMA) maintains and develops the current procedural terminology (CPT) (AMA) that includes the description of codes used in such areas as the provision of medical assistance, surgical intrusions, and diagnostic services (Rouse par.1). The codes are grouped using three categories: category I, II, and III. Considering the areas of the CPT application, the paper aims at describing each area, the differentiation between them, and provides examples.
Category I
The codes from this category are purposed to codify the wide range of medical-related activities in the United States. The Category I codes provide information about the procedures and services that are sufficiently presented and well-grounded in the appropriate literature as well as approved by the US Food and Drug Administration (FDA) (Bowie 52; Sullivan 7). The Category I have the following sections to cover: Evaluation and Management, Anesthesiology, Surgery, Radiology, Pathology and Laboratory, and Medicine ( 2.07: Intro to CPT Coding par. 11). The code includes five digits, and each section has its range. As an example, the following code can be used: the code for management of liver hemorrhage; simple suture of liver wound or injury is 473503 ( 2.07: Intro to CPT Coding par. 20). It is the most extensive category of the CPT codes.
Category II
The codes that belong to Category II are used to supplements the codes from Category I. Such codes have four digits and the letter F in the end, and it is used to provide valuable information that is not available in Category I ( 2.07: Intro to CPT Coding par. 37). They are needed to provide additional information in a particular situation. As an example, the following code can be used: if a doctor records a patients Body Mass Index (BMI) during a routine checkup & use Category II code 3008F, Body Mass Index (BMI), documented ( 2.07: Intro to CPT Coding par. 38). It should be noted that these codes are not aimed at replacing codes from Category I and III.
Category III
The codes that fall into this category are considered as temporary because they are used for the technologies or procedures than only emerge and appear to be new to the health care industry. Such codes are good to be used for collecting information that is utilized to support the decision-making process regarding the addition or removal of new technology to or from the standardized health care provider practice (UTHealth/McGovern Medical School par. 7). In other words, CPT Category III contains the pool of temporary codes that should be removed in 5 years from the moment of presentation in the case the initial code requestors do not want to use the code for further. In this case, it is necessary to propose it to be used as the Category III or Category I code. As an example, the following code can be used: the code for the fistulization of sclera for glaucoma, through the ciliary body is 0123T ( 2.07: Intro to CPT Coding par. 47). Category III codes contain five characters: four digits plus some letters in the end.
Conclusion
Summing, the paper described each area, differentiated between them, and provided examples. The CPT categories of coding cover the needs of the healthcare industry in the correct codification of information, relevant to it. The procedures of coding are regulated by the American Medical Association (AMA).
Issues of patient privacy and confidentiality are of importance for the medical profession since they show healthcare providers commitment to patient advocacy and trust to preserve high standards of care that patients expect from their nurses, physicians, and surgeons (ANA, 2015). In this paper, the scenario of mobile device risks will be analyzed to formulate appropriate strategies for their elimination, discuss the use of mobile devices in healthcare settings, and provide examples for ensuring patient privacy and confidentiality with regards to the use of mobile devices.
In a modern technology-driven society, physicians, nurses, and other healthcare professionals use laptops, tablets, and smartphones in their work (HealthIT, 2014). Subsequently, the use of such devices leads to the exposure to risks such as loss or theft of mobile devices, downloaded malware and viruses, sharing of devices, and unsecured Wi-Fi networks. No matter what device is being used, healthcare providers are responsible for protecting patients health information when accessing, storing, receiving, or transferring it. Common strategies for safeguarding patient information including setting strong passwords, installing and enabling encryption, activating remote wiping or/and disabling, avoiding file sharing applications, introducing a firewall and security software, researching apps before downloading them, maintaining physical control over devices, using security when sending or receiving health data via Wi-Fi, and deleting all stored patient information before discarding the device (HealthIT, 2013).
The use of text messaging to communicate patient information is of particular concern with regards to the issue of privacy and confidentiality in healthcare settings because more than 70% of healthcare providers use text messaging to discuss patients conditions and 54% of them do not address confidentiality problems (Dash, Haller, Sommer, & Junod Perron, 2016). While text messaging can improve relationships between healthcare professionals, increase their productivity, and save time, issues of misuse and interference with the private lives of patients present significant concerns. After a text message is sent, it can be read by an individual to whom it was not intended if poor privacy practices were in place. Because of this, appropriate security strategies are introduced at healthcare facilities. They include double-checking the phone number of the receiver before sending text messages, avoiding using patients names, initials, zip codes, home addresses, or medical record numbers, and limiting the inclusion of sensitive information (e.g., mental illness, substance abuse, sexual assault, child abuse, etc.) (Lyle, 2017).
Personal practices used for protecting patient information include changing passwords every month, updating security software, and acquiring patients consent before sharing information with other healthcare providers. These practices ensure the technology-related security of patient information while addressing patients needs and requirements. If patients do not agree with their health information being transferred through mobile devices, only face-to-face communication will be applied.
If to mention alternative strategies for protecting patient information and confidentiality, disclaimers in text messages can serve as a beneficial practice. The following is the example of such warnings:
Disclaimer: sensitive contents, including patient information protected by federal and state-federal laws. If this message was not intended for you, please note that any distribution or duplication of the enclosed patient information is prohibited.
To conclude, the use of mobile devices in healthcare practice has both advantages and disadvantages. While offering convenience for healthcare professionals, the use of mobile devices is more likely to expose personal information that patients want to keep private. Because of this, strategies ranging from passwords to disclaimers are used for preserving confidentiality.
References
ANA. (2015). Privacy and confidentiality. Web.
Dash, J., Haller, D., Sommer, J., & Junod Perron, N. (2016). Use of email, cell phone, and text message between patients and primary-care physicians: Cross-sectional study in a French-speaking part of Switzerland. BMC Health Services Research, 16, 549.
HealthIT. (2013). How can you protect and secure health information when using a mobile device? Web.
HealthIT. (2014). Your mobile device and health information privacy and security. Web.
Staff turnover rate is among the major determinants of the companys operational effectiveness because it predetermines the chances of successful growth. In general, high turnover rates point to the existence of significant deficiencies in the internal environment, including ineffective employment and training policies and interpersonal relations among team members. However, the most critical consequence of the high turnover rate is the increased volume or operational costs due to the necessity to recruit and train new employees. Therefore, it is essential to develop a comprehensive plan for eliminating or, at least, minimizing the risks of this challenge, thus contributing to the sustainable development of a facility or an organization.
Belmont Village is one of the facilities that have faced this problem. To cope with the existing issues, a focus should be made on developing a detailed sustainability plan as well as identifying clear objectives of the facilitys operation and determine criteria for evaluating implemented changes. Completing these two tasks is the aim of this paper.
Sustainability
Sustainability is a complex phenomenon. It is a unique combination of clear development goals aimed at achieving particular public health objectives (in this case, improving health outcomes of the elderly citizens and making their life more comfortable), links between all members (management, nurses, patients, and other stakeholders) of a particular facility (Belmont Village), and local groups that are not related to the health care sector (recreational parks and organizations, etc.). Due to the complexity of the phenomenon, becoming a sustainable organization is impossible without developing a comprehensive plan of actions paying special attention to the most critical elements of the system (National Center for Chronic Diseases Prevention and Health Promotion, n.d.). The main elements of interest and necessary steps to achieve sustainability in the facility under consideration are outlined below.
Stakeholders (staff, including physicians, nurses, and administrators, patients, and the affected public (e.g. potential employees and relatives of the elderly patients)): create a shared vision of sustainability (identify and increase awareness of the existing issues and offer unique patterns for eliminating them). In this case, it is essential to assure that all key stakeholders are familiar with the very concept of sustainability and know that the facility is interested in becoming a sustainable organization as well as share all plans with key stakeholders so that they are involved in the process (National Center for Chronic Diseases Prevention and Health Promotion, n.d.).
Healthcare business plan: identify clear Belmont Village development goals, including such parameters as the desired turnover rate, patient satisfaction, expenditures, health outcomes, etc., and criteria for evaluating success in meeting the abovementioned determinants. It should as well be communicated to key stakeholders because they are the driver of the potential change.
Technical complexities (connected to the implementation of the sustainability plan): hire a professional sustainability coordinator who knows how to develop production plans and achieving all set objectives (Boone, 2012).
System fragmentation: create a department responsible for developing and implementing the sustainability plan (identify functions of all staff members and communicate them) in order to avoid misunderstandings in the perception of sustainability and ones role in the facility (National Center for Chronic Diseases Prevention and Health Promotion, n.d.).
Teamwork: enhance cooperation among all staff members by creating a favorable environment and satisfying their communication needs as well as focus on the integrity of employees and respecting them (avoid extra work when unnecessary, reward positive accomplishments, foster free communication, etc.) (Boone, 2012).
Individual accountability: design the system of key performance indicators for each staff member and monitor individual performance. The idea is to motivate the employees to become involved in improving their performance by rewarding the most productive ones (Boone, 2012).
Leadership styles: make a focus on transformational leadership style because it is commonly associated with positive changes as well as guarantee that a leader is a person with adequate skills and background and the leaders position is official in the facility so that their decisions are formal and obligatory (Boone, 2012).
Goals, Objectives, and Evaluation
The sustainability framework is inseparable from setting clear objectives for future development. Because the major problem is the high turnover rate, all goals should center on eliminating this particular challenge. To begin with, it is essential to state the main goal of Belmont Village is to satisfy all needs of its residents so that they live comfortably and prosper. The central objective is to reduce the turnover rate so that there are always enough professional people to address residents peculiar needs and deliver care. It is associated with a range of smaller objectives that are provided in Table 1 below.
Table 1. Belmont Village objectives
Belmont Village
GOAL: to satisfy all needs of the facilitys residents so that they live comfortably and prosper
Objective 1
Objective 2
Objective 3
The direction of change (reduce/increase)
Increase
Reduce
Increase
Area of change
Employee satisfaction with the working environment, including remuneration for work, opportunities for communication, and self-development options
The turnover rate during the probation period and after starting working on ones own
Employee involvement and devotedness
Describe the target population
Professionals hired by Belmont Village (physicians and caregivers)
Degree of change to be measured (based on the current 40% turnover rate)
25% increase
25% decrease
25% increase
Specific time frame (month, year)
May 2017 to May 2018
May 2017 to May 2018
May 2017 to May 2018
Putting it all together
Increase employee satisfaction with the working environment, including remuneration for work, opportunities for communication, and self-development options, by 25% among all professionals hired by Belmont Village (physicians and caregivers) by May 2018.
Reduce turnover rate during the probation period and after starting working on ones own by 25% among all professionals hired by Belmont Village (physicians and caregivers) by May 2018.
Increase employee involvement and devotedness among all professionals hired by Belmont Village (physicians and caregivers) by May 2018.
Determining development goals and objectives is incomplete without identifying criteria for progress evaluation and the procedures for collecting and analyzing data. The proposed evaluation plan is provided below.
Criteria: decreased turnover rate, increased employee satisfaction, and increased employee involvement and dedication;
Data collection: employee attitudes analysis (strengths and weaknesses of the existing working environment);
Data collection procedures: caregivers and physicians will complete surveys and give interviews;
Responsible for data collection: HR and sustainability departments
Frequency of data collection procedures: surveys collected regularly to avoid the increase in the turnover rate (every 30 days) and interviews conducted with employees who decided to quit.
Collection methods:
Subjective (qualitative data, such as individual perceptions of the working environment);
Objective (quantitative data, such as turnover rate);
Surveys filled by physicians and caregivers and interviews with those who decided to quit;
Observation of interpersonal communication patterns.
While healthcare services are an essential requirement for all members of the population, the children placed in foster care need it especially badly because of the neglectful or abusive treatment that they used to receive from their previous caretakers.
Particularly, it is essential to enhance the importance of the caretakers role in both the provision of the necessary healthcare assistance to their foster children after the people in question become legal guardians of the children and maintaining consistent observation of the latters health status in order to address the emergent issues in a timely fashion. Seeing that the goals above require addressing several domains, including the management issues, getting the priorities straight, and promoting awareness about the subject matter, it will be necessary to create a comprehensive program that will serve as the foundation for meeting the needs of children in the foster care environment.
Current Issues and Priorities Identification: The US Setting
Management
A closer look at the recent trends in healthcare (particularly, the tendencies observed over the past 15 years, i.e., 20002015, need to be brought up) will disclose that there is a significant drop in the number of children requiring foster care). Therefore, the management strategy could be altered slightly so that the quality of the services provided to each child individually should increase.
Given the current trends in the foster care department, one might suggest applying the concept of an individual approach in lieu of the current general one. The given requirement can be justified by the fact that the background of the members of the foster care system has been turning increasingly diverse over the past few years, including the social status of the families, their ethnic and racial background, etc.
Another essential aspect of healthcare-related management concerns prioritizing the steps that need to be taken in order to manage the identified health issues. To be more accurate, the framework that will allow healthcare employees to get the priorities straight and manage the identified problems according to their urgency should be considered. In this respect, the tools currently used for the patient data management must be revised: Communication is also impaired because of the lack of systems for information sharing and data management (Szilagyi, Rosen, Rubin, & Zlotnik, 2015, par. 70). One must bear in mind that the adoption of the proper communication tools is imperative for the improvement of the current healthcare services provision in the foster care setting.
Ethics
As far as the ethical concerns go, the current US foster care setting presupposes addressing the problems such as the limitations in treatment provided for children, the treatment conflict, and possible surrogacy issues. The current guardians of foster children, therefore, are supposed to receive the information about the specific issues that children may have during the provision of the required healthcare services. For instance, the intolerance to certain medication, the previous health records, etc. need to be provided by legal guardians of the child and taken into account by the healthcare service members.
Culture
In case the children have a cultural background different to the one of their foster parents, the latter should be required to research the cultural specifics of the children in their care. The measure above is critical to the understanding of the health issues that the children have and, therefore, manage the emergent problems in a more efficient manner. According to a recent study, The long standing problem of racial disproportionality and the growing diversity of children in foster care require that the child welfare system make concerted efforts to ensure that all children are treated fairly and receive culturally competent care (Bass, Shields, & Berghman, 2014, par. 47). Therefore, it is essential that the corresponding cultural issues should be taken into account when managing certain healthcare problem.
Human Resources
The issue of human resources is also rather topical in the present-day foster care environment in the U.S. As recent reports say, the lack of knowledgeable and resourceful staff that will help address the needs of foster children is evident (). It is imperative, therefore, to facilitate the environment, in which the quality of services could be improved. Particularly, the HR department could design training courses that will allow the foster care members acquire the corresponding competencies within a relatively short amount of time. Particularly, the emphasis on the adoption of the emotional-intelligence-related skills must be placed (Pascual-Leone, Paivio, & Harrington, 2015).
Financial Management
Although the foster care department receives the necessary funds, the adoption of the strategy that will allow allocating the existing financial resources in a more efficient manner is required. Particularly, it is crucial that the approach of receiving funds from the corresponding sources should be simplified. In addition, the instances of financial fraud must be prevented in the designated environment, which a system of regular audits can facilitate (Lash, n. d.).
Culminating Knowledge: Synthesis and Summary
Foster care children represent a unique and very diverse group of patients for the U.S. healthcare system. As a result, the approach to be adopted to treat the target audience must be patient-based, with a detailed analysis of the cultural and social background of the children, their previous health record, the environment, in which they used to live, etc. However, at present, the provision of the services identified above is barely possible because of the lack of focus and the wrong order of priorities in the foster care management.
The current management of the foster care issues concerning the provision of healthcare services leaves much to be desired. Because of the lack of competent staff and numerous loopholes in the contemporary regulations, children suffer from inconsistent and inadequate healthcare services. Therefore, a mass campaign aimed at raising awareness together with training courses for the staff members must be designed. In addition, a redesign of the ethical foundation of the current foster care system must be conducted so that the members thereof should realize the gravity of their choices and the role that they play in childrens lives.
Conclusion: Further Improvements in the US Foster Care
The process of improving the current U.S. foster care setting and especially the healthcare services provided to the children living in foster care requires considering the problems faced from several viewpoints, including the managerial, the organizational, and the informational ones. In light of the fact that children living in foster care often come from abusive families and, therefore, must have developed severe physiological and/or mental issues, they need both immediate treatment and consistent observations in the future.
Hence, it is imperative that a program addressing the lack of awareness on the corresponding issues regarding the provision of healthcare services to foster care children should be created.
Reference List
Bass, S., Shields, M. K., & Berghman, R. E. (2014). Children, families, and foster care: Analysis and recommendations. Children, Families, and Foster Care, 14(1), n. p. The Future of Children.
Pascual-Leone, A., Paivio, S., & Harrington, S. (2015). Emotion in psychotherapy: An experiential-humanistic perspective. In D. Cain, S. Rubin, K. Keenan (Eds.) Humanistic psychotherapies: Handbook of research and practice (2nd edition) (pp 1-46). New York, NY: Routledge.
Szilagyi, M. A., Rosen, D. S., Rubin, D., & Zlotnik, S. (2015). Health care issues for children and adolescents in foster care and kinship care. Pediatrics, 136(4), n. p. AAP Gateway.
Sepsis is one of the main healthcare problems at a global level (Aitken et al. 2011; Angus & van der Poll 2013). Though the level of mortality has considerably decreased during the last decade, this problem still bothers many people (Maloney 2013; Stevenson et al. 2014). Septic shock is an outcome of organ dysfunction that is usually caused by a dysregulated host response to an infection (Singer et al. 2016). The case of an 18-year-old student admitted to the ICU in shock after a five-day illness will be used to discuss organ dysfunction that leads to septic shock.
Sepsis Definition
Many people cannot notice when an infection reaches their body (Kopterides, Mayr & Yende 2016). Though the human immune system aims at protecting against illnesses and infections, it is not always possible for the body to develop a necessary response (Hutchins et al. 2014). When the body omits the infection, the immune system releases chemicals into the bloodstream to protect the body.
However, inflammation is caused, and sepsis occurs. According to Dellinger et al. (2012), sepsis is defined as a systematic host response to the infection that may lead to severe sepsis that is characterized by sepsis-induced organ dysfunction or shock that is explained as sepsis-induced hypotension that exists even if adequate fluid resuscitation is observed. Sepsis may be an infection that is characterized by fever (when the temperature is higher than 38.30C), hypothermia (when the temperature is lower than 360C), tachypnea (when abnormal rapid breathing is observed), and altered mental state. Certain attention should be paid to the arterial blood gas results and the chemical picture of the patients blood.
In this case, the patient has a low pH level (7.23 compared to the norm of 7.35-7.45) and low HCO3 (17mmHg compared to the norm between 24-32 mmHg) (Mohammed & Abdelatief 2016). These results prove metabolic acidosis in the patient. It is the condition when kidneys are not able to remove the necessary amount of acid from the body, and the concentration of serum hydrogen ion increases extensively.
A suspected infection should be checked in terms of the following aspects: the heart rate is more than 90 bpm, the respiratory rate is more than 20 bpm, and the number of white blood cells is more than 12,000 per mm3. In this case, the patient meets all these criteria for sepsis during the first day of admission to the ED. His heart rate was120 bpm that was higher than normal. His respirations were between 16 and 32 bpm that was also higher than usual.
Finally, using the blood picture introduced in the ED, the number of white blood cells was also extensive (22,660 per mm3). At 1300 day 1, this patient met the criteria and was provided with aggressive fluid resuscitation with Dext Saline, Adrenaline, and Morphine. The next 1400, Albumin 4%, and Milrinone were added. A triple-lumen internal jugular CVC was placed as a part of emergent therapy that had to be offered to the patient in order to save his life.
It is also necessary to mention additional symptoms of severe sepsis observed in the patient. The skin was mottled without petechiae, and the extremities were cool and clammy with peripheral cyanosis. The level of lactate was 4.2. Dellinger et al. (2012) identify these two factors, lactate concentration, and skin perfusion as important symptoms of sepsis. Taking into consideration the lab results and observations obtained during the first five days in the ED and the ICU, it is possible to admit that the condition called septic shock has to be thoroughly discussed and explained in this paper.
Septic Shock
Septic shock is the condition that occurs in the body when sepsis promotes the development of circulatory abnormality. It is a considerable drop in blood pressure caused by a complex nature of interactions between the pathogen and the immune system. If there is no possibility to obtain a normal physiologic response and localize the infection, the activation of the host mechanism promotes pressure.
In its turn, such pressure may lead to the failure of the work of respiratory organs and death. In the United States, many people die because of septic shock and the impossibility to predict and prevent this condition in the majority of patients. The symptoms of septic shock, including fever, hypothermia, fast heart beating, and rapid breathing may occur in several seconds or hours, and even the most professional medical workers can do nothing to help such patients. Septic shock is characterized by persistent arterial hypotension (Aitken et al. 2011). It may be caused by different infections, including the problems with the lungs, the urinary tract, and the reproductive system.
In the case under analysis, the patients data can be used to prove septic shock as the main diagnosis. During the examination in the ED, the patient looked sick. He was vomiting and suffered from tachypnoea. His respirations were from 16 to 32 beats per minute. Low blood pressure (140/60) in addition to tachycardia and the cough caused by the infection can be used to support the fact that the patient was in shock. A chest X-ray made in the ED proved the presence of inflammation in his lungs.
Chest X-ray in the ICU showed fluid in the lungs. Sepsis and septic shock cannot be neglected. The presence of septic shock requires immediate actions against bacteria to achieve administration by means of taking antibiotics in a short period of time.
Organ Dysfunction Analysis
The analysis of organ dysfunction is based on the lab results and the physical examination. The patient had a low level of pH proving the presence of metabolic acidosis and a poor work of kidneys. It is possible to say that renal dysfunction was caused by hypoperfusion or aggressive resuscitation at the early stage of treatment (the patient was given Dext Saline and Albumin). According to the Surviving Sepsis Campaign (Dellinger et al. 2012), it is necessary to measure lactate and glucose levels in patients with sepsis. The patient had high levels of glucose (11.5) and lactate (10.4) that could be used to diagnose hyperglycemia and prove renal dysfunction again (Yoo et al 2014).
Fluid overload leads to mortality because of the presence of microbes with their possibility to devastate kidneys. With the help of chest X-rays, lung infection was identified. This type of respiratory dysfunction signalizes the possibility of bacterial gas exchange. At 0600 day 2, the level of aspartate transaminase and alanine transaminase were high proving liver damage. A high level of CK on that day (21,956) informs about heart/muscle damage. Regarding the fact that the patients primary complaint was myalgias, muscle dysfunction was observed.
Conclusion
In general, the condition of an 18-year-old boy was poor. Being delivered to the ED, he was treated aggressively to stop the growth of the infection. Such a decision was a crucial point in this five-day treatment proving that one ordinary disease that can be treated with the help of properly chosen medications may become a serious health problem that puts human life at risk.
Reference List
Aitken, LM, Williams, G, Harvey, M, Blot, S, Kleinpell, R, Labeau, S, Marshall, A, Ray-Barruel, G, Moloney-Harmon, PA, Robson, W, Johnson, AP, Lan, PN & Ahrens, T 2011, Nursing considerations to complement the surviving sepsis campaign guidelines, Critical Care Medicine, vol. 39, no. 7, pp.1800-1818.
Angus, DC & van der Poll, T 2013, Severe sepsis and septic shock, New England Journal of Medicine, vol. 840, no. 9, pp. 840-851.
Dellinger, RP, Levy, MM, Rhodes, A, Annane, D, Gerlach, H, Opal, SM, Sevransky, JE, Sprung, CL, Dougas, IS, Jaeschke, J, Osborn, TM, Nunnally, ME, Townsend, SR, Reinhart, K, Kleinpell, RM, Angus, DC, Deutschman, CS, Machado, FR, Rubenfeld, GD, Webb, S, Beale, RJ, Vincent, JL, Moreno, R 2012, Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, Intensive Care Medicine, vol. 39, no. 2, pp. 65-228.
Hutchins, NA, Unsinger, J, Hotchkiss, RS & Ayala, A 2014, The new normal: immunomodulatory agents against sepsis immune suppression, Trends in Molecular Medicine, vol. 20, no. 4, pp. 224-233.
Kopterides, P, Mayr, FB, & Yende, S 2016, Understanding the sepsis mortality belt: time to buckle down!, Annals of Translational Medicine, vol. 4, no. 16, pp. 319-320.
Maloney, PJ 2013, Sepsis and septic shock, Emergency Medicine Clinics, vol. 31, no. 3, pp. 583-600.
Mohammed, HM & Abdelatief, DA 2016, Easy blood gas analysis: implications for nursing, Egyptian Journal of Chest Diseases and Tuberculosis, vol. 65, no. 1, pp. 369-376.
Singer, M, Deutschman, CS, Seymour, CW, Shankar-Hari, M, Annane, D, Bauer, M, Bellomo, R, Bernard, GR, Chiche, JD, Coopersmith, CM, & Hotchkiss, RS 2016, The third international consensus definitions for sepsis and septic shock (sepsis-3), JAMA, vol. 315, no, 8, pp. 801-810.
Stevenson, EK, Rubenstein, AR, Radin, GT, Wiener, RS & Walkey, AJ 2014, Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis, Critical Care Medicine, vol. 42, no. 3, pp. 625-631.
Yoo, DS, Chang, J, Kim, JT, Choi, MJ, Choi, J, Choi, KH, Park, MS, & Cho, KH, 2014, Various blood glucose parameters that indicate hyperglycemia after intravenous thrombolysis in acute ischemic stroke could predict worse outcome, PloS one, vol. 9, no. 4, pp. 105-128.
A well-functioning healthcare system is critical for every country because it ensures that the population has access to various professionals and resources required for health and wellbeing. The delivery of healthcare services is a planned procedure, which is organized by the peoples needs and characteristics. In the UAE, this process started in the middle of the 20th century when a small healthcare center was created in the Al Ras area of Dubai.
This small center later turned into the Al Maktoum Hospital. The ruler at that time, Sheikh Saeed bin Rashid Al Maktoum, led the hospital to success, which was noticed by an American mission in Muscat. Their relationship started in the 1960s and was followed by the creation of new healthcare establishments throughout the UAE. Even though the development of the healthcare system started in the private sector, public facilities also became available in 1970 (Ali, 2016).
The healthcare system in the UAE operates under regulations provided by governmental bodies and is funded by them (The Economist Intelligence Unit, 2015). Mainly, these regulations are set by the Ministry of Health, Ministry of Finance, Federal Health Insurance Authority, Dubai Health Authority, and the Health Authority Abu Dhabi (US-UAE Business Council, 2014, p. 1). Beyond these agencies, the country also closely cooperates with several U.S. organizations, which provides an opportunity to create new jobs and enhance economic conditions.
In general, healthcare systems are divided into groups depending on the territory in which they operate. In this way, the Emirate of Abu Dhabi operates under the General Authority for Health Services, which is now known as the Health Authority Abu Dhabi and SEHA. This agency provides the population with a comprehensive health insurance program. The Emirate of Dubai cooperates with the Dubai Health Authority, the Dubai Healthcare City, and the Ministry of Health (Bell, 2015, par. 15). Even though the insurance plans differ within the country, they are likely to become universal at some point in the future.
Quality Improvement in UAE Healthcare
Currently, the government of the UAE is seeking to improve the quality of healthcare in the whole country. To reach this goal, the Ministry of Health has emphasized the need for facility accreditation. Ministry officials have stated that all healthcare facilities, both private and public, should obtain accreditation to prove their compliance with international healthcare standards (UAEinteract, 2013).
In trying to enhance the quality of healthcare delivery, the UAE has begun to pay much attention to various aspects that have a substantial influence on the countrys healthcare systems. In this way, the government has examined opportunities for infrastructure improvement as well as the possibility of advanced supply approaches. Thus far, the emphasis has been placed on human resources so that professionals can receive appropriate education, reach higher performance results, and enhance peoples health outcomes. The UAE actively uses new IT technologies and e-services to streamline related procedures and reduce the number of errors in healthcare delivery.
Today, the medical staff is expected to have not only job-related skills but also to have those characteristics needed for decent teamwork, such as leadership and followership. Healthcare facilities apply patient-centric care, develop more metrics for their standards, and maintain frequent safety and quality measurements, all of which provide an opportunity to identify areas of improvement. To improve its healthcare system and make it exemplary, the UAE government funds different programs and carries out hundreds of audit visits to assess the situation (Oxford Business Group, 2016).
References
Ali, S. (2016). Origins of health care in the UAE. Web.
Staffing ratio refers to the number of healthcare providers per patient in a health facility. The term can also be used to define the differences regarding staffing per patient between hospitals. There have been heated discussions on the introduction of staffing ratio mandates nationwide over the last decade. While a universal staffing ratio mandate is yet to be agreed upon, several states have taken the initiative of introducing the said mandates within their precincts.
California, for instance, was the first state to order staffing ratios mandate through a series of legislation. Other states that have passed staffing ratio mandates are Arizona, Florida, Hawaii, Iowa, Montana, Connecticut, Missouri, New Jersey, New Mexico, New York, Ohio, Virginia, and West Virginia. It is important to note that there still exists a gap between the introduction and legislation of these mandates and their subsequent implementation. Among the stated states, California is the only one that has successfully implemented staffing ratios mandates.
Staffing mandates should be made an absolute necessity. Studies conducted to assess the impact of staffing ratios have proved that there is a causal relationship between the quality of care provided by Health Service Organizations (HSOs) and overall patient outcomes. The essay will prove that having staffing ratios in legislation will provide substantial grounds for the setting of medical standards and auditing.
History of Staffing Ratio Mandates
Staffing ratio mandates can be traced back to the 60s and 70s when nurse staffing requirements were determined through work sampling. Under this system, an independent observer inspected each unit to assess the tasks being done by each nurse. A productivity scale was created for each shift and the performance of the nurses working in that shift rated. After that, the number of hours worked was divided by the average census in that shift to generate hours per patient shift (HPPS). Further, the HPPS was factored by the productivity percentage of each nurse (skill level) and added to a factor of 1.15, which accounted for the personal time, fatigue and delays encountered (PFD).
The system evolved in the 90s to a more broad-based policy that sought to measure the workload of each. After years of sampling and workload measurement with nurses as the agent factor, and the patients as the affected factor, it was noted that there was a relationship between patient staffing levels and the outcome of patients. This realization, coupled with labor unions in California, which had located a favorable environment to agitate for job security, gave rise to the staffing mandate discussions statewide.
Current State and Stakeholders
Currently, very few states have passed legislation on staffing ratio mandate with discussions on a possible universal staffing ratio mandate still ongoing (Mandated Nursing Ratios, 2005). On the same breath, there is a national campaign to accurately define the nurse staffing ratios on both federal and state levels. Examples of current legislation under discussion include:
The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (S.1063) ( Schakowsky and Brown, 2017) This bill seeks to have a minimum number of nursetopatient ratio for each hospital unite established. Additionally, it outlines requirements to have acute care facilities provide RNs based on the acuity of the patients presented.
The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R.2392) ( Schakowsky and Brown, 2017) The bill recognizes the difficulty nurses face in their workplaces. Arguably, nurses go through tough situations in an attempt to provide optimum care. According to the statement, the solution to this conundrum is to enforce a mandatory staffing ratio to ensure that each nurse works to the best of their ability without being overwhelmed.
Also, the American Nursing Association has proposed Federal RN ratios that should be implemented nationwide to promote quality care ( National campaign for safe RN-to-patient staffing ratios, n.d).
Legal and Healthcare Relevance
Legal Relevance
Having a standard nurse staffing ratio is crucial in enforcing legal compliance in most of the healthcare organizations. From a legal perspective, a standard nurse staffing ratio provides both the state and federal governments with the legal grounds to ensure that the right care is provided within health service facilities compliance is a crucial factor concerning medical facilities. On the same note, it also ensures that Americans have access to quality care.
Currently, there are limited legal statutes on the staffing ratio mandates. In turn, the local and national governments are unable to facilitate proper care within HSOs. Federal regulation requires that health organizations certified to provide medical care have adequate numbers of licensed nurses, and other healthcare personnel to provide care to all patients as needed. On the same note, supervisory and staff personnel for each department or nursing unit should be accorded to ensure immediate availability of a nurse for bedside care of any patient when required.
The stated federal requirement can be considered ambiguous given that it does not provide specific parameters with regards to the standard staffing ratios. Adequate is a vague term. Each facility can interpret it from a personalized perspective. Thus, a legal conundrum can arise.
Several things can be used to make a legal standard as opposed to the federal blanket requirement. The California legislation on staff to patient ratio can be used as an example. The Health and Safety Code (n.d, 1276.45(A)) states that for long-term units, the ratio for each of the four support staff divisions described, should not be less than 1 to 25 residents. Further, nurse staffing to patient ratios for these specific units ought not to be less than one registered nurse (RN) or at least a psychiatric specialist for each of the patients in the unit during the day. During the night, each of these groups is required to have at least one RN or a psychiatric technician for 12 residents during the night time shifts.
Currently, the intensive and critical care units in Californian healthcare facilities have an RN to patient ratio of 1:2. Additionally, operating rooms are required to have a ratio of 1:1 while antepartum units have ratios of 1:4 ( The importance of the optimal nurse-to-patient ratio, 2016). The stated is an exact representation of precise legal standards. However, many health facilities in the state do not have the required standard numbers.
Hence, having a national legal requirement that is well defined and clear will be crucial in enforcing federal legal statutes in the country. In essence, the nurse staffing ratio mandates would ensure hospitals adhere to federal regulations strictly. Also, the mandates will provide a legal ground over which audits of the facilities will be conducted from time to time in a bid to enforce compliance.
Healthcare Relevance
Empirical evidence shows that a relationship between staffing ratios in healthcare organizations and the quality of care provided therein exists. In facilities with a balanced nurse to patient ratios, the patient outcomes have always been desirable. McHugh and Ma (2014) established a link between the burnout and poor patient outcomes. Nurse burnout is as a result of low staff numbers. The stated leads to straining, lack of rest and subsequently inadequate service provision. It is important to note that burnout can be physical and psychological (compassion fatigue).
Research conducted in the US showed that 3.7% of inpatient cases occasionally lead to adverse events. Further, the study indicated that there is an error in 1 out of 20 prescriptions (Hall, 2016) due to health care worker negligence. In essence, for a nurse to provide quality and desirable care a broad spectrum of personal factors such as career satisfaction, happiness, and absence of depression should be considered.
It can be argued that hospitals need to improve their staffing ratios. Balanced degrees of the nurse to patient ratios help in job specialization and division of responsibilities. Thus, by facilitating desirable nurse staffing ratios and those of other healthcare workers, healthcare providers will be able to reduce nurse burnout, promote job satisfaction and improve the quality of care within their facilities (Lee, 2017).
Mortality levels have been associated with the level of staffing in medical facilities. According to Shekelle (2014), there is adequate evidence to suggest that a significant number of deaths that occur during hospitalization have been prevented due to the provision of more personalized nursing care. The provision of a more customized care is only possible in organizations with an adequate number of nurses. With a high number of nurses to patient ratios, hospitals can afford to ensure that each nurse is assigned a particular patient.
Suffices to mention, nurse to patient relationships are an essential factor in the healing process. Additionally, patient-clinician relationships are both emotional and cognitive. While emotional care involves mutual trust, respect, empathy and acceptance, cognitive care encapsulates sharing of patient medical, educational and family information, which is all critical for the care process (Kelley, 2014).
Systematic reviews and meta-analyses of randomized controlled trials (RCTs) have shown that a relationship between the patient and the care provider can have a significant impact on the outcomes of the patient. The connections have been instrumental in the reduction of the healing timelines and ensured completion of treatment. Kelley (2014) avers that while the datum derived from these studies is statistically insignificant, it meets the assumptive criteria. The stated personal relationships are easier to create when the number of patients assigned to a nurse is manageable.
Important to state, evidence-based practices (EBPs) are an integral part of modern medicine (Fiset, 2017). However, studies show that the most significant challenge to the application of EBPs in most medical facilities is the inadequate time for medical staff, especially nurses. Going through these EBPs, understanding and implementing them requires time. Due to low nurse staffing numbers, it becomes almost impossible to train the nurses on the EBPs. Therefore, to ensure that medical staff has the time to apply EBPs, their numbers must be improved as they will help ease tasks involved affording every person time.
Nurse staffing ratios have an impact on the quality of healthcare provided in medical facilities. The linkage, therefore, implies that for American medical organizations to realize optimum and ideal healthcare levels, they must ensure there is an adequate number of staff within their facilities. Standard staffing levels help improve the quality of care, reduce mortality rates and facilitate the creation of professional and efficient patient-clinician relationships.
Conclusion
Staffing ratio mandates are an essential part of the American healthcare system. To understand the essence of having a universal staffing ratio mandate, it would be crucial to consider the rationale for some of the global systems within the US such as the Patient protection and affordable care act. One of the reasons for the adoption of the Patient Protection and Affordable Care Act of 2010 was to ensure that there is a universal system that creates a visible pathway to a healthy American society.
With a comprehensive system, it becomes easy to set standards and enforce federal and state statutes. It, therefore, justifies the implementation of a staffing ratio mandate for all healthcare organizations to ensure that the services being provided in these healthcare facilities are within the required standards. A universal staffing system will be instrumental in reducing instances of medical errors, never and adverse events and promote healthy patient-clinician relationships as the members of staff have more time to spend with their patients.
While some states have already implemented these staffing ratios, some are yet to adopt them. Staffing ratio mandates provide legal standards which help govern compliance in medical facilities and promote the quality of healthcare. Staffing ratio mandates can also reduce the high staff turnover ratio by improving job satisfaction and division of labor.
References
Fiset, V. (2017). Evidence-based practice in clinical nursing education: A scoping review. Journal of Nursing Education, 56(9), 534-541.
Hall, L. H. (2016). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PloS One, 11(7), e0159015.
Kelley, J. M. (2014). The Influence of the patient-clinician relationship on healthcare outcomes: A systematic review and meta-analysis of randomized controlled trials. PloS One, 9(4), e94207.
Lee, A. (2017). Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Annals of Intensive Care, 7, 46.
McHugh, M. D., & Ma, C. (2014). Wage, work environment, and staffing: Effects on nurse outcomes. Policy, Politics and Nursing Practices, 15(0), 7280.
National campaign for safe RN-to-patient staffing ratios. (n.d). Web.
Schakowsky and Brown reintroduce the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act. (2017). Web.
Every organization is required to perform financial analysis to identify current and future budgetary needs. Healthcare organizations are no exception and need to evaluate their financial data to ensure that they can formulate decisions based on reliable data (Burgess & Radnor, 2013). Analyzing an organizations finances begins by evaluating how much is being spent by that organization and identifying the different items on which the organization spends its financial resources. Based on these needs, the following section of this paper will carry out an economic analysis of the healthcare center where the field practicum was undertaken. This will comprise an analysis of various tools used for budgetary measures, including the way the organization carries out its budget process, as well as an evaluation of the organizations balance and cash flow sheets. Based on the outcome of the analysis, the report will seek to provide some recommendations for the organization.
Budgeting
The survival of healthcare organizations is mainly dependent on internal and external factors that have a bearing on the operational aspects of an organizations different departments. One of the most fundamental aspects of determining the internal environment of a healthcare organization is budgeting. The budget process determines the confines within which the organization should operate during a specific period while allowing managers to report variances and offer their teams the guidance they need to navigate the different challenges that they may encounter (Liebler & McConnell, 2016).
The budget process at the health center was carried out using teamwork to ensure that the contributions of different staff members were taken into account during the process. Including staff contributions in the process of budget, preparation enables the organization to ensure that all are invested in the achievement of the organizations different goals. For example, the inclusive budget process that was adopted at the health center ensured that the staff members were aware of the resources available to accomplish their goals as well as able to anticipate the amount of money that could be used for their remuneration and welfare. Such knowledge ensured that the management would enjoy more cooperation from staff when dealing with various human resource issues in the organization.
After obtaining feedback from staff members, the management engaged in statistical operations as the second step of the budget process at the health center. At this stage, the departmental heads were expected to provide a measurable or quantified description of the requirements to be undertaken in the next financial period. For example, in this step, the human resource department provided the estimated figures for the amount of money they expected to use for salaries, while the supplies department provided estimates related to the expected purchases for the next financial period. The estimates provided during the statistical planning phase were based on the previous performance of the health center (Delmatoff & Lazarus, 2015). The management also took the time to compare past performance with current operations with the aim of ensuring the estimates were accurate.
The final step in the budget process at the health center was the preparation of expense budgets by the various departments in the organization. The departments used data from previous periods to determine the amount of money they expected to spend. Some of the expenses that were covered in the process included staff salaries; departmental heads worked with staff to determine paid leave days and conduct an evaluation regarding which staff members would receive a bonus payment or a raise in salary. At the departmental level, the administration at the health center was required to settle on the amount to be spent on supplies while ensuring that the resources budgeted for matched the needs of the department during a financial period. The overall finance department also participated in the preparation of the revenue budget, which is designed to forecast the overall revenues to be collected at the health center during the financial period.
Balance Sheet
The health center, like most other organizations, recorded financial statements that provided a summary of the financial performance of the organization. One of the financial statements that were widely used in the health center was the balance sheet, which served to indicate the financial position of the health center. The health center uses the balance sheet to document assets such as third-party payer settlements for services rendered, patient accounts receivable, loans, bank balances, prepaid services, and other investments (Foshay & Kuziemsky, 2014). The health centers liabilities include deferred taxes, long-term borrowing, payables for supplies, and different owed amounts for the purchase of equipment. The capital for the health center is also documented on the balance sheet and includes funds from the Ministry of Health that are provided to run primary healthcare services, as well as contributions from other stakeholders, which include building blocks and share donations.
The process of preparing the balance sheet at the health center begins with the completion of the asset section, where the assets are distinguished based on their longevity. The fixed assets are grouped together and subjected to depreciation, which serves to account for the wear-and-tear involved with different investments. The adoption of these techniques helps the health center to track the usability of the other machines that are available at the facility. Notably, aside from the building that houses the health center, machinery constitutes the largest percentage of the organizations assets, and hence, it is paramount that these are well accounted for on the different balance sheets as they help to reflect the actual financial health of the organization (Sullivan et al., 2014). The second step that is undertaken when preparing the balance sheet for the health center is the computation of liabilities, which serves to demonstrate the claims that creditors have against the assets owned by the health center. The balance sheet for the health center also outlines the net worth of the institution, which details the difference between assets and liabilities. An analysis of the information contained on the balance sheet was useful in providing the financial ratios for the health center.
Based on the records found on the balance sheet, the percent owners equity was 7.81%, which indicates that the community in which the health center is located owned a sizeable portion of the organization. The debt-to-total-assets ratio for the health center was 0.92, which indicates that the health center is financially healthy and can withstand losses without affecting the organizations operations. Based on the outcome of the ratio of the total assets, the health center could obtain more financing for any variety of development projects that it may desire to undertake. The debt-to-equity ratio of the health center is 11.80, which indicates that the organization has continued to perform well, considering that the baseline ratio was 13.54 at the start of the organizations operation.
Cash Flow Sheet
The cash flow sheet offers an insight into the position of the health center regarding sources and uses of cash. Through a perusal of the cash flow sheet, it was easy to discern the cash flow for the health center. The health center recorded both monthly and quarterly cash flow statements, which provided an outlook regarding the trends in cash flow at the health center. For example, the reports indicate that the health center has a healthy flow of cash, with both high profit and high cash flow. Thus, the health center has enough money to pay the different service providers and its staff. Given that the health center has a healthy cash flow, it can purchase the required supplies and lease or buy the equipment needed for the delivery of quality services (Sullivan et al., 2014). Given that the cash flow statement for the health center details the loan repayments for the health center, the organization stands a better chance of receiving credit services from lenders, which ensures that its operations are not affected by a lack of finances. The cash flow statements indicate that merchandise inventory is the main area where most expenses are incurred; hence, this gives the health center an opportunity to make the necessary adjustments to reduce the costs.
Challenges
The budget process at the health center encountered two main challenges. The most pronounced challenge during the process involved delays caused while obtaining the staff members feedback to ensure that they are part of the budget process. For example, the health center lacked the capacity to ensure that every staff member was contacted by his or her manager in a timely manner to offer individual input and insight into the budget. Thus, the managers who undertook the process of obtaining feedback from their staff ended up experiencing delays that were caused by issues such as the unavailability of staff members who were required to provide the necessary feedback. The second challenge that was evident in the budget process at the health center was the lack of adequate support systems that could be used by the organization to automate some of the budget operations. For example, the forecasting process in budgeting was done using essential tools such as MS Excel, making the process lengthy and tedious compared to what it might have been with the use of financial software.
Despite the organizations adoption of a reliable method for the preparation of the balance sheet, it is evident that the health center struggles with some of the fundamental ratios that are necessary to indicate the financial health of the health center. The only area where the organization needs to improve its operations is the percentage rate of return on assets, which stands at 3.7%, a figure that indicates the organization needs to increase its return to ensure that its operations are sustainable.
Solutions
The challenges that the health center faces regarding the budget process could be addressed through two main approaches. First, it is paramount to restructure the way the staff provides feedback during the budget process, perhaps through the use of emails, suggestion boxes, or online surveys (Sullivan et al., 2014). This approach would ensure that staff members feedback is provided in an innovative manner that saves time that would otherwise be spent by managers following up with staff members to gain their input on the different budgetary allocations. Secondly, the health center should allocate some funds to obtain reliable financial software to facilitate planning and fiscal processes. The adoption of a finance software application will enable the health center administration to track the budget process and have access to more reliable forecasting methods, which will, in turn, enhance the accuracy of the process.
With respect to the balance sheet, the health center needs to take measures that will ensure that there will be an improved return on assets. The enhanced strategies to increase the returns will also ensure that the health center continues to provide competitive services (Sullivan et al., 2014). The balance sheet would then need to be completed regularly to ensure that the actual performance of the organization is reflected. This would also enable the management to make the necessary decisions to guide the organization toward achieving its goals.
Main Challenges and Recommendations
Healthcare organizations must contend with various challenges in running different operations. The identification of these challenges as far in advance as possible is a critical step toward ensuring that they are addressed appropriately, in a manner that does not affect the organizations operations. Health care is a labor-intensive industry; most organizations are likely to have challenges in regard to staffing, and the way work is distributed among current staff members (Kellermann & Jones, 2013). Modern health care is concerned with the delivery of quality services that are aligned with emerging research that shapes evidence-based care. Therefore, healthcare organizations need to continually review their training needs. Health statistics and reporting are fundamental in enabling healthcare organizations to determine the burden of disease they face and make appropriate decisions regarding the allocation of available resources. Therefore, this section of the report seeks to provide a summary of the challenges that are faced in the healthcare center and give the necessary recommendations that can be applied to enable the organization to deal with the challenges that it is facing. The following table provides a summary of the challenges faced by the health center in different areas:
Operational Area
Main Problems
Recommended Solution
Estimation of required staff and workload distribution
The adoption of institutional staffing is based on population and organizational size.
The health center faces a shortage in the number of staff that it needs to ensure that the workload is distributed equally.
For the health center to overcome the challenges that it faces regarding staff estimation and workload distribution, there is a need to adopt a model of recruitment that focuses on the utilization of healthcare services at the organization as opposed to the target population (Kellermann & Jones, 2013). For example, given that most of the patients who seek assistance at the health center have chronic illnesses, it would be prudent for the health center to increase the number of nurses who have specialized in medical-surgical nursing (Tabatabaee, Nekoie-Moghadam, Vafaee-Najar, & Amiresmaili, 2016).
Determination of training needs
The health center lacks the capacity to evaluate the training needs for the different cadres of healthcare staff that works at the organization.
The health center faces the challenge of aligning training needs with the overall organizational goals.
The health center can address the challenge of aligning training needs with organizational goals through the inclusion of staff participation in the identification of training needs. As opposed to having the administration determine the training needs for each area of work, it is prudent and time-saving to request the staff to provide topic suggestions regarding the items that they desire to learn about related to the challenges they face in their work areas. Based on the feedback obtained from the staff, the organization can prepare appropriate training materials.
Health statistics and reporting
The first challenge that the health center faces is the need to simplify health data into a form of information that can be used by the staff at the facility.
Given that the organization recently adopted a health administration system, there is a challenge in the determination of the integration of the extensive data from the system into the existing reporting formats.
The health center should re-evaluate the current reporting format that it uses to ensure that it accommodates the new information obtained from the newly installed administration system. Among the changes that the health center should undertake is the inclusion of simplified charts and tables that can be easily understood by the staff without having to evaluate the enormous amount of data that is available.
Facility international accreditation
One of the challenges that the health center faces regarding accreditation is environment and appearance as the international accreditation process has failed to clear the facility because of cracks that appear on the walls of the emergency room.
The lack of a systematic staff training plan that is used to enhance the skills of the healthcare providers is another challenge that the facility faces regarding accreditation through international bodies.
The health center should adopt a comprehensive staff training plan as the international accreditation bodies demand that the clinical staff in a healthcare organization be provided opportunities to ensure that they can continually update their skills (Liebler & McConnell, 2016). The accreditors are always keen to determine if the organization is educating its staff in line with the emerging evidence.
Appointment system for outpatient system
Given that the health center has started to accept third-party payers, the appointment system that is used in the outpatient department requires these patients to have their insurance status verified by the finance department, leading to unnecessary delays when providing services.
The adoption of the new health administration system at the health center has led to the need for the front desk staff to input patient data into the system as they serve patients, which leads to delays, especially when there is a system or internet down-time.
The health center should offer more training for staff members who are responsible for keying in data during patients visits to ensure that they can more quickly address emerging issues and avert any increase in patients waiting time (Kellermann & Jones, 2013).
Recommendations Summary and Impact
Through the participation in the field practicum, various recommendations have come to the fore as a way of resolving the issues that existed at the health center. Each of these recommendations has an impact on the various operations that take place within the facility and may affect multiple aspects of care. The aim of this section is to provide a summary of the proposed improvements and identify the anticipated effect of the progress:
Recommendation
Impact
Increase training sessions
The training will help to improve the provision of clinical services as the staff will be able to make decisions that are aligned to the emerging evidence. The increase in staff training will also lead to higher operational costs, and hence, the finance department will be required to direct more resources toward the implementation of staff training (Liebler & McConnell, 2016). The increased amount of exercise will also increase the operational costs of the human resource department as more staff will be required to facilitate training, which will, in turn, increase the costs of operation.
Adoption of more straightforward methods to acquire staff feedback
The organization must invest in providing the staff with innovative platforms through which they can share their feedback, and hence, the finance department will be required to review its budgetary allocations to meet this need. The human resources department will also be affected by the introduction of new systems of operations that will require that the staff members are provided with adequate training to ensure that they can use their tools effectively.
Adoption of new reporting dissemination formats
The change will require that the records management department allocates time to develop a workable structure for new reports, using input from members of the staff. The department will also be required to conduct comprehensive training of staff members to ensure they can integrate and make use of the information that will be contained in the new reports (Liebler & McConnell, 2016). These processes will place increased resource requirements on the records department as it might be necessary to hire consultants to facilitate the development of the new report formats. The department will also require increased staff to help implement the training sessions. The previous forms that have been developed for use in the reporting of organizational data will also be discarded, which may increase the strain on the departmental staff in providing the new reports.
References
Burgess, N., & Radnor, Z. (2013). Evaluating Lean in healthcare. International journal of health care quality assurance, 26(3), 220-235. Web.
Delmatoff, J., & Lazarus, I. R. (2015). The most effective leadership style for the new landscape of healthcare. Journal of Healthcare Management, 59(4), 245-249.
Foshay, N., & Kuziemsky, C. (2014). Towards an implementation framework for business intelligence in healthcare. International Journal of Information Management, 34(1), 20-27.
Kellermann, A. L., & Jones, S. S. (2013). What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Affairs, 32(1), 63-68. Web.
Liebler, J. G., & McConnell, C. R. (2016). Management principles for health professionals. Massachusetts: Jones & Bartlett Publishers.
Sullivan, S. D., Mauskopf, J. A., Augustovski, F., Caro, J. J., Lee, K. M., Minchin, M.,& Shau, W. Y. (2014). Budget impact analysisprinciples of good practice: Report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force. Value in Health, 17(1), 5-14. Web.
Tabatabaee, S. S., Nekoie-Moghadam, M., Vafaee-Najar, A., & Amiresmaili, M. R. (2016). Barriers against required nurse estimation models applying in Iran hospitals from health system experts point of view. Electronic Physician, 8(12), 33483356. Web.
Risks in health care vary significantly. They can include issues that relate to patient safety (e.g., medical errors), insurance details, federal regulations and their applications, changes in policies and specifics of using new ones, etc. As risk management in hospital facilities and clinics can focus on a great number of different issues, only a set of those will be addressed in this paper.
Contracts with providers
Hospital facilities work with providers either by employing them or contracting with them. In both cases, it is essential for a risk manager to understand the degree of control that the facility has over the providers, as its liability directly relates to the providers. If the risk manager is unable to identify how the signed contracts will impact the facilitys operations, it can result in lawsuits and other negative outcomes for the facility.
Implied warranties of Article 2 of the Uniform Commercial Code
As Herzig et al. point out, specific attention should be paid to software contracts in healthcare settings (167). If not disclaimed differently, the implied warranty of title and the implied warranty of non-infringement apply to software products. The risk, however, is that the vendor might try to disclaim these warranties once an infringement claim is brought. Therefore, it is important for the risk manager to assess how possible it will be to have both the warranty and the infringement indemnity (Herzig et al. 167).
Contract review in healthcare facilities
New regulations and legislation, as well as performance evaluations, can raise questions about the necessity of contract continuation. When reviewing a contract, a risk manager needs to ensure that correct legal names are utilized in the contract, performance measures are set correctly, insurance requirements are specified in detail, confidentiality issues are addressed, the contractor is required to be trained and licensed to provide the specified services, and termination provisions are specified in detail. Without these basic components, the changes in the contract or their termination might become problematic in the future and pose an additional risk (including losses) to the facility.
Limitations of liability
Limitations of liability in healthcare are specific because the liability for death and bodily injury cannot be limited; the same applies to confidentiality breaches. Such state of affairs results in a high number of lawsuits filed against healthcare facilities. Nevertheless, it is important for a risk manager to remember that malpractice claims are valid when patients can prove that the physician was unable to comply with the professional standards, that the breach of duty caused the damage, that the patient has an injury due to this damage, and that a physician-patient relationship existed during the time the damage was done. These factors can help the risk manager assess the facilitys ability to respond to such claims and examine what it can do to prove that they are invalid.
It is important for a risk manager to remember that the gap-filling provisions (from 2-301 to 2-328) can give serious power to the court in enforcing (or not enforcing) contracts. As Clark and Ansay point out, section 2-302 gives the power to the court to regulate (e.g., not enforce) a contract in the case if a party was the victim of the procedural unconscionability (contracting that results in one-sided terms) (291). Such power is usually invoked by the court to protect buyers that are subjected to high-pressure sales tactics and/or do not have a good command of English. As to the gap filler mentioned previously in the paper (2-312), it is important to notice that the courts do not always give effect to warranty disclaimers, which should be taken into consideration if it is necessary to bring an infringement claim.
Works Cited
Clark, David, and Tu rul Ansay. Introduction to the Law of the United States. Kluwer Law International, 2002.
Herzig, Terrell W., et al. Implementing Information Security in Healthcare: Building a Security Program. HIMSS, 2013.