Category: Hospital

Mistake prevention in the work environment is achieved by educating healthcare workers to perform their jobs better (Grout 5). Specifically in the lab section, the rate of contamination associated with blood culture is lowered by having well trained laboratory personnel in place. In the case of mistake prevention, the hospital uses checklists as a way of achieving mistake-proofing. This is done particularly when the lists are made in a manner that makes it impractical to move from one step to another without making a confirmation that the previous step has been properly performed (Grout 6).

In the case of preventing the influence of mistakes, the facility employs written protocols and policies detailing responsibilities as well as providing contingencies when such responsibilities are not fully met or when they are not met at all. In addition, standardized protocols are employed in the health facility to prevent idiosyncratic improvisation. In the case of mistake detection, the hospital uses self-checks and successive checks (Grout 7). Successive checks usually involve revising the last steps in order to ascertain their completion or error occurrence. Self-checks are usually restricted to workers. They employ them to evaluate their own work. In addition, in the case of determining whether an error has occurred or is about to occur, the facility introduced a mechanism called Setting functions. It is effective as it differentiates between unsafe, inaccurate, safe, and accurate conditions.

If simulation had been adopted at our facility, it could provide significant insights into possible errors and also serve as a mechanism for the discovery of the causal and psychological mechanisms of errors (Grout 27). However, our facility has not yet employed this mechanism because of the technicalities involved. The facility stands to benefit a lot with the newly formulated Multiple Fault Trees since it offers insights into the errors or causes of failures and at the same time identifies the required resources for their generation (Grout 44). If the Fall Reduction and Bed Alarms mechanism are employed, patients in our facility would be protected from risk such as falling from their bed. They would also notify caregivers when patients are getting out of bed. Sometimes bed alarms are placed on the floor near the bed so that every time a patients foot touches the floor, an alarm sounds. This is critical especially in case of mentally disturbed patients.

Refrigeration Feedback: the refrigerators provided for the blood bank are equipped with devices that control temperature level. Thus, the fridge alarm produces a sound at the time when the temperature drops below or rises above the normal safety range. In addition, it will be easier for anybody at our facility to understand the information as alarms produce visual, digital readings and continuous chart recordings (Grout 48). Wristbands usually offer a physical space specifically for patients information to reside. Those are widely used in medicine as a means to provide sensory alerts for different conditions that patients may have. Additionally, the wristband is also used for patient identification; it can be a replacement for such technology as bar coding (Grout 49). In addition, the device has a magnetic device for storing data such as medical records. This device, if adopted by our facility, will be a wonderful improvement in terms of data storage as more often we suffer from data losses.

Works Cited

Grout, John. Mistake-Proofing the Design of Health Care Processes. AHRQ (2007): pp.1-166. Print.

Discussion

The non-profit organization in question is a hospital. Healthcare is a very sensitive issue when it comes to finances. Its price can be extraordinarily high, and yet its nature is such that a person often cannot refuse it without harming themselves. The populations that best represent the market of our non-profit hospital are people who cannot afford care at for-profit hospitals. This includes people living in a state of poverty, at-risk populations such as senior citizens, adults with intellectual disabilities, and any others that require help but have extremely limited funds. In some cases, these populations are not eligible to receive help from social groups, such as seniors who still have income-eligibility. Therefore, our hospital aims to help people who would not have any help otherwise.

Due to the non-profit nature of the hospital, financial support requires a certain level of promotion. For hospitals, a popular promotion strategy lies in the affiliation with religious denominations for additional funding. The care provided by the hospital is an invaluable resource and has a strong benefit to the community. By emphasizing the charitable mission of the hospital in its promotion, it is possible to secure several donations from both religious connections and people seeking to improve the well-being of their community. Finally, to maintain a positive attitude toward the hospital, it is important to properly redistribute the funds across the goals outlined in the strategic plan. Otherwise, the community might lose trust in our activity.

Conclusion

Non-profit organizations have to be extremely diligent in all financial matters. Non-profit hospitals operate to serve vulnerable populations because they are often unable to afford for-profit care. By promoting charitable activity and partnering with religious denominations, non-profit hospitals can maintain their operation.

Introduction

Human resources have a great influence on an organizations development (Christensen, 2005, p. 17-18). One of the important tools that might be employed by HR-managers to improve their subordinates effectiveness is a feedback in the form of a performance appraisal. It can be used to tell the employees what exactly they need to do, and how to do it (A handbook for measuring employee performance, n.d., p. 7). Our paper is a summary of an interview with Ms. Deborah Hebert, the Administrative Assistant to the Hospital Director at a city hospital, who has recently received a performance appraisal from her director.

The Summary of the Interview

During the interview, Ms. Hebert, who recently had received a quarterly performance appraisal from her director, expressed her satisfaction with the feedback provided by her reviewer. According to Ms. Hebert, the assessment highlighted both her strengths and weaknesses, and stressed the areas she had improved on.

The performance appraisal was, in general, positive; among other issues, it evaluated Ms. Heberts strengths, mentioning her skill in dealing with documents (medical ones in particular) efficiently and without mistakes; highly assessing her successes achieved while communicating with insurance companies; and noting her exceptional performance related to logistics and supplying the hospital with medication and medical equipment. The Administrative Assistant was deemed to be very reliable when it comes to paperwork and written communication.

On the other hand, Ms. Hebert also received some critical remarks on her ability to deal with the hospitals personnel. The Administrative Assistant was reported to experience problems while working in a team; according to the performance appraisal, she had tended to do a large part of work herself instead of evenly distributing the tasks among other members of her team. Given her meticulous approach to any work she does, the Administrative Assistant had spent too much time on work that should have been done by others, and thus had lagged behind on her other responsibilities a number of times.

The Administrative Assistant was also deemed not to be flexible enough while dealing with the hospitals stakeholders. Ms. Hebert had failed to persuade two of the stakeholders to provide the hospital with necessary equipment. Even though she had soon been able to compensate for this setback on her own by enlisting the help of some other hospitals partners, the performance appraisal stressed that this issue required some special attention.

A certain problem concerning time management was also mentioned. The performance appraisal highlighted Ms. Heberts exceptional diligence, but pointed out that the Administrative Assistant quite often stays at work after her workday is over. The hospitals Director emphasized that Ms. Hebert had certainly made some progress on the issue, for her stays at work had became somewhat shorter than before, but they still had not disappeared.

During the interview, Ms. Hebert emphasized that she was pleased to receive a positive performance appraisal and to have her hard work appreciated. She was also glad to see that her endeavors to compensate for her setbacks had been noted. On the other hand, Ms. Hebert, being grateful for the critical remarks, highlighted that she had also expected to receive some more recommendations about improving her performance, as well as feedback from the director on her work with the customers, which, even though it is not Ms. Hebert primal area of responsibilities in this particular hospital, still plays a major role in the institutions life.

Conclusion

As we have seen from the interview, the Hospital Directors Administrative Assistant was grateful for the feedback she received in the form of a performance appraisal, at the same time expressing a wish to get more critical remarks about her work. This example allows us to conclude that the performance evaluation can be useful to both stimulate employees to improve their work in future and to show them their mistakes. The fact that Ms. Hebert had expected more critical remarks indicates that workers sometimes want their mistakes to be pointed out to enable them to increase their efficiency. Therefore, a performance appraisal tool should not be ignored while working with human resources.

References

A handbook for measuring employee performance. (n.d.). Web.

Christensen, R. (2005). Roadmap to strategic HR: Turning a great idea into a business reality [Google Books version]. Web.

Brief Company Background

The Cleveland Clinic is one of the largest hospitals in the United States and has a long history of patient care. It was founded in Cleveland, Ohio in 1921 on the basis of Frank J. Weeds surgical practice. It staff originally included 60 employees, which included four nurses and 14 physicians. The hospital steadily grew over the years with new buildings being purchased and constructed to accommodate more patients and new types of treatments. However, on May 15, 1929, a terrible fire broke out in the hospital, taking 123 lives. The fire began due to the combustion of nitrocellulose x-ray films that were stored in the basement of the building. However, the reason for their ignition was not discovered (Access anytime anywhere, 2017).

Through the efforts of a philanthropist Samuel Mather and a number of people from the community, the hospital was able to temporarily move to a building next door. The original building was subsequently renovated. Throughout the following decades, the hospital continued to grow, with larger volumes of patients requiring additional buildings and staff. This subsequently grew into a major issue with the organization of health records (Access anytime anywhere, 2017).

Discussion of the Business Problem

Due to the long history of the hospital, it has accumulated a great number of patient records. Historically, the records archive was maintained at a physical location in the hospital, with staff being responsible for its service. It was always a complex system of patients medical records divided into various categories. The files are placed in boxes which are then stored on shelves. With growing volume of patients, this system cannot stay reliable for long.

The problem comes from the inefficiency of the current registration process. The hospital still uses physical files as the main type of patient registration, and it creates many problems for the organization. Registration is slow, files can be lost, and they cannot be quickly accessed. This means that patients have to wait for a long time before their treatment can start. People responsible for the registration are often stressed out as a result. Also, the system makes working with files a much harder process than it should be. Although there previous attempts at implementing rudimentary computer systems for patient record management, the effort did not involve the latest technologies and only partially addressed the issue.

High-Level Solution

This is not a rare problem in the world of modern medicine. Due to such factors as the phenomenon of defensive medicine, and the boom of medical technology, hospitals all over the United States are starting to deal with more patients than they can accommodate. The difficulty of keeping and managing physical records has become a major issue which the introduction of electronic health record systems is trying to address (King, Patel, Jamoom, & Furukawa, 2013). The systems allow almost instant electronic access to the patients health records from any computing device on the network (Nguyen, Bellucci & Nguyen, 2014). I believe that this type of systems can be the perfect solution for this issue.

Benefits of Solving the Problem

There are many studies that show that when a hospital creates or updates its patient registration system to use electronic health records, the efficiency of the work quickly rises and improves different aspects of the organization (Lee, 2014). Systems like these improve the speed of patient registration, decrease the level of stress in patients and employees, decreases the waiting time for medical treatment, improves customer service, and reduces the phenomenon of burnout. Also, the hospital would be able to treat more people at a faster pace when paperwork becomes easier to work with. As a bonus benefit, the system can be used as a database of patients where any file would be easily accessed by a doctor or any other person working in the hospital. This would improve efficiency in many hospital operations.

It is likely that the number of patients will continue to grow, and with time the physical archive systems will become inefficient to the point where it cannot be maintained, even if additional people are hired for this task. However, this would not be the case with a system based on electronic health records. Although the initial process of converting physical records into electronic ones will take considerable time and effort, it will make it possible to quickly transfer them in the future.

This ability allows the system to receive radical updates without losing access to any of the previously acquired data. It is inevitable that in the future, a new and improved version of the electronic system will be developed and implemented, and this time the process will take much faster due to the electronic nature of the records. Therefore, this solution will not only increase the efficiency of the system, but it will ensure that the system would be able to improve without extraneous issues.

Business or Technical Approach

By analyzing the reasons for the inefficiency, it becomes clear that a mostly technical approach is required for this task. The efficiency is low because of the method that the hospital uses to store information about its patients. It takes too long to register new patients and to retrieve the previously inputted information. The solution lies in the implementation of a powerful information system that would store the information digitally. This solution would involve a range of technological hardware.

Servers would be used to store and access the records. Due to the large size of the network, it would have to be a powerful machine that can send and receive large amounts of data at a fast speed and without a chance of a malfunction that could destroy the database. Another essential type of hardware would be computers. To ensure the highest possible efficiency, computers could include mobile computing devices such as tablets. The business side of the hospital would remain mostly undisturbed. However, some staff and organizational changes would be required to make sure that the system performs reliably.

Business Process Changes

Some parts of the business process would have to change after and during the implementation of the system. Electronic health records require the employees to be able to operate computers on a relatively competent level. To ensure this, a temporary coach might need to be hired to teach the staff on how to use the new operating system, software, and hardware. After the current staff becomes familiar with the new work process, they would be able to help new employees acclimatize to the work environment faster. Research shows that such systems do not take an extended amount of time to teach due to the competencies currently required from the hospital staff.

Another business change might lie in the need to open or expand the current IT department of the hospital. A system of this type requires a lot of maintenance to operate without errors. The team would be responsible for servicing the system in case of a malfunction, helping the hospital staff to acclimatize to the new system, updating and expanding the system if necessary, as well as general maintenance of the system.

A security specialist might also be required if the currently employed staff member is not able to address the new types of dangers. One of the largest risks and potential points of failure lies in the digital and interconnected nature of electronic systems. Although currently this issue has been given extra attention due to its high priority, there have not been a massive loss of confidential patient records information yet. In the current age of constant danger coming from the internet and malicious software, no one wants to have such valuable information to be accessed without permission, with a full leak being a possible worst case scenario. This should not be permitted, and therefore, the electronic security department would have to be either established or additionally trained to ensure safety (Ben-Assuli, 2015).

Technology Used to Augment the Solution

As previously mentioned in the paper, the augmentation of the solution would come from the technological approach. The system would consist of efficiently powerful hardware tailored specifically for the tasks commonly performed in hospitals. These tasks would revolve around patient record management and access. For example, currently, a physician might want to take another look at the x-rays for their current patient, but cannot do it immediately because it would take additional time that they cannot spare. With the new system, this would be possible due to the use of tablets which can provide access to patient records and display them onto a screen (Ben-Assuli, 2015).

This type of technology is provided by a large number of companies with the leading five systems being: Cerner PowerChart Ambulatory EHR, EpicCare Ambulatory  Core EMR, Allscripts Professional EHR, NextGen Ambulatory EHR, and athenaClinicals. The vast number of these systems allows for additional choices for the hospital depending on the requirements of its staff. Each system is slightly different and provides various capabilities to its users (The top 100 EHR companies, 2017).

High-Level Implementation Plan

A high-level implementation plan would create an overview of the potential steps of implementation of one such system for the Cleveland Clinic. The first step would involve the analysis of the needs of the hospital staff. During the analysis, such issues as slow speed of patient registration and health record retrieval would be examined. Through interviews with the staff, possible solutions could be found, as well as the information on what kinds of features the staff believes would improve the efficiency of the workflow. All of the suggestions would be gathered and utilized during the next step (Ben-Assuli, 2015).

The second step would be to take all the gathered information on this issue and to apply it to the electronic health record systems available on the market. Due to the differences in these systems, some are more likely to be beneficial than others (Ben-Assuli, 2015).

The third step is to contact the manufacturer of the system and order it with all the considerations of the staff that you were able to analyze in the previous step.

Next, the chosen company can be used to gather information on the skills required to operate the system, people who could professionally teach the staff, as well as people who could provide adequate protection against cyber-attacks (Ben-Assuli, 2015).

The fifth step would be organizational because the new departments would have to be established for the systems to function properly. This might be a complex process as the current team is less proficient with technology than it is required by the system. Therefore, the IT department would need to be either overhauled completely to address the new and different purposes or to train the current one to service the new system. The same solution applies to the network security department (Ben-Assuli, 2015).

The sixth step is dedicated to training. A schedule would have to be developed that could facilitate the training sessions without the loss of productivity. Medical practitioners often work beyond their work hours, which make this an extra-hard step. However, perhaps with more people who know the workings of the system, this information could spread faster, allowing the team to learn how to operate these systems faster (Ben-Assuli, 2015).

Finally, after all the hardware and software have been installed, after all the departmental issues have been resolved, and after the staff has been sufficiently trained, the system can become operational. Just in case something goes wrong, the system would have to be monitored and evaluated after some time. The aspects of evaluation would have to be the following: potential increase of speed in patient registration, a number of mistakes done before and after the implementation of the, as well as the general condition of the staff. Medical practitioners often suffer from stress-related issues so knowing if this implementation had a positive effect on their stress issues could be very beneficial for further study. These steps might be adjusted when the plan would be in motion as new opportunities might arise after a useful suggestion influences further actions (Ben-Assuli, 2015).

Conclusion and Recommendations

Electronic records have shown to have a highly positive effect on the workings of the hospital. Despite the scope of the project, it was still able to benefit the hospital in record time. The difficulty of setup is completely negated by the effect it has on the workflow of the hospital. For the future of the system, close attention should be paid to its updates. If the IT team is proactive, this should not take much effort on their part and would let the system stay up to date with the latest fixes it might require. Another recommendation would be in encouraging the staff to help each other in acclimatizing to the new system.

References

Access anytime anywhere. (2017)

Ben-Assuli, O. (2015). Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments. Health Policy, 119(3), 287-297.

King, J., Patel, V., Jamoom, E., & Furukawa, M. (2013). Clinical benefits of electronic health record use: National findings. Health Services Research, 49(1), 392-404.

Lee, V. (2014). Mobile devices and apps for health care professionals: Uses and benefits. P&T, 39(5), 356-364.

Nguyen, L., Bellucci, E., & Nguyen, L. (2014). Electronic health records implementation: An evaluation of information system impact and contingency factors. International Journal of Medical Informatics, 83(11), 779-796.

The top 100 EHR companies (Part 1 of 4). (2017).

Introduction: Rationale

This composition embodies a blueprint detailing the ground plan and draft for the proposed establishment of a childrens hospital in Dubai, United Arab Emirates. Rainbow International Childrens Hospital (the new setup) entails a corporation that will bestow laudable treatment and rehabilitation amenities to the children and young population of the jurisdiction. This business plan divulges the forecasted financial metrics and long-term performance of the hospital project over the next five years (Buss 2015, p. 11). It also brings to light the expected products & services, market analysis, sales & revenue, financials integers, organisation, and the exit plan.

Description of the Organisation

Rainbow International Childrens Hospital (RICH) encompasses a premeditated, child-centric nursing home. The medical facility will dedicate its exceptional healthcare regimens and personalized care to the young children within the UAE jurisdiction and adjacent GCC environs. The projected location of this imminent facility will be in Dubai, an affluent business hub in the Middle East, portrays Acharya (2015).

The initiative for this scheme stems from the regions passion of escalating the childrens medical service standards. The hospital will integrate a paediatric department that will proffer therapeutic care and an incessant commitment to treat and chaperone children along their maturation progress (Grossman 2012, p. 13). Round-the-clock childcare services will be available and will entail palliative regimens, paediatric surgeries, rheumatology, neurology, radiology, and ENT by certified nurses.

Additionally, the corporation will enlist liberal roles and missions to help integrate constructive guidance, ethical nurturing, parental satisfaction, and child counseling (Acharya 2015). The contracted nurses and physicians will implement the alleviation of lifestyle diseases diagnosed in children namely diabetes, obesity, and cancer among others agents.

Products and Services

The sketched products and services convoke a steadfast medical assistance modelled for children and infants of all ages (Karnopp 2011, p. 22). The hospice will consist of perpetual pharmaceutical amenities and paediatric therapies, attending to the voluminous young inhabitants of this locality. The entitys physicians will administer medical relief, restorative treatments, pharmaceutical consultations, and chronic pulmonary nursing (Dunn, Kathuria & Klotman 2013, p. 23).

These medical remedies will entail pulse oximetry, chest physiotherapy, enteral feeding, apnea monitoring, seizure management, stoma therapies, full ventilator support, and oxygen administration. Supplementary services will include nebulizer treatments, suctioning, tracheotomies, orthopedic interventions, and catheterizations, analyzes Allen (2008). As Acharya (2015) expounds, RICH will be the premier referral childrens hospital in the GCC region to capitalize on a paperless conveyance of technology.

The entitys inauguration will rescue the worsening situation of bed shortages and high occupancy rates. It will also enforce the issuance of the medical insurance policy (Dunn, Kathuria & Klotman 2013, p. 23). The management will also execute safety policies that guarantee a safe ambiance for all its residents as well as reinforce a socially conscious reputation/ brand recognition (Cleary & Rice 2013, p. 21).

Market Analysis

The stockholders and project proponents have conducted a market analysis that comprises of the customer profile (target market) as well as the industry analysis (competitors). This evaluation serves to depict and advice on the economic climate and feasibility of the hospice proposal (Walsh 2012, p. 19).

Industry evaluation

As Allen (2008, p. 27) illustrates, an industry evaluation embodies the examination of the prevailing competition among business rivals and similar firms. RICH may experience competition from general hospitals and, therefore, has opted to assimilate comprehensive childcare services as its unique product differentiation. The paediatric institution will link up with the nursing homes and general hospitals, reorganizing them to promoters of its exceptional pinnacle brand (Acharya 2015).

The executive board is currently working to augment the projects benefits, accessories, and the enlisted value for money as regards the services and products. Buss (2015, p. 33) adds that the projects proponent will conduct prospective marketing of the establishment by way of direct promotions and referrals by its esteemed associations. These advertisement efforts will help create a larger client base and dilute the imminent competition and position-jockeying tendencies among rivals (Dunn, Kathuria & Klotman 2013, p. 28).

Customer profile

The targeted patronage encompasses the children and young community of the indigenous and expatriate families, residing in Dubai, Ajman, and Sharjah among other UAE cities (Acharya 2015). The prevalent population of UAE and the adjoining GCC territories equals four and ten million inhabitants respectively. Lukenbill and Immroth (2007, p. 58) maintain that the local authorities speculate that the Dubai Marina, Palm Islands, and Dubai Land projects will lure more people to relocate here. The erection of these freehold properties will elevate business prospects and customer employment for the hospital.

Sales and Revenue

A sales and revenue extrapolation entails a firms weighted scenario for its future sales (Hunt & Laughon 2011, p. 47). It is an extensively crucial aspect of a business plan proposal as it stipulates the possible profits & returns, recruitment levels, growth, and management overheads among other elements. Rainbow Internationals sales forecast entails an educated guess about the industry analysis, buyer bargaining power, supplier power, economic outlook, and rivalry analysis. Table 1 (sales forecast) below tallies the patient service revenues- equivalent to the service volume * the cost per service capita (Lukenbill & Immroth 2007, p. 60).

The bottom line ratio accelerates by 10%. The projection also portrays the supplementary operating and non-operating revenues such as dietary sales and investment interests respectively (Cleary & Rice 2005, p. 34).

Financials: Performance and Delivery of Services

The guesstimated financial growth stresses the exploitation of the ventures cash flow (Hunt & Laughon 2011, p. 51). The statement of cash flows will mobilise the amassment of the accounts receivables from Medicare, Medicaid, and private medical insurances for the first two years. As time advances, however, the magnitude of the amenitys packages and provisions will stretch to accommodate a broader financier base (Acharya 2015).

The objective of this augmentation is to buttress the sources of revenue and income in conjunction with diluting the frequent intermissions that devalue the cash flow. The conjectured financial plot consists of annual tax and interest rate postulations among other quotations (see Table 2). The board assumes a stable economy exclusive of fiscal recessions and stringent federal policies that impair Medicare reimbursement and paediatric services.

As regards the discharge of services, RICH looks to incorporate a full occupancy capacity of twenty beds for the short stays (Acharya 2015). The monthly health insurance and nursing care billings will range between AED150- AED165 per day, exclusive of pertinent medication costs. The fees apportioned to the private clients, however, will be slightly more to recompense for the extra benefits expended while residing at the hospice.

Further, the proposed rates will be about 2/3 of the general hospital tariffs (Hunt & Laughon 2011, p. 54). The anomalies will hail from the personnel retention funds and public donations as well as the credits earned from recruiting senior physicians. As regards performance, the speculated break-even analysis implies that the hospital should register more than fifty patients per month to recoup costs, depending on the prevalent market rates.

Acharya (2015) alleges that the conglomerate envisages ameliorating the bed capacity to an absolute measure of 500 beds over the next ten years. The gross capital fees imperative for the planning, construction, stocking, stocking, and furnishing of the premises total to Euro 125 Million.

Projected income statements

The income statements depict accelerating sales and proceeds for the subsequent five-year duration as well as the revenues accumulated in the introductory year (see Table 2). The Directorate predicts a steady annual sales progression against the calculated expenditures (Acharya 2015).

Projected balance sheets

Table 3 beneath enumerates the speculated net worth and appraisal of the development. The yearly quotations reflect an ideal financial position (Walsh 2012, p. 38).

Organisation

The management structure will subsume two principal administrators: one clinical director and one administrative supervisor (see Table 4). The subordinate personnel will include two social workers, one administrative assistant, and two contracted speech & physical specialists, experienced in manual therapy (Acharya 2015). The two administrators will assume chief managerial positions and delegate direct services to the junior doctors as the demand for nursing escalates.

Personnel Plan

Administrative Director

The project proponent will undertake the administrative director role, accomplishing the responsibilities of a social worker during the pilot phases. Later, as the service hours ascend, the board will contract a designated employee, whose compensation will constitute of a flat fee.

Clinical Director

The clinical director role necessitates the recruitment of a qualified health care veteran- a position whose salary settlement entails AED 2,000 per week and annual TBA credits. The clinical administrator will initially operate as a skilled nurse before the appointment of a licensed nurse worker.

Administrative Assistant

The administrative assistants working duration will encompass a total of 40 hours per week at AED 45 per hour. The preliminary incentives and benefits will consist of four weeks, and eleven indemnified leave days.

Skilled nurse

The skilled nurse position will be a part-time role, accruing payments at AED 35 per hour and AED 1,500 per month for direct service and on-call hours respectively. The assigned benefits will include two weeks and six indemnified leave days.

Social worker

The contracted social worker shall amass a wage of AED 30 per hour for the direct service hours, computed at 500 hours per annum. The position benefits will accrue when the work volume ascends.

Manual therapists

The hired physicians and chiropractors will dispense manipulative remedies, fascial counter strains, and joints mobilization at AED 47 per hour recompensed at 650 hours per annum. However, no incentives shall accompany these positions, as they will be on a contractual basis.

Exit Plan

In the event that the paediatric facility is remunerative, the board may decide to relinquish the complex to a third party in pursuance of voluminous profits and investment bonds. The executive panel will engage adroit investment bankers and business brokers to trade the residency in exchange for affluent gains (Acharya 2015). If handled shrewdly, the proprietors could annex sales premiums and yields worth five times the initial capital fees (Hunt & Laughon 2011, p. 63).

Appendices

Table 1: Sales and Revenue Projections (Consolidated Statements for the First Five Years).

Table 2: Pro Forma Income Statement Forecasts (For the First Five Years).

Table 3: Pro Forma Balance Sheet Forecasts (For the First Five Years).

Table 4: Personnel Plan.

References

Acharya, D 2015, Rainbow International Childrens Hospital. Web.

Allen, J 2008, Nursing home administration, Springer Pub., New York.

Buss, W 2015, How to start a medical hospital business, SamEnrico, London.

Cleary, B & Rice, R 2005, Nursing workforce development strategic state initiatives, Springer Pub. Co., New York.

Dunn, A, Kathuria, N & Klotman, P 2013, Essentials of hospital medicine: a practical guide for clinicians, World Scientific Pub. Co., Singapore.

Grossman, L 2012, Infection control in the child care center and preschool, Demos Health, New York.

Hunt, P & Laughon, D 2011, The nurse leaders guide to business skills strategies for optimizing financial performance, HCPro Inc., Danvers.

Karnopp, J 2011, Family childcare basics advice, activities, and information to create a professional program, Gryphon House, Silver Spring.

Lukenbill, W & Immroth, B 2007, Health information for youth: the public library and school library media center role, Libraries Unlimited, Westport.

Walsh, R 2012, Start a business for less than 2,000: from airbrush artist to wellness instructor, 75+ profitable business startups for under 2,000, Adams Business, Avon.

Hardy Hospital: a SWOT analysis

Strengths

One of the strengths of the organization under the study is that Hardy Hospital has a functional computerized materials management system. Additionally, the regular stock items are frequently used and have a very low risk of obsolescence. The hospital has a very efficient requisition process that reaches various departments on time. The hospital has also allowed making special orders for those items that are not used regularly.

At the same time, the hospital has a team of qualified personnel that can deliver quality services to patients. The procurement process at the hospital ensures that everything is done transparently. Moreover, the hospital has a spacious warehouse that takes care of the storage needs of the hospital. Besides, the hospital is also able to access additional financing using a bond issue. It implies that the hospital is not constrained in terms of resources needed to enhance the quality of services it provides to the patients.

Weaknesses

One of the weaknesses of the hospital is that it has encountered high costs in terms of operating expenses. Additionally, the ordering process at the hospital does not reflect the needs of the hospital, resulting in both overstocks and insufficient stocks. The integrity of the information in the materials management system is questionable, given that some employees are not keen while updating the right information.

The special orders require a lot of commitment from the hospital department coordinators and head nurses to prevent them from inefficient executing of their duties. The purchasing process at the hospital is very long and may result in a stockout of the key items. Additionally, the lead time for the ordered items is unnecessarily long. It can result in a situation where service delivery is severely hampered. The hospital is also required to comply with a very strict procurement and tendering process as it is a state institution.

Opportunities

There has been advancement in technology that can be used to ease the ordering process and make it more efficient. It would ensure that the hospital would be able to avoid either excessive or insufficient stocks and enhance the quality of services offered at the hospital. Furthermore, this would simplify the ordering process and make it even more efficient and responsive to the needs of the hospital. The hospital can hire other employees who can specifically be in charge of special cases. It ensures that the department coordinators and the head nurses are not overburdened and can fully concentrate on their core duties.

Threats

Other hospitals, especially the private ones, do not have to follow a very strict ordering process, which puts them at an advantage over Hardy Hospital. It ensures that they have sufficient stocks that enhance their level of service delivery as compared to that of Hardy Hospital. Some other hospitals might be in a position to attract the employees from Hardy Hospital and also take advantage of its vulnerability to win over its clients.

The hospital should enhance their level of service delivery. Since the hospital is a state institution, it is constrained in terms of the funding that it is extended by the government. Additionally, since the government funds the hospital, it also determines the cost of the services that the hospital should charge its patients with.

Quality Initiatives

Hospital quality improvement often involves the implementation of a range of protocol bundles. Stony Brook University Medical Center (SBUMC) takes part in the Institute for Healthcare Improvements (IHIs) multiple quality initiatives. First, SBUMC has adopted a two-level sepsis treatment bundle to curb inpatient cases of sepsis and sepsis-related mortality rate. The first protocol covers initial response/actions (first six hours) after a patient presents with sepsis, while the second one provides for 24-hour treatment actions. Following the implementation of this bundle, the hospital achieved a 33% decline in sepsis mortality and a three-day reduction in length of stay (LOS) after a year (Swensen, Dilling, McCarty, Bolton, & Harper, 2013).

Second, SBUMC has also implemented an evidence-based protocol to reduce central line infection rates in ICU. It involved a standardized method for accessing and evaluating central lines as well as for tubing (Swensen et al., 2013). As a result, there was a 41% and 66% decline in the central line infection rate in the pediatric ICU and surgical ICU, respectively, between 2012 and 2013 (Swensen et al., 2013). Third, the facility has established an exemplary clinical unit modeled around the Plan-Do-Check-Act methodology to reduce inefficiencies and medical errors. The quality initiative has led to reductions in falls, medication errors, and mortality.

Reduction of Health Care Costs

Quality gains and cost reductions result from well-executed initiatives that improve clinical efficiency and reduce hospital-acquired infections (HAIs) and readmission rates. The factors that can help SBUMC achieve a reduction in healthcare costs without compromising quality relate to collaborations with national and state-level independent organizations dedicated to quality.

The AHRQ through the Comprehensive Unit-based Safety Program (CUSP) offers staff training on evidence-based protocols or tools for quality improvement (Swensen et al., 2013, p. 48). Therefore, by participating in programs like On the CUSP: Stop CAUTI SBUMC would achieve lower HAIs that account for high hospital costs ($758 per CAUTI case) (Swensen et al., 2013). In addition, SBUMCs collaboration in similar programs, e.g., Stop BSI can reduce central line-associated bloodstream infection (CLABSI). Participating hospitals were able to reduce CLABSIs in their ICUs by 40% and costs by $35 million (Swensen et al., 2013).

Disseminating quality improvement priorities and strategies across the facility is another way of achieving health care cost reduction. A learning collaborative approach could be used to communicate practice bundles in the facility. Quality bundles are assigned to multidisciplinary teams that devise quality interventions and implementation strategies. Using this approach, Ascension Health in Missouri reduced mortality by over 13.5% and annual health care costs by $6.8 million due to decreased HAI cases.

Free Market Health Care System vs. Single Payer Government System

While in the single-payer model, health care spending is controlled through government interventions, in a free-market system this monopoly is lacking, favoring the entry of diverse coverage options into the market. The two systems differ in terms of accessibility/waiting times, new technologies, and rationing with implications for quality. The single-payer model is considered more efficient than the free-market system. However, according to Capretta and Dayaratna (2013), the waiting times are higher in the single-payer system than in a free-market system, a scenario that decreases HCAHPs scores and quality. An example involves Canadas single-payer system where waiting times to see a physician increased following a flu outbreak. The long waiting list worsened the patients condition, leading to increased ER visits.

Unlike in a free-market system, scarce funding and rationing can affect quality in a single-payer model. In the latter, the government decides on the funding levels to allocate to health care; hence, hospitals resort to a rationing strategy that targets the marginal cases (Capretta & Dayaratna, 2013). An example is the UK system (single-payer) where patients in need of dialysis died because facilities could not run the machines full time due to funding constraints. In contrast, a free-market system attracts investments into the sector, which leads to competitive or quality healthcare products for patients. For example, the U.S. free-market system offers diverse products tailored to diverse patient needs and budgets.

The two systems also differ in terms of investment in healthcare technology. While in a single-payer system funding limitations and bureaucracy affect the adoption of medical technology, a free-market system spurs investment in technology, which results in quality improvement. For example, due to limited CT scans in an Ontario hospital (single-payer), thousands of patients are kept on a waiting list for over two months. In contrast, the free-market system delivers quality and affordable packages to patients. For example, insurers can contract low-cost facilities to provide quality and affordable services to patients. In addition, the system allows patients to pay more for specialized services. For example, Swiss patients can pay more for improved inpatient amenities.

Common-Law Quality Initiatives

Certain 21^st-century quality initiatives have their roots in the common law. They include medical error prevention, adoption of healthcare technology/innovation, and continuing education for professionals (Cunningham, 2015). Medical errors account for the high sentinel events and mortality rates in hospitals. Medical error reduction through nurse/physician communication initiatives like bedside reporting contributes to better clinical and patient outcomes. The adoption of healthcare technology, e.g., EHRs, facilitates hospital reporting and performance monitoring. In addition, technology helps streamline clinical processes and increase efficiency/quality. Professional education is required to improve the staffs capacity to adapt to best practices. Specialized knowledge, skills, and competencies are required for improved efficiency and clinical outcomes.

Importance of Healthcare Quality for the Organization

The business case for healthcare quality relates to an improvement in clinical outcomes and associated incentives. Hospital quality improvement initiatives have been associated with better clinical outcomes, e.g., increased cancer screening, fall reduction, low adverse events, decreased CAUTI rate, etc. (Swensen et al., 2013). Investing in quality improvement would bring significant financial gains to the organization in terms of increased quality-related incentive payments and reduced process inefficiencies. There are two main rationales for this argument. First, preventing sentinel events would result in significant cost savings  human and financial resources  due to reduced readmissions and LOS. Second, improved hospital/physician quality outcomes are associated with growth in the market share (Swensen et al., 2013). Therefore, there is a compelling case for offering quality care to patients.

Examples

Quality improvement not only benefits patients but also hospitals and insurers. Process streamlining removes care variability for patients and brings a significant return on investment. An example illustrating this view involves a Mayo Clinic that implemented a project to standardize processes (lean methodology) at its orthopedic and cardiovascular outpatient clinics. The project achieved annual cost savings of $2.6 million attributed to LOS reduction from 3.8 to 2.6 days, improved utilization of CT scanners, and a decline in 30-day hospital readmissions by 0.4% (Swensen et al., 2013). This shows that quality improvement can yield cost savings through clinical process efficiency.

Another example illustrating a business case for quality initiatives involves the Virginia Mason Medical Center. The facility adopted a low back pain protocol for its patients. There was a reduction in waiting times from over 30 days to one day and clients undergoing MRI scans (Swensen et al., 2013). In addition, patient satisfaction and Medicare reimbursements related to improved patient experience measures increased. Enhancing inpatient efficiency is associated with improved HAI-reduction reimbursements. For example, Covenant Health System in Texas adopted a clinically integrated system in its five hospitals. The hospital achieved reduced LOS, CAUTIs, and ventilator-related pneumonia cases (Swensen et al., 2013). The hospital qualified for VBP incentives for the reductions in the HAIs identified by the CMS. Thus, a focus on quality improvement would bring a positive return on investment directly or through Medicare incentives.

Protecting Patient Information

Compliance with the HIPAA provisions would avert costly audits and non-compliance penalties. To facilitate secure information exchange without compromising its security, a holistic and HIPAA-compliant information protection plan should be adopted. First, the organization should protect patient data from unauthorized access through system login passwords. Enhanced security controls would ensure that confidential information is not disclosed to unauthorized groups, including insurers (Cunningham, 2015). Second, the facility should implement certified EHRs to support the secure transmission of patient data to meet meaningful use requirements. Compliance with meaningful use would ensure secure generation and transmission of clinical data related to 23 objectives over a given reporting period. Third, developing a risk management process would not only ensure compliance with the HIPAA security rule, but it will help detect and mitigate security threats. Therefore, ongoing risk assessments will help prevent threats that could compromise the security of patient information.

References

Capretta, J., & Dayaratna, K. (2013). Compelling evidence makes the case for a market-driven health care system. New York, NY: The Heritage Foundation.

Cunningham, R. (2015). Once a welfare add-on, Medicaid takes charge in reinventing care. Health Affairs, 34(7), 1080-1083.

Swensen, J., Dilling, J., McCarty, P., Bolton, J., & Harper, C. (2013). The business case for health-care quality improvement. Journal of Patient Safety, 9, 44-52.

The average length of stay in inpatient facilities of developed countries remains static or shows a moderate decline over a 20-year period. This statistic has become a critical indicator of efficiency for hospitals and the overall health system. It reduces costs per patient as the expensive inpatient costs can be shifted to cheaper alternatives such as post-acute care. Medical progress causes longer average lifespans, which results in more people seeking health care services. Health care costs accrue exponentially and put financial pressure on individuals, health systems, insurance companies, and government budgets.

The system aims to redistribute and lower the costs, particularly on a case-by-case basis, through a variety of methods such as decreasing the average length of stay. However, it must maintain a balance between lowering costs and reducing efficiency. Medical care continues to follow a trend of quality patient care as a profit-boosting approach (OECD, 2017). Reduced length of stay helps to address issues such as hospital-acquired diseases and safety risks (such as patient falls) which prolong inpatient care. Length of stay is a complex statistic that is influenced by and has an effect on many factors of hospital operation and management.

Attention is given to developing models to monitor the most viable length of stay required without decreasing quality of inpatient care. Duration of stay for patients differs based on the medical diagnosis as well as demographics. This is analyzed and compared to the possible costs that the hospital may incur. It is an attempt to standardize hospital resource distribution based on the data. In turn, it provides a fair and clear statistic on cost allocation. Many facilities have limited spots for inpatient care, especially if accommodations are required for treatment. Current data only encompasses occupancy rates and average rates. However, models able to accurately predict the length of stay of a patient will sufficiently improve hospital administration and increase patient care efficiency (Tsai et al., 2016).

References

OECD. (2017). Length of hospital stay. Web.

Tsai, P., Chen, P., Chen, Y., Song, H., Lin, H., Lin, F., & Huang, Q. (2016). Length of hospital stay prediction at the admission stage for cardiology patients using artificial neural network. Journal of Healthcare Engineering, 1-11. Web.

Introduction

There is no use denying the fact that the sphere of medicine is one of the most important issues which guarantees existence of human society and civilization. Since ancient times, it helped to cure different diseases and protect the life of people. Going along with society, it has achieved a great progress and modern specialists in the sphere of medicine are able to do a lot of things which save lives of patients and help them to recover. Thus, unfortunately, even this progress is not the guaranty of the absence of mistakes which lead to the death of a patient. Medication mistakes nowadays are one of the main causes of deaths in hospitals. About 1,5 million Americans are injured by this issue (Anderson, 2010) and it costs $3,5 billion for the budget (McCann, 2014). With this in mind, it is possible to suggest that the problem of medication errors becomes one of the most important issues nowadays and the necessity to find a good solution is obvious. Nevertheless, it is possible to suggest that introduction of severe monitoring and creation of special tools which could help to avoid these mistakes could be taken as the only possible solution.

Resting on these assumptions, it is possible to say that the main purpose of the given paper is the attempt to analyze the situation in the healthcare sector nowadays and determine the main aspects of the problem of medication errors. The paper is based on the information connected with the functioning of Springfield Central Hospital (disguised name). The reason for this choice lies in the fact that this organization implemented the new technology in its functioning which main purpose was to help to get rid of the nagging problem of medication errors (Spector, 2012). Due to this fact, a computerized physician order entry (CPOE) system was implemented in the functioning of the hospital in order to solve the existing problem.

Thus, to a great surprise, the system turned out to be inefficient because of several important reasons. With this in mind, it is possible to say that the given work analyzes these reasons and tends to find another possible solution which will be able to help to reduce the number of medication errors in Springfield Central Hospital. Moreover, the work also centers around the possible electronic systems and solutions which will be more efficient. At the end of the paper a certain conclusion is made and the thoughts and information are reconsidered.

Discussion of the people alignment efforts for Springfield Central Hospital

First of all, the analysis of the given case should be started with the discussion of the people alignment efforts which could improve the situation. There is no use denying the fact that the human factor is one of the main reasons of the appearance of medication errors in the healthcare sector. That is why, it is possible to assume that some efforts aimed at the decrease of the level of negligence and inaccuracy among the staff could be rather beneficial (Hospital Errors are the Third Leading Cause of Death in U.S., and New Hospital Safety Scores Show Improvements Are Too Slow, 2013). First of all, more attention should be given to prescriptions which are ordered to a patient as it is one of the main sources of medication errors. Moreover, it is possible to recommend to increase the skills in computing as the failure of CPOE could also be taken as the evidence of poor attainments. The system could have helped in case the staff were able to use it correctly.

Theories of change implementation

Thus, is should also be said that implementation of some main concepts of the Theory of Change could help to solve the existing problem (An Introduction to Theory of Change, 2005) in Springfield Central Hospital. Having determined the decrease of the number of medication errors as the main long term perspective, it is possible to say that all further actions should be planned in accordance with this purpose. The first point should be the strengthening of control over prescriptions which are ordered to patients. Very often, doctors and nurses just confuse the numbers or titles (Medication Errors, 2015) because of various reasons. That is why, it is possible to suggest the pattern according to which all prescriptions should be checked by a certain group of specialists or specialists, who work at the same hospital. Only having passed through the procedure of verification, prescription could become legal and treatment of a patient in accordance with these prescriptions could start. Moreover, another point of the possible plan is the procedure of constant advance training which could help to save the high level of professionalism among the specialists who work in the hospital. This training should also include development of computer skills among the staff.

Sequencing of new technology

Besides, it is also possible to underline the necessity of some changes in existing technology. CPOE failed because of several reasons and one of them was the patient confusion. Very often, specialists selected the wrong patient and confused the prescriptions and medications. That is why, to avoid this sort of problem, it is possible to suggest the implementation of the more complicated system which would function only if the name of a patient is chosen rightly. With this in mind, the procedure which checks this sort of data several times should be introduced. It can help to avoid this sort of problems as a specialist, which is going to prescribe a certain medicine to a certain patient, will have to confirm several times that a patient and medicine is chosen correctly. Moreover, the photo of a patient should be added to his/her personal file for a specialist to be able to recognize him/her and associate the name with appearance.

Conclusion

With this in mind, having analyzed information connected with the given issue, it is possible to make a certain conclusion. First of all, it should be said that the problem of medication errors is very topical nowadays and it leads to many deaths among patients. That is why, there are certain attempts to get rid of this problem by implementing new practices and techniques in the work of hospitals. The attempt to use CPOE, which was supposed to improve the state of this issue and decrease the number of medication errors, failed. Thus, it should be admitted that there were several reasons for this failure. With this in mind, the given work suggests the main ways to get rid of these reasons and improve the state of affairs in the healthcare sector. Nevertheless, during the process of investigation of the given issue, the idea that medication errors are on f the main problems of modern medicine was obtained. With this in mind, it is possible to conclude that deep investigation of the given sphere is needed in order to understand the main point of this problem and find the best possible solution to the nagging problem of medication errors.

References

Anderson, P. (2010). Medication errors: Dont let them happen to you. Web.

An Introduction to Theory of Change. (2005). Web.

Hospital Errors are the Third Leading Cause of Death in U.S., and New Hospital Safety Scores Show Improvements Are Too Slow. (2013). Web.

McCann, E. (2014). Deaths by medical mistakes hit records. Web.

Medication Errors. (2015). Web.

Spector, B. (2012). Implementing Organizational Change: Theory Into Practice. Boston: Prentice Hall.

Introduction

Managing unionize employees is often a challenge for companies that operate in labor-intensive industries. The constitution of the US and those of most countries allow workers to join associations and take industrial action against their employers (Yates, 2009). This has led to the formation of numerous trade unions that focus on protecting the interests of their members. For instance, they negotiate for better remuneration schemes and improved work conditions on behalf of their members. However, the actions of trade unions can severely reduce the productivity of organizations that heavily depend on their employees to meet customers needs. This paper presents arguments against the unionization of workers in the context of a hospital with 1,000 nurses. It will also recommend a staff management plan as an alternative to participation in unions.

Arguments against Unionizing Nurses

Patient Outcomes

Unionization of nurses is undesirable because of its negative effects on patient outcomes. The Florence Nightingale Pledge states that &devote myself to the welfare of those committed to my care (Spetz & Herrera, 2011, pp. 60-67). The mandate of this pledge can only be delivered by nurses who think, speak, and act independently rather than through a trade union (Spetz & Herrera, 2011, pp. 60-67). Nurses are servants of their patients. Thus, their professional freedom should not be undermined by labor unions that make decisions on their behalf. Ethical nurses are expected to relinquish self-interest.

Moreover, they are expected to focus on high moral standards by acting in the interest of their patients. This requirement cannot be achieved through participation in unions that strive to achieve their objectives at the expense of patients. For instance, nurses have always been forced to abandon their patients to participate in strikes. This leads to unnecessary suffering and deaths among patients.

One of the popular arguments for unionizing nurses is that it helps in improving job satisfaction and motivation, which in turn leads to improved patient outcomes (Budd & Patton, 2004). Research indicates that this argument is not always true. Job satisfaction among nurses is not only achieved through salary increments or improving the nurse-to-patient ratio, which are the major concerns of unions. Nurses who work in hospitals with inadequate facilities will lack motivation even if they are highly paid. Thus, unionizing nurses does very little to improve patient outcomes.

Ineffectiveness of Unions

Labor unions are very ineffective in nearly all sectors of the economy (Yates, 2009). This can be illustrated by the sharp decline in the number of nurses who are members of labor unions. Most unions are led by people who are not medical professionals. Thus, they do not understand the dynamics of the healthcare industry and the needs of nurses. Oftentimes, labor unions fail to achieve their objectives through collective bargaining. Most negotiations usually end in compromises, where nurses have to accept less than what they demanded in terms of salary increments or improved work conditions (Spetz & Herrera, 2011). One of the factors that limit the effectiveness of labor unions is corruption and political interference. Corrupt union leaders usually betray their members by taking bribes to accept unfavorable offers. As a result, nurses continue to suffer.

Nurses have to pay for their membership in labor unions. However, the performance of the unions is never measured by nurses. The reality is that much of the periodic contributions made by nurses go to waste due to mismanagement (Yates, 2009). Nurses do not get value for their money since unions represent general/ group interests rather than the specific needs of individual nurses. Indeed, the needs of nurses are varied and unique to every hospital. This limits unions ability to act in the interest of nurses.

Financial Implications

Unionizing nurses will have a negative effect on financial management. Nurses account for nearly half of the hospitals workforce. In this regard, enforcing collective bargain agreements that focus on salary increments or increasing the number of nurses can be a serious challenge. For instance, increasing the salaries of 1,000 nurses by even 10% will require a substantial amount of financial capital, which might not be available. This will expose the hospital to the risk of being debt-ridden, especially if it has to borrow funds to implement unplanned salary increments or nurse recruitment programs (Yates, 2009). In addition, the profits of the hospital will reduce if the cost of enforcing collective bargain agreements cannot be passed to patients.

Empirical studies indicate that patients often bear the financial burden of implementing the demands of labor unions (Spetz & Herrera, 2011). For example, an unplanned increase in salaries might force the hospital to increase the cost of accessing its services. Moreover, the hospital might be forced to eliminate services that it cannot provide in a profitable manner in order to reduce costs. The overall effect will be poor patient outcomes (Budd & Patton, 2004). Specifically, access to medical services will reduce due to high prices. In addition, the quality of care will be compromised due to financial constraints.

Motivation and Incentive Programs

Motivation among nurses is an important determinant of the quality of healthcare in every hospital. Nurses have to be motivated through appropriate incentive programs so that they can deliver high-quality services. However, participation in labor unions is an impediment to the implementation of an effective reward or incentive system. Undoubtedly, productivity in the hospital is determined by the natural leaders who provide valuable inspirations and align the work environment to the needs of nurses. These leaders have to be recognized and rewarded so that they can keep improving productivity among nurses (Yates, 2009).

A contractual agreement between a labor union and the hospitals management will limit the extent to which excellent performers can be rewarded. For instance, increasing the salary of the best performing nurse or using bonus pay to reward committed nurses can result in a dispute concerning wage disparities. Since the best performers will be earning more than the marginal performers, the union is likely to organize a strike to compel the hospital to increase the salaries of every nurse. This limits the freedom of supervisors to reward excellence in their departments.

Maintaining the highest quality standards among nurses is not negotiable. Thus, underperforming nurses should not be rewarded. In addition, consistent underperformance should lead to dismissal, especially if the management has taken all available measures to improve the underperformers productivity. The union will prevent the hospital from acting in the interest of the patients by retaining only the best nurses (Spetz & Herrera, 2011). This perspective is supported by the fact that labor unions use legally binding agreements to protect their members from being fired. This constraint will lead to misallocation of resources by rewarding underperformers. Moreover, patient outcomes will decline since nurses will not have the incentive to do their best.

Productivity and Innovation

Innovative patient care can only be provided through effective interactions between experienced nurses and fresh graduates who possess new perspectives and high enthusiasm. Combining experienced nurses with fresh graduates is an effective technique for catalyzing change in the workplace. Achieving this combination is often difficult when nurses belong to a labor union. Most unions resist the employment of fresh graduates on short-term contracts since temporary employees are difficult to unionize (Yates, 2009).

Nurses who enjoy the protection of their unions do not consider fresh graduates as a threat to their employment. Specifically, they have no incentive to improve their productivity to avoid being replaced by fresh graduates. Similarly, they will not be interested in going the extra mile to achieve innovation. The resulting reduction in ideation and creation of new knowledge will reduce the competitiveness of the hospital in terms of its ability to satisfy patients needs (Yates, 2009).

Work Schedules

The union will limit the hospitals ability to implement flexible work schedules. Financial constraints might prevent the hospital from replacing nurses who are on training or annual leave. This can lead to long shifts in order to avoid interrupting the provision of medical services. Although the long shifts might be disadvantageous to some nurses, they will facilitate the implementation of training programs at a low cost. Eventually, they will lead to a win-win outcome since all nurses will get training opportunities, the hospital will reduce costs, and patients will access improved services. However, this outcome cannot be achieved if labor unions resist long work shifts.

Recommendations

The attempt to unionize the nurses can be prevented through the following plan. First, the hospital should focus on addressing the needs that are likely to motivate nurses to join a union. To begin with, the hospital should provide an improved reward system that enables nurses to earn a decent salary (Sims, 2007). It should also enable the hospital to motivate nurses to increase their productivity and to focus on innovation. The work environment should be improved to enhance satisfaction among nurses. This can be achieved by providing flexible work schedules, training programs, staff support programs, and opportunities for career advancement (Sims, 2007). Nurses should have adequate facilities or equipment to perform their duties effectively in order to achieve their work targets.

Second, a staff management committee should be established to handle the welfare of nurses and other employees. Nurses should dominate the committee since they are the majority in the workforce. The main responsibility of the committee will be to articulate the concerns raised by nurses. It will also collaborate with the management to find and implement appropriate solutions. Nurses should also be represented effectively in all management committees. This will improve the participation of nurses in all decision-making processes. The resulting improvement in the relationship between nurses and the management will negate the need to join a union (Sims, 2007).

Conclusion

Nurses should not be allowed to join a union in order to avoid deterioration of the quality of healthcare and the competitiveness of the hospital. If nurses are allowed to join a union, the hospital might be forced to incur costs that are not sustainable in the long-term. Besides, productivity among nurses is likely to decline due to the protection that they will enjoy by participating in the union. This will have adverse effects on service quality. In this regard, the attempt to unionize the nurses should be thwarted by addressing nurses needs internally.

References

Budd, K., & Patton, M. (2004). Traditional and non-traditional collective bargaining: Strategies to implement the patient care environment. Journal of the American Nurses Association, 9(1), 1-23. Web.

Sims, R. (2007). Human resource management. New York, NY: John Wiley and Sons. Web.

Spetz, J., & Herrera, C. (2011). The effect of unions on the distribution of wages of hospital-employed registered nurses in the United States. Journal of Clinical Nursing, 20(2), 60-67. Web.

Yates, M. (2009). Why unions matter. New York, NY: McGraw-Hill. Web.