Category: Hospital

Introduction

There are significant reforms within the health care sector. These reforms are notable globally. Several service delivery points, including hospitals continue to transform their systems. The fundamental aim of these strategies is to remain relevant and competitive within the entire industry. The six-sigma approach is a strategic management system that has been applied by most organizations (Pande, Neuman & Cavanagh, 2002). This paper analyses the concept of the six-sigma approach. It also highlights some of the issues management and operational issues observed within the Red Cross Hospital. Furthermore, there is a critical examination of the significance and value of the implantation of the six-sigma strategy in this hospital. Finally, it correlates the value to the likelihood of solution of management and operational challenges eminent within PPD the organization.

Discussion of Six-Sigma

There are various reasons why organizations tend to adopt transformative management approaches. Some of these reasons include increased competition and technological applications. Employees also associate with competitive organizations that focus on their general welfare. Observably, hiring and operational costs have escalated to significant levels due to these effects. The six-sigma focuses on quality improvement and effective service delivery (Stamatis, 2004). The six-sigma is a core tool in strategic management. It aims at quality improvement and focuses on leaner and sustainable projects. There are core divisions within this quality model. Each of these symbolizes different tenets applied in transformative processes. Some of the critical issues considered under this model include quality assurance, transparent systems and evidence- based management. However, there are other several concepts within the approach. Organizations have recognized the need to apply this system. The Red Cross Hospital is one of such organizations.

Discussion of the Issues at Red Cross Hospital

The Red Cross hospital majorly provided great focus to the concept of quality assurance for a long period. As a result, the organization could not realize the benefits associated with the six-sigma approach for project management. Evidently, the hospital encountered several challenges before implementing this concept through an external consultant (Jaap, Does & Bisgaard, 2012). However, it is important to note the capacity of the management to identify the crucial need of implementing the six-sigma system within its operations. There were different challenges. For instance, the project objectives never resonated appropriately with the overall strategic goals. Additionally, the management lacked logical strategies for determining the appropriateness of projects. These also included any contribution to every long term processes. Notably, the organization also lacked a consistent procedure applicable in the determination of cost effectiveness of all projects.

Indicatively, it was also difficult to initiate decision-making. Various assumptions on quality care took center stage and the management could not access any prospective saving from other projects. There existed poor systems for validating project information. Therefore, monitoring and evaluation systems were impaired, making the management to navigate blindly. Frustrations emerged due to lack of a consistent project management framework. Moreover, most implementation initiatives were characterized by time wasting due to lack of operational guidelines (Jaap, Does & Bisgaard, 2012). Employee training on issues of project management was paralyzed and characterized by poor results. There existed the challenge of double engagement of employees. It was realized that most employees undertook their personal roles and those within different projects. This practice lowered the level of quality service. These challenges persisted for a long duration due to poor management systems. Despite the high initial costs associated with the six-sigma, the hospital had to implement it in order to transform its system.

How Six-Sigma Created Value at Red Cross Hospital

There are different ways in which the six-sigma created value at the Red Cross hospital. Generally, the approach integrated several quality management instruments. These assisted to solve the potential challenges within the hospital. The system enabled the hospital to consider efficiency and sustainability factors during project initiation (Jaap, Does & Bisgaard, 2012). Furthermore, the management of these projects complied strictly with the five definite phases. The completion of every phase within the methodology followed a particular and standardized sequence of activities. It was now possible to monitor and evaluate all activities undertaken within different departments in the hospital. This process was accomplished through a standardized and matrix system.

The sixsigma enabled the management to assign distinct roles and responsibilities to every employee within the organization. This was achieved through the application of different color symbols. Evidently, these definite roles made the organization to cut its unit costs and increase the level of service delivery to its potential clients. Training and capacity building of various workers became easy. It is also notable that there was an explicit system of communication and feedback within different strata of the organization (Jacowski, 2008). Through critical improvements on fundamental managerial tools and techniques, the organization was able to leverage its overall performance. Effective systems for conducting performance appraisal for employees and within different departments were also attained. Generally, it is manifest that the system provided a unique advantage to the organization.

How the Value Realized At Red Cross Hospital Translate to PPD Organization

The value realized at the hospital has a lot of significance to the PPD organization. Being a budding organization focused on clinical research, there are many lessons to be derived from the application of six-sigma approach. PPD organization must recognize the significance of aligning its operations to the standards outlined within the six-sigma system (Harmon, 2003). This is crucial for all organizations dealing within the health care sector. PPD needs to develop proper systems and install various operational guidelines prior to the adaptation of the system. Some of the vital considerations that must be made include changes in the philosophy, project management frameworks and definite roles for staff. Moreover, tools and instruments for implementation are critical and must be put in place.

In general, there must be a well-defined interconnections and feedback systems within the PPD organization. As a clinical research associate, (CRA) one of the most important roles will be to help in the integration of the six-sigma within the relevant departments. As indicated in the case of Red Cross hospital supervision, monitoring and evaluation will be important components of this integration process. All standards of operations within the clinical departments will be realigned. This must be according to the requirements outlined within the six-sigma scheme (Mital & Pennathur, 2010). These might also include the safety measures, reporting conditions and data management.

Summary

The general observation is that organizations benefit from the application of six-sigma principles. However, this benefit is accomplished after all the required and relevant measures are integrated within the entire organization. Many resources must be channeled for this transformative process. Additionally, it is crucial for the management to ensure maximum level of employee engagement and support.

References

Harmon, P. (2003). Business process change: A managers guide to improving, redesigning, and automating processes. Amsterdam: M. Kaufmann.

Jaap, v., Does, R. & Bisgaard, S. (2012). Dutch Hospital Implements Six Sigma. Trade Journals, Business And EconomicsProduction of Goods And Services, 2 (4), 11-14.

Jacowski, T. (2008). Integrating Project Management Into a Six Sigma System. Web.

Mital, A. & Pennathur, A. (2010). Industrial resource utilization and productivity: Understanding the linkages. New York: Momentum Press.

Pande, P. S., Neuman, R. P. & Cavanagh, R. R. (2002). The Six Sigma way team fieldbook: An implementation guide for project improvement teams. New York; Toronto: McGraw-Hill.

Stamatis, D. H. (2004). Six Sigma fundamentals: A complete guide to the system, methods and tools. New York, N.Y: Productivity Press.

The level of the judicial court system in which this legal opinion occurred

The level of the judicial court system emerged from the US Court of Appeals Fourth Circuit (Reynolds 710). Cases involving a hospital in North Carolina and the other hospital in Virginia were determined in these proceedings. Several court cases that involved National Association for the Advancement of Colored People Legal Defense and Education Fund between 1956 and 1967 provided the foundation for the removal of the widespread discrimination in hospitals and professional associations (Reynolds 710).

Until the mid 1960s, there was overt hospital discrimination in the US. Moreover, these discriminatory practices were legally sanctioned in many states. According to Reynolds, discrimination was demonstrated in several ways, including denial of staff privileges to minority physicians and dentists, refusal to admit minority applicants to nursing and residency training programs, and failure to provide medical, surgical, pediatric, and obstetric services to minority patients (710). Attempts to end to hospital discrimination involved the participation of several stakeholders such as professional organizations; the federal government; public health, hospital, and civil rights organizations (Reynolds 710). There was also a direct attack on hospital policies on discrimination. As a result, the two landmark rulings involving the above-mentioned hospitals set new precedents for hospital discrimination.

The opinion of the lower court that was finally overturned in Simkins

On appeal of the case, the Fourth Circuit Court overturned years of legal decisions that supported a complex system of discriminatory hospital care. This was the first landmark ruling (Simkins v Moses H. Cone Memorial Hospital  1963). It altered the use of the federal governments public funds to expand and maintain segregated hospital care. The role of Chief Justice Simon E. Sobeloff remained instrumental in this landmark ruling. The Supreme Court used its power granted in the US Constitution (Introduction to the United States Legal System Structure of Government par. 2).

The lawyers actively sought for state action or the involvement of the federal government with regard to activities of a private hospital. They wanted a protection against discrimination based on the provisions of the 5^th and 14^th Amendments of the US Constitution (par. 2). The federal government had to decide whether to render an opinion on state action or the relief on discrimination.

Consequently, in a historic move, the assistant Attorney General offered a long brief in which the position of the Black medical professionals and patients was supported. The federal government argued that the use of the federal funds in a discriminatory way was not constitutions and therefore Black professionals and patients could get medical services and privileges they sought.

Based on the Simkins ruling, other court cases cited this ruling to strengthen their arguments against hospital discrimination in the US.

The federal laws that were highlighted in Simkins v. Moses H. Cone

The Hospital Survey and Construction Act (or the HillBurton Act) 1946 was critical in this case. The Act aimed to offer federal grants to advance construction and physical plants of the US hospital systems. States were free to distribute money to expand existing hospitals or construct new ones. This applied to both government-owned facilities and voluntary not-for-profit hospitals.

Under the Hill-Burton Act, any hospitals under the program were not allowed to discriminate based on race, color, national origin, or creed, but separate but equal clause in the Act allowed hospitals to discriminate. It was the separate but equal clause, which would come under attack during the case of Simkins. The lawyers argued that the clause violated the 5^th and 14^th Amendments of the US Constitution, which had prohibited against racial discrimination.

Although President Johnson ratified the Title VI of the Civil Rights Act of 1964 three months later, it was instrumental in this case. It sought to broaden the concept of equality to all federal programs because voluntary compliance was difficult to achieve. This marked the foundation for the universal access to healthcare in the US.

The role of the federal law in deciding this case

The federal law provided the basis for argument in this case. The federal government interpreted the law to support the position of Black professionals and patients. The government concurred that it was unconstitutional to use federal funds in a discriminatory way. Hence, Black physicians, dentists and patients were granted similar privileges and services based on their statuses.

In interpretation of the federal law, the judges recognized the extensive use of public funds to support comprehensive governmental plans. In this regard, the extent of the both national and state governments participation in hospital construction was relevant and therefore, the case did not rest on the issue of equality or lack of it.

The US Supreme Court set a precedent for subsequent cases. For instance, the case of Simkins was regarded as a landmark case and became a point of reference for more than 260 cases between the year 1963 and 2001. It played a critical role in other legal decisions and showed tremendous shift in legal opinion toward hospital discrimination. The federal law again was applied in the case of Eaton, which initially the District Court had dismissed based on factual situation and a lack of changes in the law.

The federal law, therefore, played critical roles in promoting racial integration and compliance among hospitals.

The Constitutional amendments and issues in the case

Initially, the goal was to ensure voluntary compliance with hospitals. This, however, would later prove difficult as discrimination persisted. The filibuster had marred the Civil Rights Act 1964. New regulations were formulated for the Title VI that outlawed the distribution of funds to hospitals or any other state agencies that discriminated minority groups. The President assented to these changes and they became a model for other agencies.

There was poor voluntary compliance because Black physicians and patients still experienced racial discrimination. In 1965, the Medicare Act was enacted to ensure that the US senior citizens would gain access to hospitals irrespective of their races. The Medicare Act aimed to promote racial integration. However, racial policies and practices were still rampant in many hospitals and lawmakers used their influences to amend the appropriations bill to allow segregation arguably on medical grounds. In counter arguments, it was noted that the appropriations bill was not under the jurisdiction of hospitals. Second, several agencies and other stakeholders had approved Medicare hospital certification guidelines and segregation therefore undermined it. Third, the amendment 207 undermined the provisions of the Civil Rights Act and thus had the potential to reverse gains achieved in eliminating racial discrimination in healthcare. Finally, it had large legal loopholes to promote racial segregation.

The Court of Appeals Fourth Circuit judges asserted that race was simply not a factor to influence the admission, assignment, classification, or treatment of patients (Reynolds 710).

The case was limited in its reach

While Simkins was heralded as a landmark ruling and it became a point of reference for many hospital discrimination cases, it was limited in its reach because the US Supreme Court did not grant writ of certiorari. As a result, only facilities, which were proposed or under construction in certain jurisdiction of the Fourth Circuit Court (Maryland, Virginia, West Virginia, North Carolina, and South Carolina) were required by the law to ensure nondiscrimination.

In addition, the new Hill-Burton laws were not applicable to facilities that had already utilized federal funds. It is imperative to note that Hill-Burton construction projects were under the clause of separate but equal, all-White or all-Black. Although several other institutions had given assurance on nondiscrimination, Black professionals and hospitals continued to experience discrimination in hospitals.

The surgeon general, however, published that hospitals were required to offer services without discrimination because of race, creed or color.

The federal official and agency that finally extended the cases ruling and the spread of cases outcome across the Nation

The role of the surgeon general in extending the case outcome was noted in the publication. The publication required all hospitals to provide assurances that services will be made available without discrimination because of race, creed, or color to both patients and Black professionals.

Chief Justice Sobeloff and other judges of the Fourth Circuit Court shifted the legal opinion on racial discrimination in hospitals. On several occasions, the Supreme Court reversed the decisions of the District Courts on rulings regarding racial discrimination and segregation.

The NAACP Legal Defense Fund was also instrumental in promoting the outcomes of the cases. For instance, the fund worked with its lawyers to identify hospitals that did not observe compliance and submitted their cases to courts. In addition, it wanted other agencies such as the Department of Health, Education and Welfare (HEW) to develop a rigorous compliance program, first under the HillBurton program and then under Title VI of the 1964 Civil Rights Act (Reynolds 710). The fund aimed to extend the law to all hospitals in the US, introduce public debates on activities of hospitals other healthcare providers and ensure that they complied with the both federal and state laws and regulations. Lawyers also considered the tax-exempt status of some facilities (Showalter 7).

Later influences were noted in court cases such as Dr. Hawkins and Dr. Cypress applications and an attempt by Senator John C. Stennis to promote patient segregation, which the House of Representatives defeated.

The case makes or fails to make a big difference in decreasing health inequities

Clearly, the case of Simkins had a critical positive influence on hospital discrimination for over two decades. It provided opportunities for hospital integration based on the Hill-Burton Act and the provisions under the Civil Rights Act and the Medicare hospital certification program.

While the case resulted in significant improvements, Robert C. Bowman seems to suggest that the current healthcare design has left some Americans behind (Bowman par. 1). The Institutes of Medicine (IOM) has a critical role to play in healthcare design.

The case resulted in widespread changes, but American healthcare systems and designs continue to undergo many changes and ignore other quotas (Teitelbaum s27). While the IOM has promoted notable changes, its design has also failed to account for some sections of healthcare stakeholders such as physicians and health insurance companies. At the same time, the primary care has not reached some sections of the population.

The IOM and other healthcare stakeholders must solve primary care, address healthcare access and long-term investments.

Works Cited

Bowman, Robert C. Is the Institutes of Medicine Waking Up? Basic Health Access. 2013. Web.

Introduction to the United States Legal System Structure of Government. n.d. Web.

Reynolds, P. Preston. Professional and Hospital DISCRIMINATION and the US Court of Appeals Fourth Circuit 19561967. American Journal of Public Health 94.5 (2004): 710720. Print.

Showalter, J. Stuart. The Law of Healthcare Administration, 6th ed. Chicago, IL: Health Administration Press, 2011. Print.

Teitelbaum, J Burke. Health care and civil rights: an introduction. Ethnicity & Disease 15.2 Suppl 2 (2005): S27-30. Print.

Abstract

Hospitals are very sensitive places, and there is a need to ensure that proper coordination and communication is maintained. This paper seeks to discuss some of the best strategies that can be used to improve the quality of service delivery within a hospital setting. Some of the issues that have been identified are the expansion of the waiting room, having different waiting rooms for children, adults, and patients with contagious diseases, and organizing in-service classes for the nurses. Strategies that can improve the efficiency of this facility include in-service education for the healthcare providers, improving the state of the equipment at the hospital, and increasing the number of personnel.

Objectives

Analysis of this hospital has confirmed that there is a need to make improvements in various departments within the hospitals. Patients need a relaxing environment when they visit healthcare facilities to help them psychologically. Clean, spacious, and well-ventilated rooms help them by ensuring that those with contagious diseases do not spread it to other patients. The following are some of the long-term objectives that this hospital should give focus on.

• To expand the building structure to have separate waiting rooms for adults, children, and patients with communicable diseases.
• To install an inter-departmental communication system that would enable all the departments to share patients information as first as possible.
• To develop a comprehensive curriculum the staff would follow for their in-service education to improve their efficiency.

To achieve the above long-term objectives, the management of this hospital must work in close coordination with the staff to understand the current needs. The following short-term objectives would help elevate the current condition of service delivery.

• To improve the speed of service delivery by improving the capacity of the current work-force, and increasing the number of employees to reduce the time taken by patients in the waiting room by half.
• To improve communication between departments by developing a clear guide in which files from one department would reach other necessary departments within the shortest time possible.

These objectives would be pivotal in ensuring that service delivery at this firm is improved to meet the needs of the patients. However, achieving these objectives requires a clear strategy that would be used by the top management to ensure that the needed success is achieved. The management must develop actionable strategies that would be used at various management levels to ensure that the set objectives are achieved as a way of improving service delivery of this facility. The strategy should be conscious of the financial and time constrain that is needed to ensure that this project can be successfully achieved. Having identified the objectives, the following strategies can help this firm achieve them within the desired time.

The first strategy should focus on how to expand the facility to accommodate the current surplus population of patients. This strategy will focus on the financial planning of this facility. The management should start by understanding the cost of this expansion. Then it should consider the sources of funds available from the proceeds and savings of this hospital. If the available funds are not enough, it can seek a grant from the government, or a loan from financial institutions to finance this project. When sourcing funds for the construction, the management should also find a way of funding the communication system that would be fitted once the construction is completed.

Once the construction is completed, the management should then commission the installation of a communication system that will enable the free flow of information from one department to another. The system should also come with a database that would be used for storing information for future use.

The management should then designate rooms for children, adults, and those with contagious diseases. When this is done, a clear program should be set for in-service classes for all the employees to improve their service delivery.

Timeline of the project

It is important to have a clear plan on how the available time will be used to ensure that this project is brought to successful completion. At this planning stage, it is necessary to draw a timetable that would define all the activities that will be undertaken in this project and the time that would be needed to complete them. Defining the activities will also help in identifying some of the challenges that can be met in the project, and how they can be mitigated. The project manager will also be able to factor in the time that would be consumed while mitigating these challenges. This research is expected to take two and a half years. The Gantt chart below specifies the activities that will be carried out in this project

Gantt chart

Established in the year 1975, Patton-Fuller Community Hospital (PFCH) has enjoyed considerable success, a consequence of staffs dedication to providing quality patient care services. With regards to the economic trend analysis commencing from the era of the economic downturn (2008) to the year 2009, the board has a reason to be optimistic about the year 2010, in spite of a backdrop that is a consequence of the then economic depression. Basically, following a two-tier (2008 and 2009) audit report, the Chief Financial Officer (CFO), Zacharie Hardie, underscores his optimism by stating that PFCH will weather the storm (Patton-Fuller Community Hospital, 2009).

Principally, a critical analysis of an annual report reveals an upward trend in the post-economic recession period. The balance sheets indicate again in the total assets (more than $35 million). However, one may argue that this is offset by the liabilities, but while enjoying higher revenues as well as low expenses relative to the previous year, this finally translates to a total gain (more than $15 million) in the net income, though still operating at a loss ($373 thousand).

This is set to improve further, translating into profits in the year 2010, as the economy heals more. The liabilities incurred and hence the revenues gained are indicative of the boards rational investment plans. The budget projections of the year 2009, was a little shy of the actual, for instance, it had projected a net operating loss of $4,416,000 contrary to the aforementioned loss. As such, the year 2010 is set to gain exponentially. No loss is expected; however, the interest rates of the loans borrowed in the preceding year will be highly felt in the year 2010. Because of the Managed Care intervention, the net patient revenues are set to increase, nevertheless, the patient census is expected to reach maxima and steady (Patton-Fuller Community Hospital, 2009).

As regards staffing, the year 2010 is expected to be busy with a host of patients a little more than the preceding year thus;, the board is expected to hire few nurses to improve on the nurse-to-patient ratio. On a lighter note, the factors limiting staffing include the patients population together with the wages. With the negligible change in patients population, I expect the wages to increase by a slight margin. I expect the hospital to continue upholding its staffing strategy, which is done with respect to patients census. In effect, they cut on the net expenses vital in increasing the profit margin (Hardie, 2009).

Other elements of the budget projections that are expected to change in the year 2010, courtesy of the economic trend, include utility costs. Chiefly, with the previous years purchases of novel and yet sophisticated equipment, the costs of electricity, water, and fuel will have to increase. Nevertheless, the rates of depreciation cum amortization are set to remain the same as the previous years since no more supplies of equipment are anticipated.

As Managed Care continues with its collection of funds though in a lackluster manner, an increase in the coffers of the Doubtful accounts is projected. This will impact positively on the net income, for it increases the current assets.

In a synopsis, the positives that are projected in the year 2010 decimate the costs, and as such, the economic uncertainties synonymous with the year will surely go unnoticed.

References

Hardie, Z. (2009). 2010 Operating Budget Assumptions. Arizona: University of Phoenix Press.

Patton-Fuller Community Hospital. (2009). Annual Report 2009. Arizona: University of Phoenix Press.

The article under consideration dwells upon integrated delivery systems. The author states that these organizations are often regarded as a more efficient alternative to the existing care delivery systems (Frakt par. 6). The author notes that proponents of the approach emphasize that integrated delivery systems are more cost-efficient as the can save money due to integration and provide high-quality services due to proper coordination. Nonetheless, the author also emphasizes that the recent research shows that integrated the delivery system is not cost-effective as the prices turn out to be higher while the quality of services similar to the one provided in more conventional health care organizations.

The article in question is a valuable source as it provides important insights into the peculiarities of integrated delivery systems. Frakt notes that the integrated delivery system is a health care organization that includes several units, employs different physicians and can even have a nursing home or other facilities (par. 6). The author also mentions that these organizations are thought to be a way to reduce hospitals costs and prices for health care services. At the same time, it is clear that these systems are associated with high prices and similar quality.

The article has manifold implications for practitioners as well as policy makers. First, it contributes to the ongoing debate on the matter. It is vital to share ideas and make people involved in the discussion as they will potentially use the systems. Furthermore, the author unveils existing drawbacks of the new approach. Importantly, the researcher notes that officials tend to be rather excessively optimistic as to integrated delivery systems. They encourage health care organizations to adopt the new approach and become integrated entities. Nonetheless, the efficiency of the systems is almost intangible. One of the major pitfalls is employing physicians as it is associated with higher costs.

The article can become a starting point in the transformation of the integrated delivery system into an effective tool for the delivery of high-quality health care services. It is essential to focus on such issues as the employment of physicians and coordination. The effort should be invested in these areas as they make integrated delivery systems rather ineffective. The idea of the provision of integrated health care services is very good, and it can change the entire health care system for better. Patients will not have to try to monitor the health care services provided as this is often quite a complicated task. Patients do not have the necessary skills to do that, and it makes the efficiency of the existing health care system rather questionable. Therefore, it is important to make the systems work.

It is possible to note that the article in question provides important insights into the benefits and downsides of integrated delivery systems. It is clear that the system is less efficient as it is widely accepted, but it is still obvious that this approach can and should work efficiently. The discussion of the major issues can result in the development of effective methods to overcome the difficulties. Of course, patients will be the ones to benefit from the creation of a truly integrated delivery system that will be cost-effective. The government will also be able to save significant funds. One of the most significant merits of this article is its ability to draw peoples attention to the problem.

Works Cited

Frakt, Austin. The Downside of Merging Doctors and Hospitals. The New York Times, 2016. Web.

There is no use denying the fact that with the development of different technologies some traditional issues become changed. Implementation of computers in the work of various organizations helped to increase their efficiency and minimize the effort which is needed to accomplish a certain task. Being one of the most important spheres in modern society, healthcare is also influenced by the development of technologies (Zeng, 2009).

One of the most significant changes which it undertook was the implementation of the health care information system (HIT). The introduction of the given system led to the appearance of the need for HIT specialists. Nowadays, the role of a HIT manager is very important. This specialist, who usually has a masters or bachelors degree, manages and secures the patient records (Health Information Manager: Job Description and Requirements, n.d).

This data is extremely vital for the health of a patient and influences the whole process of recovery. That is why its efficient management can be taken as the guaranty of a patients progress. The work of a HIT specialist can help to make the processing of patients data faster and easier, which, in turn, can lead to the improvement of final results (What is a health information manager? n.d). That is why the work of a specialist of this sort can be taken as a great advantage.

Moreover, it is possible to say that some other spheres of the functioning of the hospital can be influenced by this technology. It is possible to presuppose that this technology can help to get rid of medication errors by analyzing all prescriptions and adding them to the database. With this in mind, it is possible to conclude that the work of a HIT specialist is very important and influences the functioning of the whole hospital greatly.

It is possible to say that the modern age can be characterized by great rivalry. With this in mind, different organizations and companies try to increase the level of their efficiency. That is why traditional approaches to management are now revised. There have been two ways to control the functioning of the organization. These ways are top-down and bottom-up strategic management.

The sense of the first lies in the fact that all serious decisions are accepted by the top manager of a company (Advantages and disadvantages of the top-down and bottom-up implementation approaches, n.d.). This approach is taken as a traditional one and is used by many organizations nowadays. However, there is another approach, which supposes that ideas should come from common workers as they can create a good and new idea that could increase the level of the efficiency of a company (Filev, 2008).

These two approaches can also be used in the health care sector. Taking into account the fact that nowadays the attempt to implement the HIT system is made it is possible to cogitate about these two approaches in its terms. Resting on the character of the system, it is possible to say that the bottom-up strategy can be taken as the best under these conditions. It can allow HIT managers to implement their ideas into the functioning of the hospital and make it more efficient (The Bottom-Up approach, n.d). Additionally, it could help to minimize the risks connected with the usage of the new system as they will be able to control it directly. With this in mind, it is possible to conclude that the usage of bottom-up strategy can help to reduce the risks and make the work of the whole system more clear and efficient.

References

Advantages and disadvantages of the top-down and bottom-up implementation approaches. (n.d.). Web.

Filev, A. (2008). Top-down and Bottom-up Project Management: Leveraging the Advantages of the Two Approaches. Web.

Health Information Manager: Job Description and Requirements. (n.d.). Web.

The Bottom Up approach. (n.d.). Web.

What is a health information manager? (n.d.). Web.

Zeng, X. (2009). Redefining the Roles of Health Information Management Professionals in Health Information Technology. Perspectives in Health Information Management, 6(summer), n. pag. Web.

The article describes the management improvement process underwent by the Huggins Hospital in Wolfeboro, New Hampshire. According to the article, the hospital, which was constantly expanding and modernizing its infrastructure in several ways, was unable to maintain the efficiency and cost-effectiveness of its operations. It was not until the management decided to look into its regulatory and compliance standards that the improvement was visible.

The need for change became apparent after the completion of the new facility in 2010. The new hospital featured the newest equipment and was built in accordance with the latest standards. However, it quickly began to show the same signs of infrastructural deterioration as the other parts of the organization, which was at least partially due to the lack of technical expertise required for utilizing the new technologies. It was thus decided to change the course of action oriented at operational and fiscal improvement. However, this conflicted with the self-governing approach traditional for the establishment. Thus, the decision has been made to seek the services of a third-party team of experts capable of providing leadership, efficiently handling innovative technologies, and capable of operating the facilities and services.

Huggins thus sought the assistance of ABM Healthcare Support Services, the company specializing in improving services and patient experience. Once the communication in the work environment was established, ABM has initiated change on multiple levels. Most prominently, it introduced training programs for the employees, instilled new policies that introduced minimal disruption to the existing practices, and located the compliance and regulatory issues which were thoroughly documented and addressed.

The most notable innovation was a web-based computerized maintenance management system (CMMS). Such approach has several advantages over traditional methods of supervision and management, as it introduces additional accessibility, transparency, and allows for a more streamlined approach in scheduling and tracking orders as well as managing contractors and assets. As a result of these innovations, several achievements were visible, such as reduced order completion rates, reduced spending and vendor outsource costs, increased compliance percentage, and improved employee qualification, among other things.

The concept of computerized maintenance management system can be beneficial for the facilities management for several reasons. First, the CMMS is fully automated and centralized, allowing for the easy access from any device, including the ubiquitous personal mobile ones. This speeds up the process, eliminates the unnecessary steps, and streamlines the communication between the staff and the management. Next, such approach uses a unified database which makes the interaction between departments easier  for instance, in this case, the synchronization of information on assets with the schedule of orders and tasks in progress offered a convenient and timely way of planning the future operations. Finally, the control stage improves significantly after utilization of CMMS, as the overseeing becomes possible through a single point of contact reaching to all the relevant areas. This is confirmed by the fact that ABM was requested to provide oversight and management of the Materials/Purchasing department, (Scheffer, 2016, para. 6) which confirms the success of its actions.

What I found especially interesting about the described process was the quick and determined switch from the traditional self-managing management practice to the third-party one, and the obvious success of the decision. This denotes the importance of the appropriate change process that does not disrupt the existing practices.

The CCPM technique has several notable strengths. The most prominent one is its the fact that it utilizes computing hardware. This makes the technique extremely time-saving, as the large cluster of managerial routine becomes automatized. It also improves accessibility not only to the management but to the employees, who benefit from the improved transparency and can receive and send feedback without delay. Besides, it enhances the involvement of the staff in the process by allowing to expose them to the complete picture of the project rather than restrict to their niche. Finally, the automatized and standardized nature of CCPM increases the reliability and concreteness of the evaluation process, allowing the easy and comprehensive representation of intermediate and final results. However, the technique is not without its weaknesses. First, it requires the high level of proficiency among both the management and the staff. While the former is not a problem in the case of a third-party contractor, the latter needs to be addressed by the proper training. Second, the software can not possibly account for all of the factors to correctly plan and assess the procedures, and requires fine tuning which, if done improperly, will disrupt the validity of the results and predictions.

While the company chosen by the Huggins Hospital is oriented towards services in the healthcare industry, the methods used by them can be applied to the non-healthcare facilities and buildings. The approach they chose uses the CMMS to plan, oversee, manage, and control the infrastructure maintenance operations, which does not restrict the area of application to the field of healthcare. Besides, the nature of the procedures described in the article suggest the possibility of its use outside the constructions management. In fact, the decision by Huggins to assign ABM to oversee and manage the Materials/Purchasing department illustrates the versatility of the method in question perfectly.

References

Scheffer, R. (2016). Huggins hospital finds solution to improving facilities management. Web.

Introduction

The use of antimicrobials in hospitals is a subtle practice that requires stewardship. Pharmacokinetics and pharmacodynamics of antimicrobials are complex processes that demand understanding of safety and efficacy standards by the experts who can adhere to the stewardship guidelines.

Misuse of the antimicrobials can lead to drug toxicity in patients, encourage the emergence of multidrug resistant microbes, and increase health care system costs. The emergence of multidrug resistant microbes due to inappropriate use of antimicrobials has not only increased prevalence of microbial diseases but has also resulted into diminishing effectiveness of antimicrobials.

The health care system is grappling with the challenges of treating and preventing the emergence of resistant microbes using few effective antimicrobials since many have encountered resistance. Tamma and Cosgrove assert that, the implementation of a monitoring and intervention system is vital to optimize the effectiveness of currently available antimicrobial agents and preserve our ability to use them in the future (2009, p.245).

In this view, hospitals have designed diverse stewardship programs that supervise and check the use of antimicrobials. To find out the effectiveness of the stewardship programs in hospitals, random interviews were conducted on the number of medical professionals concerning the available antimicrobial stewardship programs and their effectiveness.

Since proper implementation of the antimicrobial stewardship is imperative in the control of emerging multidrug resistant microbes and reduction of medical costs, assessment of available and effectiveness of programs gives an insight. However, the big question remains; how can the hospitals implement antimicrobial stewardship programs effectively.

Antimicrobial Stewardship

Emerging multidrug resistant microbes and increasing costs in health care system threaten capacity of fighting microbial diseases. The multidrug resistant microbes emerged due to poor stewardship in the use of antimicrobials. Moreover, there is an impending crisis in the treatment and control of microbial diseases because development of antimicrobial has slowed down while at the same time the available antimicrobials are diminishing due to the resistance (Rapp, 2010, p.4).

This crisis poses a great challenge to the health care system. To find out the nature and the effectiveness of antimicrobial stewardship programs in hospitals, a series of random interviews were conducted to determine their effectiveness. Medical professionals answered several questions dealing with the availability of antimicrobial experts such as physicians, microbiologists, epidemiologists, pathologists, and pharmacists.

The research interviews also looked at strategies of administration, laboratory procedures, therapeutic committees, and the availability of pertinent information. To assess the effectiveness of the antimicrobial stewardship, the research also observed and interviewed medical professionals concerning clinical guidelines, prescription strategies of antimicrobials, review of prescription, post-prescription assessment, and application of technology.

Results

The interviews carried out and the observations made showed that in the hospitals, not all antimicrobial experts were available. The available antimicrobial experts were physicians, pathologists, and pharmacists, while epidemiologists and microbiologists were not available. The interviews further revealed that overwhelming cases of microbial diseases at times overstretch the available antimicrobial experts.

On the strategies of administration, the research studies showed that there were some laxities concerning implementation of the responsive measures that ensure antimicrobial stewardship.

There were also very weak laboratory procedures that are involved in the assessment of the therapeutic outcomes while the therapeutic committee had no measures for supervising the safety and efficaciousness of the antimicrobials. The pertinent information regarding antimicrobial stewardship was not readily available and accessible thus prescription strategies were poorly implemented.

Discussion

The availability of all necessary antimicrobial experts determines the effectiveness of the antimicrobial stewardship programs that aim at reducing the emergence of multidrug resistant microbes and costs of managing microbial diseases. Since the hospital lacked some of the crucial antimicrobial experts, implementation of antimicrobial stewardship programs would not be effective.

Epidemiologists and microbiologists are critical antimicrobial experts who work collectively in assessing therapeutic outcomes in order to establish the emergence of multidrug resistant microbes. Their research data is very essential in designing antimicrobial stewardship programs.

Concerning administration, Roberts and Weinstein argue that, commitment to implementation of antimicrobial stewardship programs must come from upper levels of hospital administration that are willing to invest resources in program development; otherwise funding for initiating and sustaining a stewardship program may be inadequate (2009, p.10).

Weak administration or lack of administrative will severely affect implementation of the antimicrobial stewardship programs. Poor laboratory procedures and lack of pertinent information discourage implementation of the antimicrobial stewardship programs because robust data will not be available to aid in monitoring and designing of real time programs that are consistent with the trends of microbial diseases.

Conclusion

The emergence of multidrug resistant microbes due to the misuse of antimicrobials has prompted health care system to root for the implementation of antimicrobial stewardship programs. Studies conducted in a hospital revealed that there is poor implementation of the antimicrobial stewardship programs thus encouraging the emergence of multidrug resistant microbes and increasing health costs in the management of the microbial diseases.

For effective implementation of the antimicrobial stewardship programs, hospitals should ensure that they acquire all critical antimicrobial experts, have proper administrative mechanisms, comprehensive laboratory procedures, stringent prescription measures, and availability of pertinent information. Optimal utilization of these resources in hospitals will boost the implementation and the effectiveness of antimicrobial stewardship programs.

References

Rapp, R. (2010). Practice Guidelines for Implementing Antimicrobial Stewardship. Journal of American Society for Health-System Pharmacists, 41(6), 1-20.

Roberts, R., & Weinstein, A. (2009). Hospital and Societal Costs of Antimicrobial Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship. Virginia College Virtual Library, 1-17.

Tamma, D., & Cosgrove, E. (2009). Antimicrobial Stewardship. Infectious Disease Clinics of North America, 25(1), 245-260.

Introduction

According to the interviewee, Corona Regional Hospital was established in 1933 to provide health services to community members. Since then, the hospital has grown to meet many of the community needs by providing healthcare services. It has enough qualified doctors and nurses who give medical assistances to both inpatient and outpatients visiting the hospital.

Besides the regular and full time employees, the hospital also has volunteers. The volunteer opportunities are divided into Hospice, adult and student. The hospital center has a 24 hour services including emergency room, oncology, services for women, pediatrics, maternity and surgery. Nonetheless, this is a report of an interview carried out in the hospital.

Corona Regional Hospital interview report

An interview was organized with an official representative of Corona Regional Hospital to find more about the services the hospital offers to both inpatients and outpatients seeking health services. The mission of the hospital center is to serve the communities so as to be the healthcare partner of choice for patients, physicians and staff members.

The interviewee was asked to give information on the category and numeric size of clientele the Corona Regional Hospital center serves within a period of one year. The interviewee stated that Corona Regional Hospital center offers health services to newborns and also to those seeking geriatric services.

Besides, Corona Regional Hospital receives approximately 11500 inpatients every year. Moreover, it also receives about 3600 patients seeking services at the Ambulatory Surgery Center in a year. These are surgeries done in situations where admission in a hospital is not always necessary. Again, within one year, the hospital receives approximately 42000 patients in its emergency rooms.

The interview also sought to know what kinds of services are provided in the Corona Regional Hospitals facilities. The response from the interviewee was that the hospital provides a range of health services. Some of the services mentioned included acute inpatient. Acute inpatient is an individual whose medical condition may necessitate that he or she stays in the hospital while still undergoing medication and or treatment.

According to the interviewee, Corona Regional Hospital also provides obstetrics and gynecology services (Azziz 42-54). Obstetrics is a specialty of medicine that is primarily concerned with taking care of reproductive tracks of all women and their children; while gynecology is a medical field primarily concerned with the female reproductive system (Azziz 42-54).

The scope of this field of medicine is limited to ovaries, uterus and vagina. However, it is highly possible for a doctor to be both a gynecologist and obstetrician at the same time. According to the interviewee, Corona Regional Hospital has some doctors who are both gynecologists and obstetricians.

Moreover, the hospitals scope of services also encompasses Intensive Care Units where patients with life threatening health conditions are given sophisticated support coupled with invasive monitoring, Progressive Care Units where patients whose health conditions are serious but do not require the services of Intensive Care Units, surgery, inpatient psychological services, outpatient psychological services and Emergency Rooms.

The hospital also provide services such as sleep Lab, Acute Rehabilitation services, Newborns, Ambulatory Surgery Centers, Skilled Nursing Facility, Speech Therapy, Physical Therapy and Maternal Child Outpatient Services.

The respondent was also asked to comment on reimbursement and sources of funding for Corona Regional Hospital. Regarding the source of funding for the hospital, the interviewee stated that the hospital gets its funding from the patients who pay for health services provided.

The hospital gets its revenues through cash payments by the patients who visit the hospital center and also via online through the use of Visa, Master Cards, Amex and Discover cards. The interviewee emphasized that these are the major sources of funding for the hospital.

On the issue of reimbursements, the interviewee revealed that the hospital has been a beneficiary of reimbursements from the government. The government pays for medical services sought by patients who have Medicare plans. However, the interviewee clarified that Medicare reimbursement does not cater for conditions arising from patients long stay in the hospitals facilities. For instance, he mentioned bedsores.

This has limited the amount it gets from reimbursements given that some patients suffer from conditions that may demand they stay a little bit long as inpatients. The interviewee could not provide significant information on any third party reimbursement covering the services provided by the hospitals. Nevertheless, he alluded to the fact that he could remember patients had used third party insurance companies to meet their medical costs.

Asked on the types of regulations and accreditations that affect the hospital, the interviewee mentioned such accreditations as CMS, Joint Commission, ISQua and NCQA. The interviewee explained that these accreditations have enabled the hospital to attract and retain loyalty of many customers who seek health services. According to the interviewee, the hospital also has other accreditations from Title 22, California Department of Health and Occupational Safety and Health Administration.

The health industry within the United States is regulated by certain policies which all healthcare providers must comply with. In relation to this, the interviewee said that Corona Regional Hospital follows both national and international standards and regulations on healthcare services.

The interviewee stated that the hospital fully complies with Health Insurance Portability and Accountability Act. The hospital is also compliant with Emergency Medical Treatment and Active Labor Act and Joint Commission on the Accreditation of Healthcare Organization.

The interview sought to find out about the hospitals medical record system. The response from the interviewee indicated numbering and filing systems as the most dominant parts of the recording system used by the hospital. In the numbering system, Terminal Digit and Encounter Number models are used. The filing system entails Terminal and Encounter being filed electronically in the Electronic Health Record.

In relation to physician documentation completion requirements, the interview found out that the hospital uses Title 22; this requires that all deficiencies are signed, dated and timed within 14 days after discharge. The hospital also complies with the requirement that the facility retain a delinquency rate that is less than 50% according to the provisions of California Department of Public Health, CMS and Title 22.

With regards to retention policies, the interview found out that Corona Regional Hospital follows a policy of retaining all medical records of its patients for a period of seven years after the last date a patient is seen at the hospitals facility. However, for mothers and babies, the records are retained for a period of nineteen years.

The interviewee stated that to release any patient information, the hospital complies with the federal and states Release of Information regulations, especially the Health Insurance Portability and Accountability Act.

Through the interview, it was discovered that Corona Regional Hospital utilizes a number of software for its legal medical records. Some of these include 3M, OPUS, RMS, PAX, Nuance and Horizon. The interviewee clarified that the hospital is still at the hybrid stage in the process of its computerization to Electronic Health Record system.

Corona Regional Hospitals privacy policies are in line with the Health Insurance Portability and Accountability Act. This is to ensure that patients medical information is not passed to unauthorized individuals, groups or institutions.

Conclusion

Corona Regional Hospital was established in 1933 to provide health care services to the local community members. In has since expanded to cover a wider region. The interview sought to find out about how the hospital operates, especially with regards to its facilities, policies and regulations within the healthcare industry.

Works Cited

Azziz, Ricardo. Obstetrics and gynecology: cases, questions, and answers. New York: McGraw-Hill Professional, 2006.

Specific environmental changes that Central Michigan Hospital must report

Central Michigan Hospital (CMH) is credited for delivering quality Medicare services to patients using the available resources. The hospital focuses its synergies on the provision of cancer care, family birthing, emergency care, and imaging services. However, the exemplary record of service delivery to patients is threatened by diverse environmental changes. The changes include rapid technological advancement, changes in social values, economic and legal issues. In particular, the rapid advancement in the technology sector demands heavy investment in new machines such as health care informatics that most companies cannot sustain.

Economic and legal changes also threaten to impede systematic service delivery in the hospital. Economic instability is caused by the global economic crisis and rapid changes in social beliefs about the relevance of modern medication, which is impeding the hospitals progress. Economically, the global economic crunch has lowered the hospitals financial capacity, thereby affecting infrastructural expansion. Patients also find it difficult to seek the hospitals services due to a lack of sufficient funds.

Specific constraints CMH faces in dealing with change

Indeed, dealing with the structural and policy changes is proving to be difficult due to resource constraints in CMH. First, the employees are not in support of the changes being introduced. The employees who are the drivers of operations in the hospital are resisting digitization programs as they fear losing jobs. Resource inadequacy is another major constraint with serious connotation to the change initiative. The change process that involves hiring advanced professionals, procuring high standard machines and improvement of workers welfare requires a huge capital base. Likewise, several legal requirements and procedures that are to be met by changing the system of operation, such as amending the procurement guidelines, are highly frustrating.

The structural changes CMH is undertaking in dealing with change

To realize the changes that are aimed at improving the effectiveness of service delivery in the hospital, CMH has developed various structural changes or adjustments. The structural changes include the performance of extensive sensitization programs to enlighten employees about the need for change. The idea is to instill a culture of change acceptance. The management of the hospital also plans to amend the institutions financial policy. This will foster the soliciting of funds from donors and financial institutions in order to finance development projects.

The impact of traditional culture on resistance to change at CMH and rites related to the traditional culture

The culture of health care workers appertains to their working beliefs, values, shared ideas, norms, and opinions. The culture influences the way they deliver services, communicate, show concern, and respond to changes. For instance, health workers who are used to manual systems of operations cannot be easily persuaded to accept digital systems. Such workers will always strive to resist any attempt to introduce technology, as evident in CMH case.

The traditional culture of work that the employees are used to has been fuelling their resistance to any form of change, whether in working hours, technology, or responsibilities at the hospital. The employees have also been resisting the new culture of accountability being introduced, given that they were used to absolute freedom at work. The instrumental rites that characterized and influenced service delivery in the hospital include prayer or supplication, dreams, divination, and concern about scientific health practices.

The concern nature of human resources in a change process

Successful realization of change is based on the quality of human resource capacity in most companies. No institution can attain its change objectives without the involvement of human resources. In particular, the individuals are the ones who implement the changes proposed and performed daily activities to satisfy clients. In Michigan Hospital, the doctors, nurses, clinicians, and support staff, among others, ensure that patients receive the best services. They contribute immensely to the implementation process of the new changes as preferred. Therefore, its importance cannot be underrated.

The specific actions CMH leadership is taking to boost change processes

The CMH leadership is undertaking various actions to ensure that the change process is successful. Such actions include the inculcation of a culture of change through sensitization programs. The programs are to enhance the employees understanding of technology importance and new ways of service delivery. The area is also meant to create awareness among employees of being not targeted. They should view the process as a quality advancement strategy. The leadership is also boosting change processes through the adoption of democratic management standards, promotion of inclusivity in decision-making and execution of employee training or capacity development programs.

The frame used in facilitating change

The hospital does not ignore the use of a frame to facilitate change, and the frame is called the eight-step change model.

The management of the hospital adopts the use of Kotlers eight-step change model frame. The frame provides a clear-cut change process highlighting what should be done from the preamble stages to the end. The frame gives a chronology of events starting from the creation of urgency of the need for change, formulation of a powerful coalition, and creation of a clear vision for change. The activities are followed by effective communication of the vision, removal of obstacles, building the change, and making it stick.