Category: Hospital

The theme of research is The problems of mismanagement at hospital respiratory units and ways of solving them. Taking into consideration the topic of the investigation, it is possible to suggest a qualitative research design to perform the study. Out of the variety of qualitative research methods, grounded theory seems to be the most suitable in this case (Neuman 2014). Grounded theory is an approach that is frequently used with interpretivist methods (Collis & Hussey 2013). This kind of inductive theorizing presupposes establishing new analytical ideas from the existing theories rather than performing the analysis of the known concepts (Neuman 2014). An example of the employment of grounded theory is the study by Mishra, Gupta, and Bhatnagar (2014) focused on the exploration of work-family enrichment.

Using grounded theory enables researchers to establish the reasons, moderators, and outcomes of work-family enrichment. The approach is useful because it allows scholars to investigate the ideas based on known theories without having to formulate a theory of their own. Mishra, Gupta, and Bhatnagar (2014) emphasize the accuracy provided by grounded theory when it is employed in business research. Since the current project is also associated with business and management, grounded theory seems like a good choice of methodology. Another way of using grounded theory is the study by Fay (2011) concentrated on the employees choice of approaches to informal communication. This research is an example of how qualitative methodology may be used to identify patterns of communication between co-workers through a thematic analysis of their messages.

In order to contextualize research from a qualitative perspective, it is necessary to gather some background details (Collis & Hussey 2013). For the present study, such data will involve social, legal, and political issues. To understand the context of research perfectly, the information about mismanagement at different hospitals has to be collected, and the reasons causing such a state of affairs should be investigated.

The sampling method that will be most valuable for data collection is random sampling (Anderson 2013). This method gives a researcher a possibility to have the most reliable and independent data. When employing random sampling, any issue or participant included in the study has equal chances to be investigated (Neuman 2015). Moreover, this method helps to calculate the correlation between the whole population and the sample that is called the sampling error (Neuman 2014). Thus, random sampling suggests more reliability of the collected data.

There are some differences between qualitative and quantitative research that outline the benefits and limitations of each approach. The advantages of qualitative research over quantitative one include the possibility to analyze the data more precisely, base the framework of research on available data, and operate within the adaptable structures. Another asset of qualitative studies is that they are based on observations and peoples experiences. Also, a smaller sample size that is usually used in this type of research enables scholars not to spend much money on the study (Ary et al. 2018). Along with many benefits, qualitative research also has some limitations. The major one is the subjectivity of the gathered data. Other disadvantages include difficulties in presenting data, researchers negative impact on the course of the project, and a rather low possibility to replicate the results (Neuman 2014). Feasibility constraints of qualitative research are related to the search of the participants, data, and other materials necessary to perform the study. The key differences in planning research from a quantitative and qualitative perspectives include the choice of methodology, differences in the number of participants, sampling approaches, and data analysis tools.

Reference List

Anderson, V 2013, Research methods in human resource management, 3rd edn, London, UK: Chartered Institute of Personnel and Development.

Ary, D, Jacobs, LC, Irvine, CKS & Walker, DA 2018, Introduction to research in education, 10th edn, Boston, MA: Cengage Learning.

Collis, J & Hussey, R 2013, Business research: a practical guide for undergraduate and postgraduate students, 4th edn, Palgrave-MacMillan, London.

Fay, MJ 2011, Informal communication of co-workers: a thematic analysis of messages, Qualitative Research in Organizations and Management: An International Journal, vol. 6, no. 3, pp. 212-229.

Mishra, P, Gupta, R & Bhatnagar, J 2014, Grounded theory research: exploring work-family enrichment in an emerging economy, Qualitative Research Journal, vol. 14, no. 3, pp. 289-306.

Neuman, WL 2014, Social research methods: qualitative and quantitative approaches, 7th edn, Harlow, UK: Pearson.

Introduction

This report has been written at the behest of Mr. ABC, the CEO of XYZ Medical Manufacturing and Supplies Company Limited, in response to increasing concerns among employees following intentions to outsource certain manufacturing operations to businesses abroad. After consulting with several departmental heads within the organization, I collected findings and made a series of recommendations as discussed below.

Findings

Departmental heads reported to the HR Department that their juniors were worried that they would be among the 200 employees who would lose their jobs following outsourcing to foreign companies. Many personnel has been psychologically prepared to grow professionally within the organization, but they are now confused about the next move they would make. Departmental heads are also concerned that they were not consulted by the management on the plans to start outsourcing manufacturing to foreign businesses.

There is a concern that the organization would be affected by delayed delivery of products from abroad, and this would have a negative impact on its earnings. Most companies that outsource their products have often kept customers waiting for products to arrive from overseas. This would result in the loss of customers to business competitors. It is expected that the quality of products from overseas companies would be lower than what workers produce within the organization.

This would be attributed to the lack of close monitoring of workers by a person who knows the customer needs. In fact, the initial products would be of high quality, but the quality would decrease with time. There is also concern that the initial goal of reducing costs would erode as time passes. Delivery costs would increase, and this would result in lower profit margins. In addition, an increase in labor wages would culminate in higher operating costs.

Recommendations

• The management should find other ways of reducing costs other than adopting outsourcing.
• One tested option for outsourcing that would result in the reduction of costs is Lean Manufacturing and Six Sigma. This would also increase the quality of medical products supplied to hospitals.
• All departmental heads should be consulted when making decisions that would result in major changes within the organization.

Conclusion

Outsourcing would not result in a long-term reduction of costs and improvement of the quality of medical products. The organization should adopt other ways of reducing costs and improving the quality of products. This would not lead to the loss of jobs and the shutdown of one factory.

Introduction

In the conditions of economic development, the enterprises face multiple changes in the business environments, and it provokes the necessity for the design of managerial tasks aimed to control the external and internal transformations and to create the adaptive operational processes and systems. The systematization of internal control which has a purpose of timely identification of the resources reserves and disproportions becomes especially significant because it allows the companies to elaborate and adopt the measures for reduction of risks and achievement of financial sustainability.

The renovation of activities targeting the increase in customer satisfaction and productivity enhancement requires the introduction of new methods of organizational processes, technology, and finance arrangement. In this case, the preventive control procedures, including evaluation of effectiveness and efficiency, are regarded as the essential activities for rationalization of decision-making and selection of alternative programs of development. Many of organizational issues can be resolved through the formation of Accounting Information System (AIS) based on the analysis of internal factors of growth and evaluation of external influences.

The purpose of the paper is the assessment of AIS implemented in the UAE Lifecare Hospital (LCH), a unit of VPS Healthcare Hospital, located in Musaffah district of Abu Dhabi. The company provides advanced healthcare services for the district population and operates over twenty departments, including laboratory services, emergency services, and pharmacy (Life Care Hospital Musaffah Profile, 2014). A large scale of operations requires a thorough control and allocation of resources. The evaluation of LCHs AIS frameworks and activities will help to establish the extent of its effectiveness.

Analysis of Control Frameworks (CF)

CF for Internal and External Organizational Environments

The organizational control processes ensure the establishment of mutual interrelations between the managerial system and the managed objects or activities. The control processes help managers to accumulate the important information about the actual state and consequences of the managerial decisions implementation. The function of internal control implies the evaluation and analysis of working outcomes, and it helps to assess the extent of working efficiency and correct the selected trajectories if needed. Organizational AIS should comply with all factors associated with the current position of the company in the market (Hanifi & Taleei, 2015). And these factors may be both internal and external.

According to LCHs model of control, the internal environment includes organizational structure, culture, and resources. The external factors are competitors in the market, consumers, suppliers, shareholders, and governmental institutions. In LCHs CF, the external factors shape the rules and standards of internal conduct and establishment of relationships with stakeholders; these standards serve as the orientation for the firm to follow.

LCH evaluates multiple external factors such as level of customers income, currency exchange rate, inflation level, taxation rates, market competition, etc. to control its financial operations. The neglect of external factors may lead to profitability decline and adoption of inadequate financial policies (Marin, 2015).

The internal factors included in LCHs model may be represented as the set of seven groups of factors: resource and market, technology, integration strategy, financial and economic policy, social performance strategy, and managerial indicators (Snoj, Gabrijan, & Milfelner, 2010). The internal organizational factors are shaped by LCHs executive group that conducts the multidimensional analysis of these factors as an initial phase of the decision-making process. The internal analysis helps LCH to identify the operational limits and select the appropriate directions for the potential improvements and detect the weakest spots in AIS.

The current CF for evaluation of internal and external factors adopted by LCH may be considered effective because it helps the organization to analyze the information received by monitoring the environment, identify the risks and opportunities, and develop the strategies for their management.

CF for Physical Assets

LCHs CF allows the organization to control the tangible assets supply, detect the surplus of unutilized objects, and develop a plan for the enhancement of fixed assets implementation (Avellanet, 2005). LCH regularly controls the formation and application of tangible assets through the realization of the following steps:

1. the detection of storage and preservation conditions in the enterprise facilities,
2. analysis of expediency of purchase which helps to reveal the completeness, timeliness and correctness of the fixed assets entered into account,
3. inspection of compliance with the order of acquisitions and disposals,
4. analysis of effectiveness and correctness of assets presence and movement in the accounting, statistical and tax reporting documentation.

CF for Information Technology (IT)

IT is an essential part of LCH business operation and service provision. The company uses an integrated system to meet various demands in healthcare provision and increase customer satisfaction (Achieving excellence through innovation, 2016). The activities included in LCHs IT control model are the conduction of IT analysis for the detection of the topical issues in organizational IT structure and related business risks; measuring the level of IT user satisfaction; IT inventory; conduction of IT infrastructure and IT management audit; and analysis of processes automation.

The control activities facilitate the development of complex IT strategy and help to reduce the risks of IT malfunctions which may result in productivity decrease (Li, Peters, Richardson, & Weidenmier Watson, 2012). The current CF for IT allows LCH to evaluate system functioning, prevent defects and systematic disintegration and take timely measures for technology advancement.

CF for Cash Flows

LCH established multiple relationships with business partners, customers, and other organizations on the everyday basis, and these professional interrelations are based on financial settlements and payments. The settlement of cash transactions should follow the strict regulations (Duhovnik, 2008). It is better to inspect cash transaction continuously because of the high level of asset mobility that may lead to financial abuse (Duhovnik, 2008).

LCHs cash control activities include daily cash inventory, daily reporting, evaluation of completeness and timeliness of cash posting, control of write-offs in flow, analysis of financial discipline and correctness of operations presence in the accounting reports. The mentioned continuous control activities comply with the legal regulations and accounting standards. The cash control activities are meant to prevent accounting standards violations and facilitate the course of annual audit inspection by providing the structured and well-systematized information (Duhovnik, 2008).

Information Processing and Documentation

Informational management functions in the informational field within the organization and is characterized by the set of methods and means which allow the staff members to arrange the processes of reception, transformation, storage, and distribution of data (Li et al., 2012). Information processes are aimed at the optimization of organizational management, development of informational resources in the enterprise and their usage in business.

The first type of LCHs information processes and documentation are meant to provide economic data to the external users, i.e. investors, tax service organizations, shareholders, etc. Such documents include 10-K reports, accounting documents, and so on. The second type of information processes relates to the tasks of internal analysis used for the strategic management and decision-making.

The development of organizational knowledge happens through the processes of information accumulation and analysis, evaluation of environment, and formulation of goals in business (Hanifi & Taleei, 2015). The second type of information documentation is associated with the organizational reporting system that serves as the basis for the development of strategic tasks, i.e. daily reports, managerial reports, or archives.

Information procedures are widely used in the hospital for the establishment of professional relations with customers, and storage of patients data. LCH uses the patient cards for the archiving of customers history and facilitating communication with healthcare providers. The documents are also used to keep statistical reporting that can be used as a valuable informational resource for the improvement of relationships with patients and service provision enhancement.

Conclusion

The analysis of LCHs AIS helped to reveal that control is an intrinsic part of the managerial cycle. It helps to establish the mutual connection with the managed activities, shapes the information about the changes within the operational processes and management systems. The major portion of information is kept in the accounting system and can be effectively used in the decision-making process.

The integration of AIS indicators into the development of managerial strategies may help to increase productivity, cost-efficiency, and effectiveness of resources allocation. AIS facilitates informational flows both within and outside the organizations  enhances communication modes and data sharing with the major stakeholders, and, as a result, increases the quality of customer satisfaction. Overall, a well-developed AIS may be regarded as a core advantage in any industry because it improves working productivity and, in this way, contributes to the increase in organizational competitiveness.

References

Achieving excellence through innovation. (2016). Web.

Avellanet, A. W. (2005). Fixed assets: Internal controls and risks. Internal Auditing, 20(4), 3-13. Web.

Duhovnik, M. (2008). Improvements of the cash-flow statement control function in financial reporting. Proceedings of Rijeka School of Economics: Journal of Economics And Business, 26(1), 123-150.

Hanifi, F., & Taleei, A. (2015). Accounting information system and managements decision making process. Management Science Letters, 5(7), 685-694. Web.

Li, C., Peters, G. F., Richardson, V. J., & Weidenmier Watson, M. (2012). The consequences of information technology control weaknesses on management information systems: The case of Sarbanes-Oxley internal control reports. MIS Quarterly, 36(1), 179-204.

Life Care Hospital Musaffah Profile. (2014). Web.

Marin, R. M. (2015). The possibility of developing a sustainable financial-accounting information system. Valahian Journal of Economic Studies, 6(1), 103-112. Web.

Snoj, B., Gabrijan, V., & Milfelner, B. (2010). Internal and external market orientation as organizational resources  consequences for market and financial performance. Trziste = Market, 22(2), 223-241. Web.

Introduction

The performance of employees in an organization is influenced by the work atmosphere and organizational culture that values the input of the individuals in the workplace. According to Bowen and Ostroff (2004), the expectation of many employees is to have a good work environment. For instance, a safe, healthy and friendly environment aids in bringing the best out of the employees, and it is a core element of job satisfaction.

The friendly environment can be achieved by the organizations human resource managers putting in place an HR policy that balances all the processes of the organization. For example, a clear framework for managing disputes, development of public relations, and effective communication. The factors are crucial in the creation of efficient work teams which enhance the performance of an organization.

In the case of the pharmacists at a tertiary hospital in the Gulf Region, there are challenges that affect the execution of their mandates as desired. For example, communication dilemmas, disputes, incentives and organizational culture challenges are the major impediment to the performance of the pharmacy. The following paper applies congruence model, an organizational-wide level model to determine how the fit or lack of it between the elements affect the organization with the key focus on pharmacy practice and management.

Overview of the challenges in the Pharmacy

An organization cannot achieve a motivated team without good human resource management practices that motivate the employees in order to promote the work satisfaction. A critical analysis of the work dynamics of pharmacists at the tertiary hospital in the Gulf Region shows that there are challenges in the work processes. This is due to many issues that the pharmacists face ranging from leadership, employee relationships, communication, use of technology and compensation.

Ideal work environment plays a critical role in ensuring optimal performance of the employees. The work environment in the organization is not conducive. There is no good fit between the pharmacy department and other departments and as a result, cases of drug shortages are reported. Even though the pharmacists blame it on technology failure in which sometimes they have to bypass the barcodes, it is clear that there is no good leadership to coordinate the departments in order to ensure that IT systems are working as required. This signifies the lack of effective communication which affects the general performance of the organization. It lowers the motivation of the pharmacists to deal with unsatisfied patients.

Also, there are challenges of workload especially during the peak hours where many customers have to wait for long to be served. The other problem relates to the cooperation between employees. Therefore, there is the need to look for means to address the challenges that pharmacists face in their line of duty. The shortfalls can be related to inadequacies in factors such as supervision strategy, work load, job security, and staff cooperation.

The employees are not motivated due to disparities in the financial compensation system. For example, there is favor of expatriates over the locals. The disproportional payment negatively affects the motivation of the pharmacists. Also, there are indifferences in the staff/manager relationship which affects the general work processes. These factors lead to a riffle effect and hence the lack of cohesive work teams which increases instances of mistakes and employees ignoring each other.

This is the case of with Pharmacist A, who is less motivated due to lack of training. The manager has also not guaranteed a proper climate in which pharmacist A can train so that they perform duties and tasks. Non-cooperative employees during training sessions, as well as laziness during training, have affected the ability of pharmacist M to achieve full potential.

Based on the above dynamics that negatively influence the performance of employees, managers should ensure that work environments focus on the development of relationships so that employees achieve their full potential. In the third case, there are challenges of communication dilemma in which there is no clear channel of communication. There are conflicts in orders given to the pharmacists by different leaders, and hence, it becomes very difficult to determine what to implement and what to ignore. Secondly, there is no formal training process for new employees; the organization has left employees to self-learning process.

Thus, it is evident that functions of the organizations are disjointed which creates a platform for many disputes. This scenario relates to findings by Bhattacharya and Wright (2005) who pointed out that lack of congruence in the workplace demeans the performance of employees and hence affecting the competitive advantage of an organization. In the case of the hospital, with the current incongruence, it cannot achieve its mandate of providing optimal care to the community.

Thus, there is the need for proper set up of organizational structures that will enhance leadership that unifies the operations of the hospital. This can be achieved by invoking better HRM processes. It is worth noting that lack of proper organization leads to serious problems in relation to the management of daily activities. Hence, the need for proper processes that ensure fit in the organizational processes in terms of coordination between the pharmacists, organizational culture, leadership, and a good work relationship. This will ensure that personal needs such as work-life balance, remuneration, and personal satisfaction are achieved. On the other hand, motivated employees will improve the performance of the organization.

Congruence Model

Different factors affect the performance of an organization. The performance of an organization can be enhanced by understanding the drivers or the causes of performance and how they relate. Based on the analysis of the factors that influence the hospital, there is a depiction of some issues that derail optimal performance of pharmacists. In order to put in place measures to address the current challenges, application of Congruence Model can be used to examine the key elements affecting the operation of the hospital and how they can be applied to create fit in the organization.

The congruence model was developed by Michael Tushman and David Nadler. The Congruence Model is a management tool that is used to analyze issues affecting an organization in relation to team organization and measures that can be applied to fix the challenges. Congruence is a measure of the extent in which pairs of components fit together. Nadler et al. (n.d.) stated, Other things being equal, the greater the total degree of congruence or fit between the various components, the more effective will be the organization (p. 43).

In this perspective effectiveness relates to the degree to which the outputs of groups, individuals, and level of the organization are comparable to the expected outputs. The model is based on tenets of organizational performance, and it incorporates key elements of people, structure, culture and tasks (Nadler, Tushman & Hatvany, n.d.). According to Nadler et al. (n.d.), high congruence among the elements is a predictor of better performance.

On the other hand, the lack of congruence lowers the motivation of employees and hence reduces output. For instance, an organization with competent employees, but that lacks organizational culture results in the lack of fit which affects the overall work environment. Thus, the competence of the employees cannot be manifested in the organization.

Application of the Model

With the age of technology, many organizations have employed the use of technology by automation of their operations. However, the lack of good relationships within an organization the achievement of the results required. A case example relates to the automation of systems in the tertiary hospital, but still there are shortages in the stores, and the movement of inventory is not clearly monitored due to possible lack of coordination between departments. Thus, the congruence model provides a better way of organizing the various elements that are key to organizational performance in order to promote the performance of the organization.

Task (work) is one of the four components the Congruence Model. The first step towards congruence in an organization is to understand the core activities of the organization. The main consideration of the components is to examine the crucial tasks that are carried out within the organization. This is mainly based on how work is done and how it is processed. Therefore, the HRM should examine the knowledge required to carry out the work, the intrinsic rewards that may be provided in order to complete the work, the approach needed to ensure efficiency to carry out the work. Task is also related to the interdependencies between the people executing the work.

Concerning the tertiary hospital, the processing and execution of the pharmacy processes are faced by challenges of poor coordination. For instance, there are challenges with the application of technology in dispensing the drugs. In addition, there is no coordination between employees which negatively the work output. In general, there is no fit in the work processes, and hence, the accuracy and efficiency of the hospital are affected.

The second component of the model is the people. This component deals with the identification the type of individuals who are involved in performing the organizational tasks. In the process of the identification, there is the need to consider the preferences of the people, their expectations, and the perception they hold about their duties. Demographic factors also come to play such as ethnicity and gender.

The preferences entail the peoples requirements in terms of compensation, career progression, and commitment to the organization. The factors are critical in influencing the relationship between the employees and their ability to work towards attaining the organizations goals. This is a critical factor in the pharmacy; most of the incongruence seems to happen due the management and leadership of the organization failing to put in place strategies to address the needs of the pharmacists.

For example, there are concerns that the compensation in the organization is disproportional. Besides, some employees go out of their way to put extra effort in their duties, but they are not rewarded. It is the expectation of many employees that compensation should take into consideration the personal work output. However, this is not the case at the tertiary hospital.

The various cases presented by the employees shows that the HRM leadership is disconnected with the expectations of the employees and hence the low motivation. According to Malik, Danish and Munir (2012), leadership consists of strategies that motivate, inspire, and encourage individuals with the aim of spurring growth and development in an organization. Motivation helps the followers to make priorities by concentrating on the goals of the organization rather than their personal goals. This is paramount in the organizational development. A key element of motivation is a reward in the form of salaries that correspond to the performance of the employees. Therefore, to ensure fit, there should be a leadership style that fosters all direction communication such as transformational leadership style.

Organizational structure is the third component which entails the examination of the formal structure of the organization, the systems, and processes that aid in the performance of the organization. The component focuses on the design of the organization, the standardizations, how the work is quantified and the subsequent rewards, and the rigidity of the lines of the management process. In the tertiary hospital, there are no systems that measure the performance of the employees hence no reward system based on performance. Also, the pharmacy lacks a clear organizational structure, which leads to the communication dilemma as there is no formal structure on how instructions are passed to the pharmacists.

Finally, the fourth component is the informal organizations which include the arrangements within an entity which are usually implicit but contribute to the overall organizational behavior. The factors can enhance or derail the performance of the organizations. A great deal of the informal organization depends on the attitudes, motivation, and beliefs. Leadership style plays a critical role in the informal organization. Concerning, the hospital, there is the lack of clear work culture which is depicted by the lack of teamwork spirit. The pharmacists do not responsibility within their department as collective requirement; instead, they blame each for mistakes that happen. For example, mistakes made by the untrained pharmacist make the colleagues ignore and blame her.

From the four elements of the congruence model, it can be pointed out that performance of the pharmacy department is not efficient as expected. This is due to incongruence that characterizes the operations. The implications of the analysis are that there s the need to reorganize the hospitals processes in order to achieve a fit that will restore the pharmacy to improved performance. Figure 1 is a sample of the organization of the four critical elements required to achieve the performance of an organization.

Process of Achieving Congruence

The congruence between the HR practice and the strategy of the firm has been emphasized as a key factor in the strategic human resource management. Wei (2006) noted that it entails bringing together the function of human resource to the strategy of the organization. Furthermore, many studies have been conducted to find out the relationship between the human resource strategic management, and the performance of the organizations. The key finding has been that there is the need for a fit in the overall organizational performance in order to achieve the desired performance. Fit refers to the planned pattern of human resource deployment and activities that enhance a good work environment in order to achieve the organizational goals.

Fit can either be vertical or horizontal. The vertical fit entails congruence among the HRM practices while the vertical fit aids the alignment of human resource practices within the organization in order to ensure better management of the firm. This may include proper communication systems. Thus, for an organization to ensure increased performance, there is the need to achieve the both the horizontal and vertical fit.

The determinants of horizontal fit include the HR organizational policy, investment and key processes of the human resources management and the options of the HR practices. These factors result in congruence of the HR practices. For example, in the tertiary hospital, vertical fit relates to the policy of the organization in relation to the employment, training and compensation of the employees.

In the case for the pharmacists, the HRM lacks a good policy on the training of the employees and hence the incongruence in relation to the relations among the pharmacists and hence the mistakes in the drug prescriptions and monitoring of inventory. Similarly, the compensation of the employees differs depending on the affiliation or nationality instead of performance based remuneration. Therefore, there is no good balance of the processes. Wei (2006) observed that if some functions are treated as less important than others, there is the likelihood of HRM inclining to the functions perceived as great and hence with time, divisions in the management occurs which leads to neglecting the perceived lesser functions.

For example, a policy that does not place attention to practices such as training and compensation and emphasizes only on employees ability to meet targets, leads to poor congruence. The case has been experienced in the hospital, for example, it seems training of new employees has been relegated to the category of the less essential functions. The result has been compromised drug prescription.

To achieve the horizontal fit, there is the need to ensure balance by incorporating a policy that emphasizes the importance of all HR practices. In such case, new recruits in the hospital should be given training priority. In addition, compensation should be streamlined to ensure that there are no disparities, and individual performances are recognized and appreciated. The policy should also result in a recruitment policy that ensures that there are enough pharmacists to serve the customers.

On the other hand, vertical fit is usually impacted by the organizational values and cultures. According to Cable and Edwards (2004), determinants of vertical fit influence how quick a strategy can be executed in an organization. The values and cultures of an organization are influenced by the leadership and management of the organization. For example, in the pharmacy, there is no clear culture and values of the organization. As a result, the communication processes in the organization lead to dilemma as the pharmacists do not know the orders to follow.

In addition, there is a problem of performance culture in which the pharmacist blames the technological failure to the inability to have all drugs stocked in the stores. The disconnect affects the overall performance of the organization and patients are disappointed in the final states of treatments by pharmacy department.

The proposition to achieve the vertical congruence in terms of leadership, performance culture and overall organizational values, is that there should be a work design that is compatible with the overall work environment and the adjustment of the practice in order to ensure that there is a strategic change. The strategic change will make sure that pharmacists work in a manner that will promote patient-centered care. It is worth noting that pharmacy plays an integral role in the overall process of health care provision.

A failure in the department implies that the main goals of the hospital are not realized. Overall, for congruence to be realized in the hospital, the four elements have to fit together, i.e. the culture, structure, people, and tasks. Nadler et al. (n.d.) pointed out that when there is unison to support and promote improved performance, it leads to an organization-wide system that can realize its core mandates by functioning effectively. However, when the unison lacks, there is increased friction in the organization, which limits the ability of the organization to perform optimally.

Conclusion

The performance of any organization is affected by how different factors interact to create a good work environment. In the case of the pharmacists in the tertiary hospital in the Gulf Region, it is evident that the various elements of the organization are not in congruence. This has been the main cause of the inefficiencies and ineffectiveness. Thus, there is the need to realign the processes of the organization to achieve a fit in the operations.

The changes should be aimed at creating synergies in the four elements in order to attain a cohesive workforce that will transform the functions at the pharmacy departments. It is worth noting that it is the task of the human resource managers to initiate leadership that will lead to the transformation towards achieving the required balance. The primary role of any management team is to ensure that organizations function efficiently. One fundamental process of achieving performance is by making sure that there is congruence in the organizations. This is crucial for health institutions that have to provide patient-centered care.

References

Bhattacharya, M., & Wright, P.M. (2005). Managing human assets in an uncertain world: applying real options theory to HRM. International Journal of Human Resource Management, 16(6), 929-948.

Bowen, D.E., & Ostroff, C. (2004). Understanding HRM-firm performance linkages: The role of the strength of the HRM system. Academy of Management Review, 29(2), 203-221.

Cable, D. M., & Edwards, J. R. (2004). Complementary and supplementary fit: a theoretical and empirical integration. Journal of Applied Psychology, 89(5), 822- 824.

Malik, M., Danish, R., & Munir, Y. (2012). The role of transformational leadership and leaders emotional quotient in organizational learning. World Applied Science Journal, 16(6), 814-818.

Nadler, D. A., Tushman, M. L., & Hatvany, N. G. (n.d.). Managing organizations. Boston: Little, Brown and Company.

Wei, L. (2006). Strategic Human Resource Management: Determinants of Fit. Research and Practice in Human Resource Management, 14(2), 49-60.

One can hardly imagine professional activity without modern technologies including the opportunities that the usage of databases gives. I am not an exception. In this paper, the database used in my working environment and its characteristics are described. Further, the entities that are part of the database are given. Finally, an entity-relationship (E-R) diagram for one of the entities is made.

I work in Northwell Hospital. In my work setting, AHA Annual Survey Database is used. This database is notable for exclusive national survey data: it is a comprehensive census of United States hospitals based on the AHA Annual Survey of Hospitals, conducted since 1946 (AHA annual survey database, n.d.). The guarantee of relevance and accuracy is one of the advantages. The information is constantly being collected on hospitals: annual hospital surveys are carried out.

Each year, a questionnaire concerning different data, such as services availability, hospital administration, financial management issues, and staff, is sent to about 7000 registered hospitals in the United States; as a rule, the response rates are high, approximately 90%; all data are collected and verified by the American Hospital Association (Pol & Thomas, 2012). Under these circumstances, one may consider the AHA Annual Survey Database current.

The purpose of the present database is to serve as the tool for making health care reports: it provides statistics produced from various sources that may help investigate present-day tendencies. In this context, state health care organizations and health care specialists, especially researchers, are expected to be the primary users of this database. However, the list is not limited to health professionals. AHA data are also used by government agencies, media, and the industry for accurate and timely analysis and decision-making; besides, some information from the database may be used to support sales, business development, planning, and marketing (AHA data and directories, n.d.).

Thus, potential users of the database are diverse. As for ease of use, the database is user-friendly. Information is represented in several categories. Organizational structure, facility and service lines, inpatient and outpatient utilization, physician arrangements, expenses, staffing, and other sections are examples (AHA data and directories, n.d.). This governance makes work easier.

Addressing the relationships among different actors in the context of different settings, one may use the diagramming technique known as an entity-relationship diagram (Opel, 2009). Patient, Physician, Ward, Testing, and Medicine are among the entities included in the database. The choice of these entities allows for taking into account both individuals involved in health care and the most crucial components of the environment that surround them.

Patients are the center of health care: the system is intended to help them. Physicians are equally important since they do their best to cure people: they make diagnoses, order various tests, and give patients medical treatment. Wards stand for the environment: patients and physicians need proper conditions for recovery and productive work correspondingly. Testing refers to the early stages when doctors send their patients for different tests to evaluate their health and form a diagnosis. Finally, medicine implies a wide range of drugs that doctors prescribe.

Overall, AHA Annual Survey Database plays an essential role. Owing to the data provided, researchers have a chance to refer to relevant and exact data and write their papers. There is no doubt that working with this database is beneficial since it covers important health care issues and offers scope for further quality of services improvement.

References

AHA annual survey database. (n.d.). Web.

AHA data and directories. (n. d.). Web.

Opel, A. (2009). Databases: A beginners guide. San Francisco, CA: McGraw Hill Professional.

Pol, L. G., & Thomas, R. K. (2012). The demography of health and health care. New York, NY: Springer Science & Business Media.

Houston Methodists Utilization Management Program

Houston Methodist embraces various models and health terminologies in order to remain a leader in healthcare delivery. Comprised of six different hospitals, the institution focuses on the best health practices in an attempt to deliver quality care to more citizens in Houston. The hospital has implemented a powerful utilization management program to address the needs of more patients and deliver quality care to them (Houston Methodist, 2016). The institution utilization management (UM) program is implemented as a powerful initiative capable of supporting the needs of every patient.

The UM program is characterized by a number of functions (Plebani, Zaninotto, & Faggian, 2014). The first function is known as preadmission review and management. During this function, different physicians analyze and understand the health needs of every new patient. Admissions for inpatients are done depending on their needs and the availability of resources. Such resources are used to ensure the targeted individuals receive quality medical support. The admission process is managed by competent healthcare professionals in order to present the most desirable proposals (Houston Methodist, 2016).

The second function of the program is the admission, continued to stay, and readmission review (Houston Methodist, 2016, para. 3). This function treats healthcare delivery as a continuum especially for patients who have been admitted to different hospitals. During this stage, patients are monitored in order to ensure they receive quality medical support. The relevant decisions and medications are considered during this phase. The ultimate goal is to ensure the admitted patients get exemplary health support. The UM team embraces the most appropriate practices to prevent never events and support the diverse needs of different patients.

The next stage is the management of observation status of patients (Houston Methodist, 2016, para. 5). The hospital has hired utilization specialists and case managers (CMs) to manage the experiences of newly-admitted patients. These professionals monitor the health conditions and outcomes of the targeted patients. The status of every patient is analyzed in order to ensure the available resources are used to address his or her needs. Whenever necessary, referrals are made thus ensuring the best health services are available to the targeted patients.

Precertification of managed care for patients is another critical aspect of the UM program (Houston Methodist, 2016). This practice is aimed at analyzing the quality of care provided to different patients. Recertification is done to minimize delays or inadequacies of care. Any form of delay is addressed by the relevant professionals. The hospitals UM program supports more physicians embrace evidence-based practices that can benefit different patients. The program has been observed to reconcile patient-specific needs with the services available at the hospital.

Another unique function of the UM is the medical necessity denial management (Houston Methodist, 2016, para. 8). The purpose of this function is to monitor when services might not be able to meet the needs of the patients. Denials are appealed in a timely manner in order to ensure the patients receive quality care. Every identified issue throughout the healthcare delivery process is identified and addressed (Plebani et al., 2014).

This program, therefore, continued to support the institutions goals. A pre-billing review is done for Medicare cases. This practice is aimed at assuring that medical necessity, level of care, and documentation meet the provided federal regulations.

Comparing and Critiquing Houston Methodists UM Program to that of Johns Hopkins Hospital

Houston Methodist is one of the best healthcare institutions in the United States. This is the case because the institution uses powerful procedures to deliver quality and evidence-based care to its patients. However, the hospitals UM program can be compared with that of a model facility such as Johns Hopkins Hospital (The Johns Hopkins Hospital, 2016). The latest rankings show clearly that Johns Hopkins Hospital outperforms Houston Methodist in terms of health service delivery. A comparison of these institutions UM programs can present meaningful insights that have the potential to make Houston Methodist successful.

Johns Hopkins Hospitals program has four unique phases. These include referral management, preauthorization, concurrent review, and the retrospective review. On the other hand, Houston Methodists UM program does not have distinct steps or phases. The referral management phase is aimed at minimizing unnecessary admissions. Cases that do not meet the existing criteria are denied or allowed to get appropriate care elsewhere.

The second phase embraced by Johns Hopkins Hospital is executed to ensure the best decisions are made throughout the healthcare delivery process. Preauthorization is done to ensure the patients are allocated to the most desirable healthcare settings. The concurrent review phase minimizes denials while at the same time ensuring every patient is placed at the best point of care (The Johns Hopkins Hospital, 2016, para. 7). The process is also used to coordinate care and plan for discharge. The final stage monitors the quality of care available to different patients in the hospital.

After comparing the UM programs used by the two hospitals, it is notable that Johns Hopkins Hospital adheres to the recognized standard for utilization management. This is the case because unnecessary admissions are avoided during the first stage. At Houston Methodist, the UM program is not properly defined (The Johns Hopkins Hospital, 2016). What stands out is that the hospitals program is guided by its mission of delivering exemplary services to more patients.

From an analytical perspective, it is notable that Johns Hopkins Hospitals UM program embraces the power of utilization review to ensure the needs of more patients are supported. This is the case because the program monitors the existing gaps throughout the healthcare delivery process and presents powerful recommendations that can support the needs of the targeted patients. The utilization review is executed to analyze the quality of patient care and decision-making processes (The Johns Hopkins Hospital, 2016).

Delays and never events are prevented through the use of an effective utilization review. The gathered information is used to make new improvements capable of delivering quality and timely care to every patient.

Similarly, the utilization review process has continued to play a positive role at Houston Methodist. This is the case because it leads to new ideas and practices that can result in improved patient care. The existing gaps in care delivery are identified during the review process. Positive decisions and quality improvements are made based on the information obtained during the utilization review process. The hospital acquires new resources and human capital in order to improve the quality of care available to more clients (Houston Methodist, 2016). This approach explains why Houston Methodist is a revered healthcare institution.

Areas for Improvement and Recommendations to Improve Patient Care

Houston Methodists utilization management (UM) program has been effective in delivering quality care to more clients. However, the program does not have distinct phases or functions. This issue has caused confusion thus affecting the performance of different healthcare providers. The institution should therefore borrow a lot from Johns Hopkins Hospital. The approach will ensure the UM program is capable of supporting the needs of more patients (The Johns Hopkins Hospital, 2016).

The institution should also ensure the utilization review process is supported by feedback from different stakeholders. Such reviews can be used to implement the most desirable improvements (Plebani et al., 2014. This evidence-based practice will eventually make the facilitys healthcare delivery model sustainable.

The main recommendation that can make a difference for Houston Methodist is the inclusion of lean-based principles. These principles will ensure the UM program is evidence-based and guided by the unique needs of the targeted clients. The use of the principles will make it easier for the hospital to minimize wastes and deliver evidence-based services guided by the changing needs of the targeted customers (Lawal et al., 2014). The lean concept has been applied in healthcare to improve the processes used to deliver care to different patients. This approach will play a critical role in improving the quality of patient care.

The second recommendation is summarizing the UM program so that it captures four distinct phases. These phases will improve the level of coordination and monitoring. Different issues such as billings and placement of patients will be executed in a timely manner. The approach will make it easier for the hospital to strike a balance between the existing resources and the needs of its patients (Lawal et al., 2014). Different healthcare professionals and workers should be empowered to support the needs of more patients. These recommendations will make Houston Methodist one of the leading providers of culturally-competent, timely, and evidence-based health support.

References

Houston Methodist. (2016). Web.

Lawal, A., Rotter, T., Kinsman, L., Sari, N., Harrison, L., Jeffrey, C.,&Flynn, R. (2014). Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol). Systematic Review, 3(1), 103-123.

Plebani, M., Zaninotto, M., & Faggian, D. (2014). Utilization management: a European perspective. Clinica Chimica Acta, 427(1), 137-141.

The Johns Hopkins Hospital. (2016). Web.

Introduction

Healthcare organizations embrace the power of different concepts to support the needs of their clients. Such concepts have the potential to transform the quality of care available to many patients (Olaniyan, Brown, & Williams, 2011).

Utilization management (UM) is one of these concepts. Utilization management is the evaluation of medical appropriateness, necessity, and efficiency of the use of health care procedures, services, and facilitates the provision of applicable health benefits (Johns Hopkins Healthcare LLCC, 2016, para. 3). Many healthcare organizations are currently using UM to improve performance, guide clients, and support the needs of their clients (Tubbs, Husby, & Jensen, 2011). This discussion describes Johns Hopkins Hospitals utilization management plan.

Johns Hopkins Hospital: Utilization Management Plan

The targeted hospital for this analysis is the Johns Hopkins Hospital. The organization is one of the leading healthcare providers in the United States. The facility embraces various strategies and practices in order to support its patients health needs. The institution has powerful utilization management (UM) program aimed at ensuring that every client receives timely and sustainable health support (ProQuest, 2016). The UM program is characterized by preauthorization (referral management), concurrent review, and managed behavioral health (Johns Hopkins Healthcare LLCC, 2016, para. 1).

Overview of Johns Hopkins Hospitals Utilization Management Plan

The institutions UM program is characterized by different procedures in an attempt to ensure various health resources are used effectively. The UM processes focus on the best approaches towards promoting the efficiency and appropriateness of various health care procedures or services. The hospitals UM program is guided by the provisions of the applicable health benefits plan (Johns Hopkins Healthcare LLCC, 2016, p. 1). By so doing, the hospital finds it easier to monitor and ensure every practice addresses the health needs of more patients.

The first aspect of the UM program is known as referral management or preauthorization. The goal of referral management is to ensure various resources are used adequately to support more individuals. This management procedure is used to enter requests into the hospitals claims systems. This is usually done for specific services that might not require health or medical reviews (Johns Hopkins Healthcare LLCC, 2016). Every request is examined carefully to attract more eligible people. A plan-specific criterion is developed to support coverage. These management procedures make it easier for members to identify physicians capable of coordinating care.

The second phase of the UM program is preauthorization. The goal of this stage is to ensure various medical resources are utilized appropriately. This role is completed by the pre-service review team. The team examines every non-emergent request for treatments for coverage (Johns Hopkins Healthcare LLCC, 2016, p. 2). Preauthorization expectations tend to vary depending on the nature of the outpatient services.

Preauthorization is mandatory in the hospitals inpatient setting. This procedure is needed for all elective, inpatient hospice, acute rehabilitation, and mental health settings. The participating stakeholder in the institution should request preauthorization (Tubbs et al., 2011). The UM program requires that every emergency inpatient admission is approved within forty-eight hours (Johns Hopkins Healthcare LLCC, 2016). The request for admission can be done by the admitting provider or other hospital workers.

The other critical aspect of the UM is a concurrent review. The purpose of the concurrent review is to improve both outpatient and inpatient services. The review promotes the effective utilization of different resources through constant analysis of medical necessities and the use of nationally-recognized guidance. The review helps the workers identify specific services that are available to different patients throughout the healthcare process (Tubbs et al., 2011).

Physicians might coordinate different facilities within the institution. Discharge planning is usually initiated once a patient is admitted. Discharge planning is always revisited and decided depending on the clinical status of the targeted patient. A personalized planning approach should be performed by the healthcare team and the discharging physician (Johns Hopkins Healthcare LLCC, 2016). It should be observed that the concurrent review plays a positive role in identifying the unique needs of the patient. Sentinel events are reduced or avoided through the concurrent review process. Never events are reported to the Quality Improvement Department (QID) in order to improve performance.

The retrospective review is aimed at analyzing post-health-care (Johns Hopkins Healthcare LLCC, 2016). This process is critical when there was not a preauthorization request or review. More often than not, unauthorized inpatient admissions will result in a retrospective review and will occur after the patient is discharged from the facility (Johns Hopkins Healthcare LLCC, 2016, p. 4). The other attribute of the UM program is the triage and initial assessment (The Johns Hopkins Hospital, 2016). This process is done by the behavioral health intake team and usually focuses on substance abuse and mental health care requests. During this process, providers are required to submit comprehensive treatment and assessment plans.

From a critical analysis, it is notable that the hospitals UM plan plays a positive role in improving the quality of care and support available to more clients. The preauthorization review process ensures that the existing resources are utilized adequately. After admission, the UM program guides different professionals to utilize the available resources adequately (Johns Hopkins Healthcare LLCC, 2016). The teams identify the best practices capable of delivering evidence-based care to more patients. Coordination is done to support and assist the patients accordingly.

The concurrent review process is critical towards identifying specific issues that might undermine the quality of care. Sentinel events are also prevented or minimized. The ultimate goal is to ensure the hospital improves the quality of care continuously. The retrospective utilization review is aimed at analyzing the nature of care received by a specific patient. This discussion shows clearly that the UM program is appropriate for delivering quality medical support and care to more members of the community (The Johns Hopkins Hospital, 2016). Experts believe strongly that the institutions UM program supports its organizational strategy.

Weaknesses of Johns Hopkins Hospitals Utilization Management Plan

The above utilization management (UM) plan is effective and continues to support the goals of the institution. The UM program is guided and supported by different provisions postulated by the government. Physicians and healthcare workers focus on the best approaches in order to support the needs of more patients. However, there are some weaknesses that make the program less effective.

The first weakness is that the UM program does not have a clearly-defined method to identify the consistent use and allocation of resources. One of the unique attributes of a powerful UM program is the ability to examine the consistent patterns of adequate utilization (Plebani, Zaninotto, & Faggian, 2014). This concept is critical because it makes it easier for healthcare organizations to align their resources with the unique needs of the targeted patients. This weakness explains why Johns Hopkins Hospital still encounters some challenges whenever trying to support the changing needs of many patients.

The other missing attribute in the hospitals utilization management plan is the feedback process. The role of the review process is to ensure the review plan is monitored and modified frequently in order to make it sustainable. The ongoing process of modifying the program is to address new challenges, support the needs of more patients, and acquire better resources that can result in effective healthcare delivery (Plebani et al., 2014).

The institution has a Quality Improvement Department that focuses on sentinel (or never) events. The QI department has continued to address the issues affecting the facility. However, the absence of a feedback process makes it impossible for the institution to achieve most of its goals.

Overcoming the Weaknesses

The most important thing for Johns Hopkins Hospital is to consider these weaknesses and ensure the best resources are used to support the needs of more patients. The first approach is implementing a powerful system to identify consistent patterns of high utilization (Plebani et al., 2014). The system will ensure all resources are aligned with the unique needs of more patients. The use of the high utilization strategy will make it easier for the hospital to improve the sustainability of both inpatient and outpatient care.

The second weakness explains why the institution has not been able to improve the effectiveness of the UM program. The weakness should be addressed through the use of a feedback process. The process will ensure the best ideas and views are used to modify the UM program. The review process should be an ongoing practice aimed at improving the effectiveness of the program.

References

Johns Hopkins Healthcare LLCC. (2016). Utilization Management Policies. Web.

Olaniyan, O., Brown, L., & Williams, K. (2011). Concurrent utilization review: Getting it right. Physician Executive, 37(3), 50-54.

Plebani, M., Zaninotto, M., & Faggian, D. (2014). Utilization management: A European perspective. Clinica Chimica Acta, 427(1), 137-141.

ProQuest. (2016). NHS England provides funding for clinical utilization review programmes to improve patient flow. Web.

The Johns Hopkins Hospital. (2016). Web.

Tubbs, L., Husby, B., & Jensen, L. (2011). Ten common misconceptions about continuous improvement efforts in healthcare organizations. The Cambridge Business Review, 17(2), 21-28.

Situational Analysis

Steps for Undergoing Situational Analysis

The first step is to determine a framework. This means that the obtained information will be presented coherently. There are several frameworks Rashid Hospital administration may choose from. In most cases, the existing frameworks can be easily adapted to the specific needs of the organization. The current framework will include a possibility to make comparisons with other hospitals located in Dubai. Moreover, the framework is expected to highlight the exclusive feature of the fall prevention plan that is implemented within the framework of this paper.

The second step is to categorize the data that is already available to Rashid Hospital. The administration is responsible for storing all the sources of information and all the available data. This means that the available data will be analyzed and structured by the staff. The administration at Rashid Hospital believes that the statistics that were collected during the previous stage will be efficiently used throughout the time frame after the implementation of the fall prevention plan. The administration is aware of the fact that the collected information may be irrelevant or inaccurate, so the managers are used to going through the process of analyzing the obtained information and scrutinizing the latter to eliminate any inaccuracies.

The third step is presented by the process of identifying the information that is still mandatory to implement the fall prevention plan successfully. During the process of collecting the data, no significant gaps were identified. At this point, the administration of Rashid Hospital developed a set of genuine objectives related to the novel fall prevention plan. The most important thing during this step was that the staff at Rashid Hospital collected only practical data and did not wait for a perfect opportunity to publish the composed plan.

The fourth step is related to the collection of supplementary data. Moreover, it was intended to help the nurses and other staff better comprehend the key objectives of the newly developed and published fall prevention plan. The plan was distributed to the appropriate personnel, and the timeframe was specified.

During the fifth and sixth steps, the administration of Rashid Hospital compiled the final report and distributed it respectively. It was updated promptly to reflect only relevant and conversant data. The obtained data regarding the efficiency of the new fall prevention plan was shared will all the staff, and then feedback was collected.

Elements of the Internal Environment

The key element of the internal environment that was taken into consideration by the researcher is the managerial resource-based factor related to management. This aspect includes the nurses willingness to provide high-quality care and be a passionate health care provider. A supporting role, in this case, was given to the managerial decision-making process as the nurses readiness to provide eminent health care service utterly depended on the leadership style employed at Rashid Hospital.

Strengths and Weaknesses of the Competitors

The key competitors of Rashid Hospital are American Hospital Clinic, NMC Hospital, Medicare Clinic, and Emirates Hospital. These four hospitals are considered the most dangerous competitors because they all share several strengths and weaknesses that are characteristic of the majority of Dubai Hospitals. The key strengths include research interests and powerful management practices. Also, Emirates Hospital and American Hospital Clinic make the best use of their active clinical research and intermountain organization. All four hospitals carefully approach their patient population. The sixth strength is the fact of efficient collaboration inherent in these hospitals (both internal and external). The last strength is a unique reimbursement strategy that is common for hospitals located in Dubai.

One of the significant weaknesses of the hospitals mentioned above is their outdated marketing approach. Moreover, their educational practices are not as efficient as in the USA or other Western countries. The third weakness of Dubai hospitals is that they commonly do not perform follow-up assessments. Another problem is that these four hospitals feature uncredentialled physicians. The fifth weakness consists in the fact that such components of IT systems of the hospitals as protocols and databases are also outdated and rarely upgraded despite the technological progress. The last weakness relates to the referrals out of network which can be found in almost all hospitals across the Emirates.

Data Sources

Service Description

Within the framework of the current paper, the researcher concentrated on the review of the implementation of a new fall prevention plan in the cardiology department. This innovative plan was developed by the information regarding the occurrence of falls among hospital patients that were obtained by Rashid Hospital staff. The key point of improving this particular service was the fact that Rashid Hospital did not have a fall prevention plan in place before and it was interesting to see the outcomes of this innovation. Within the framework of the current research, a fall is defined as an unintentional loss of control (from any position) that ends up in landing on the floor or jamming into other surfaces or items. The occasions where staff members were able to prevent the patients from injuring themselves are also included. The researcher expects to track all the relevant data concerning patient falls (including the incidents where the fall did not result in an injury).

Throughout the research process, it was identified that the fall prevention plan that will be developed at Rashid Hospital should not lack several important details. Therefore, developing a flawless fall prevention plan became of the key priorities as it would allow to take over the Dubai healthcare market and nearby areas (Yoder-Wise, 2013). The new fall prevention plan was intended to function within Rashid Hospital for a month. The administration of the hospital expected to share its new fall prevention plan data with other hospitals in the area in case if it showed significant progress in comparison to other available fall prevention plans.

The administration of the hospital considered the core healthcare requirements and was able to fine-tune the existing fall prevention plan in a rather effective manner. They included the realities of the UAE into their vision and specifically addressed the issues of patient safety within Rashid Hospital. Rashid Hospital significantly improved its position in the healthcare market owing to the developed fall prevention plan. The key reason for the statement above is a well-known fact regarding the unwillingness of the majority of Dubai hospitals to renew their fall prevention plans and obtain a critical strategic advantage by doing that (Sare & Ogilvie, 2016). It can be started right away that the fall prevention plan that was developed within the framework of the current research had a pivotal impact on Rashid Hospital staff and their performance. The number of patient falls was reduced, and that might be the best explanation of why the developed fall prevention plan was an eminent one.

General Goals of the Service

The core goal of the proposed service was to improve the organizational performance at Rashid Hospital and increase the responsiveness of the hospital staff when it came to patient safety. The mission of Rashid Hospital was inherent in that goal. Moreover, the implementation of the novel fall prevention plan significantly impacted managerial approaches at Rashid Hospital and how the patients were receiving care. The development and implementation stages majorly subsidized to the staffs interest in evidence-based care and their awareness regarding patient safety.

The second general goal was to develop a fall prevention plan that fully complied with the vision of Rashid Hospital and mirrored the core values of the organizations employees. By implementing this particular plan, Rashid Hospital was able to improve the quality of care and several other aspects of healthcare (Persily, 2013). Another important fact is that Rashid Hospital was able to rationalize its essential principles of patient-oriented care and accomplish one more goal.

The last general goal that was developed and accomplished by Rashid Hospital staff is an in-depth analysis of the existing data regarding the incidence of falls among patients. The current project was intended to bring a strategy to life that would reflect the impact of an updated fall prevention plan. The employees were rather motivated to implement this new plan and line up their practice by it. As it was expected, the staff made an effort to help throughout the processes of researching on the topic and developing the final version of the plan (Yoder-Wise, 2013). The deployment of this project showed that the employees at Rashid Hospital are committed to providing high-quality health care services only.

Specific Objectives for the Service

Description

Some specific goals were taken into consideration by Rashid Hospital management before implementing the new fall prevention plan. The first specific objective related to improved patient safety. Rashid Hospital administration expected to investigate the problems inherent in fall-related risk factors.

Another specific goal was to standardize fall-preventing interventions. The care providers were expected to implement fall-preventive customer-centered improvements. These two factors were perceived as an opportunity to help Rashid Hospital employees understand the value of a fall prevention initiative and stabilize the healthcare environment. This specific goal was also aimed to promote the core organizational values of the hospital. By aligning their practice with this particular goal, the administration of Rashid Hospital ensured the provision of transparent care and necessary patient support.

The last specific objective was the customization of the interventions that were included in the fall prevention plan. Within the framework of the existing research, this issue was considered rather relevant because it presupposed an increased level of observation and was expected to impact the patients attitude toward the hospital as well. The administration of Rashid Hospital was also keen on environmentally adapting to the issues connected to fall-related injuries (Penner, 2013). Despite the evidence from the reviewed literature, the fall prevention plan that was developed within the framework of the current research was not found to impact the costs of healthcare services in a significant manner.

Consistency with the Hospital Mission

The administration of Rashid Hospital considered that the implemented fall prevention plan was consistent with the mission of the hospital. It was expected that the employment of the fall prevention plan would affect critical performance indicators. Moreover, consistency with the mission of Rashid Hospital could be witnessed in the trivial costs of the project (meaning that the hospital was intended to provide high-quality services for a fair price) (Yoder-Wise, 2013). It can also be mentioned that the consistency mentioned above was spotted in the probable impact of the employed fall prevention plan on the health care competition in the area. The core mission of Rashid Hospital was supported by the connections that were expected to improve the standing of the hospital. Other hospitals and medical experts evaluated the developed fall prevention plan and provided Rashid Hospital with their critical assessment of the service (Penna, 2015). The consistency can also be explained by the ability of the administration to motivate the employees and promote basic organizational values.

Implementation Plan

Activities Included

The implementation plan consisted of several critical stages that were accurately followed to trigger positive outcomes in terms of the developed fall prevention plan. The existing procedures were scrutinized and carefully evaluated by the workflow at the hospital (Penna, 2015). One of the most important factors that impacted the first stage of the implementation plan was the absence of a fall prevention plan. The next stage contained the development of a specific strategy intended to help the patients learn more about the dangers of falls and other related hospital hazards.

The patients were told about the implementation of the new fall prevention plan, and the removal of health illiteracy within the framework of the developed fall prevention plan was rather important for the current project because it minimized the influence of the human factor on the outcomes of the implementation of the new fall prevention plan. Then, a group of health care professionals brought together a special committee that was intended to evaluate the new fall prevention plan (Sare & Ogilvie, 2016). The committee secured the implementation of the plan and guided the deployment of the fall prevention plan throughout the whole process. The future of the fall prevention plan was also discussed and included certain information regarding the changes that had to be made in the hospitals workflow (Canning et al., 2014). All the critical ineptitudes were successfully minimized using assembly and productive discussions.

Implementation Plan Elements for Each Activity

At Rashid Hospital, the staff was heavily involved in the process of developing and implementing the new fall prevention plan. The first activity was the measurement of the falls that occurred during the last month. Then, the employees were up to comparing those numbers to the number of falls that occurred at the same time during the last year. After some meetings, it was decided by the team that several actions have to be taken to improve the developed fall prevention plan (Sare & Ogilvie, 2016). Some colorful bracelets were introduced to Rashid Hospital staff that represented the patients that were at risk.

Another element of the implementation plan was the discussion regarding what patients were originally at risk. It was found that the patients with terminal illnesses, heart diseases, and poor eyesight were expected to make the list of the patients who fell the most. After the revision, the team concluded that it was also essential to place several caution signs that would warn the patients about wet floors and other hazards (Thompson, 2015). That element of the plan was included to improve the safety of the staff and the patients that were not members of the risk groups as well. The last element was the assignment of several nurses to a single patient so that they could monitor him throughout the whole 24 hours. This activity was intended to improve interpersonal relations between the nurses and patients and secure the environment at Rashid Hospital.

Relationship between Elements for Each Activity

The relationship between the elements of each activity can be discussed as a relationship between the stages of implementation of the new fall prevention plan. The first activity (the measurement of falls) is contingent on the involvement of the staff and their willingness to improve the quality of care (Canning et al., 2014). Based on the obtained information, the committee decided to expand the measures intended to support patient safety and included additional preventive measures in the plan. The last factor that impacted the relationship between elements for each activity was the rotation of nurses. The efficiency and reasonableness of this decision will be discussed in the last section of this paper, but it can be started right away that nurse rotation significantly affected Rashid Hospital patient satisfaction.

Anticipated Outcomes

Set of Indicators

As it had been proposed, the outcomes of the implementation of the new fall prevention plan were measured using a Balanced Score Card system (Swayne, Duncan, & Ginter, 2013). Three core performance indicators were used to evaluate the efficiency of the novel fall prevention plan:

• Patient satisfaction
• Number of patient falls (in before/ after format)
• Nurse rotation time (meaning how much time a nurse spends with the patient before they leave or close their shift) (Glembocki & Fitzpatrick, 2013).

Indicator Threshold

The thresholds for the indicators mentioned above were set as follows:

• Patient satisfaction
• Satisfied  pass
• Unsatisfied  failure
• Number of patient falls
• Less than in April 2016  acceptable
• More than in April 2016  failure
• Nurse rotation time
• Slight overlap or timely rotation  acceptable
• Slow rotation or a disproportionally long shift  failure

Report

Communication

The performance of Rashid Hospital was found to increase in all three indicators. The costs of the project were evaluated as minimal, and the deployment of a new fall prevention plan was identified as obligatory (Hempel et al., 2013). The administration was also interested in developing a long-term plan to mitigate the complications that may transpire throughout the implementation of this fall prevention strategy. The positive impact of the fall prevention plan was also discussed by both the employees and patients. The majority of patients mentioned that they had learned a lot of necessary things regarding their safety. In general, they said that they felt a lot safer when they stayed at Rashid Hospital. The process of reducing the patients health illiteracy helped the latter to expand their knowledge base and become a part of an important health care project (Hempel et al., 2013). The nurses, at the same time, claimed that their professional skills were significantly improved by the developed fall prevention plan. The overall mark for patient satisfaction is pass.

The number of falls among Rashid Hospital patients was found to be significantly reduced by the novel fall prevention plan (see Figure 1).

Figure 1. Falls among patients in Rashid Hospital during April 2017.

Overall, the nurses stated that it became much easier to monitor patients, and the decision to implement the bracelets of different colors significantly facilitated the process of providing care to the patients. The latter, at the same time, claimed that it became a rather motivating experience, and they did not expect that they would find out so many new things regarding their illnesses or safety measures that had to be met (Canning et al., 2014). Both health care professionals and Rashid Hospital patients specified that the decision to place warning signs all over the hospital was also a useful asset. Finally, the majority of Rashid Hospital patients expressed their satisfaction with the services, and the ultimate decision regarding the fall prevention plan was that it became the key contributor to the reduced number of falls among the patients that had been identified as the members of risk groups (Canning et al., 2014). The final mark for this particular assessment is acceptable because the number of patient falls was reduced by 81.25% in comparison to the number of falls that occurred during the same month in 2016.

The nurse rotation time became the most questionable indicator due to miscellaneous results of the assessment. According to the patient survey, the rotation was found to be ineffective and should be reviewed. The majority of nurses, at the same time, supported the opinion that the rotation schedule should be reviewed. Within the current prevention plan, the nurses were supposed to rotate after a 12-hour shift (with a one-hour lunch break). This meant that only two nurses were responsible for a patient within 24 hours. According to the data obtained from the nurses, they were willing rather spend fewer hours observing the patient than work for an extended period (11-12 hours) to be able to concentrate and provide their patient with the best health care services.

The idea behind this was that three nurses were able to manage the patient perfectly (Sare & Ogilvie, 2016). Nonetheless, it was also important to take into consideration the fact that disproportionally long shifts and slow rotation became the main bottlenecks of the existing fall prevention plan and majorly impacted how it was perceived by all the partakers of the research project. The ultimate mark for this particular part of the fall prevention plan is failure, but the adverse outcomes of an ineffective rotation schedule were related mainly to the nurses at Rashid Hospital and not the patients. The ultimate results and feedback signal that an efficiently developed fall prevention plan has mainly positive influence on the health care facility and its presence in the hospital environment should be considered indubitable.

References

Canning, C. G., Sherrington, C., Lord, S. R., Close, J. C., Heritier, S., Heller, G. Z.,& Fung, V. S. (2014). Exercise for falls prevention in Parkinson disease: A randomized controlled trial. Neurology, 84(3), 304-312. Web.

Glembocki, M. M., & Fitzpatrick, J. J. (2013). Advancing professional nursing practice: Relationship-based care and the ANA standards of professional nursing practice. Minneapolis, MN: Creative Health Care Management.

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B.,& Ganz, D. A. (2013). Hospital fall prevention: A systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494. Web.

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Sare, M. V., & Ogilvie, L. (2016). Strategic planning for nurses: Change management in health care. Sudbury, MA: Jones and Bartlett.

Swayne, L. E., Duncan, W. J., & Ginter, P. M. (2013). Strategic management of health care organizations. Malden, MA: Blackwell Publishing.

Thompson, C. (2015). Prevention practice and health promotion: A health care professionals guide to health, fitness, and wellness. Thorofare, NJ: Slack Incorporated.

Yoder-Wise, P. S. (2013). Leading and managing in nursing. St. Louis, MO: Mosby Elsevier.

Introduction

The YouTube video Healthcare Quality Assurance Success Story explains how modern innovations are making it easier for hospitals to improve their customer-service functions. Technologies are improving the process of screening, real-time decision-making, and the delivery of timely services (Military Credentialing, 2012). Strategic decision-making processes can make it easier for service providers to achieve positive results. The case study of the Army National Guard shows how the idea of healthcare quality assurance (QA) can benefit many hospitals (Military Credentialing, 2012). This discussion, therefore, examines the QA approaches used by the Houston Methodist Hospital.

Description of the Targeted Facility and Organizational Structure

Houston Methodist is a leading provider of different health services in the Greater Houston area (Houston Methodist, 2016, para. 3). The institution is composed of six hospitals and one academic medical facility. The success of this institution is attributable to its core values. These values include accountability, integrity, excellence, and respect (Houston Methodist, 2016). These values are followed to ensure enviable care is available to more patients in the targeted region.

The major priorities targeted by the hospital include service, quality, and safety (Houston Methodist, 2016). The organizations research institute undertakes numerous studies and clinical trials. Such studies are undertaken to support various medical objectives. Some of the completed researches have made it easier for Houston Methodist to deal with diabetes, cancer, cardiovascular disease, and infectious conditions (Houston Methodist, 2016).

This healthcare facility has a simple organizational structure that supports the targeted goals. Decisions and managerial functions are executed by the Board of Directors (BoD). The key members of the BoD include the chair, vice-chair, secretary, chief executive officer (CEO), and the treasurer (Houston Methodist, 2016). The CEO (also the President) undertakes a wide range of activities to support the hospitals goals. The current CEO is called Marc Loom (Houston Methodist, 2016). The chairman of the BoD is Ewing Werlein (Houston Methodist, 2016). The six hospitals are managed by senior leaders who empower their respective employees. The ultimate goal is to ensure the targeted clients receive exemplary health services.

Quality Assurance Program

Houston Methodist embraces various research initiatives that have the potential to improve the quality of services available to many community members (Houston Methodist, 2016). The institution has a Quality Assurance (QA) analyst who collaborates with different researchers and healthcare providers to improve service delivery. The QA Analyst collaborates with research teams and other caregivers to ensure the institution realizes its potentials.

The institutions QA program has been carefully designed in such a way that that it promotes excellence. The department focuses on the major challenges and obstacles affecting the nature of healthcare delivery. The ultimate goal of the QA program is to ensure more people receive quality medical support. The department monitors every healthcare delivery function to ensure it complies with different federal and state policies (The patient experience, 2016). The department monitors various research activities and clinical trials. The Clinical Trial Managers (CTMs) and Principal Investigators (PIs) liaise with the QA Analyst to ensure the targeted findings can address various health problems. This discussion shows clearly that the hospitals QA program is supported by different players.

The QA analyst performs special duties to make the institution successful. One of these duties is the use of modern informatics to monitor various activities in different branches. The QA program embraces the most desirable strategies to make appropriate decisions. The program is used to resolve most of the discrepancies and issues affecting the organization (The patient experience, 2016). The QA Analyst empowers different workers to ensure there is continuous improvement of the health services available to more Houstonians.

The healthcare facility has been embracing the use of new technologies to address problems, improve organizational functions, and implement new changes. The QA department maintains credentials thus making it easier for the hospital to support the needs of different patients. The QA department supports relationship management throughout the institution (The patient experience, 2016). This strategy plays a critical role in identifying evidence-based practices, analyzing patients needs, and outlining new functions that can result in healthcare readiness.

Mandated Requirements

As mentioned earlier, Houston Methodists QA program is characterized by specific requirements that make it successful. The program is always aligned with the studies and research works completed by different employees. The researchers should report their trials and approaches to the QA department (Houston Methodist, 2016). This strategy makes it easier for the QA analyst to monitor the effectiveness of different research studies. The analyst plays a critical role in ensuring the studies support the organizations core principles and values.

The other unique requirement is that QA is treated as a unique aspect of the organizations business model. The QA analyst trains nurse practitioners (NPs), caregivers, and subordinates to minimize errors. The QA Analyst encourages different stakeholders to present their feedbacks and identify the major weaknesses affecting service delivery (Houston Methodist, 2016). The gathered information is used to improve various functions and promote the most desirable practices.

The healthcare facility has been providing technical resources to streamline every quality assurance process. The members of staff in the healthcare facility are trained to use various computer packages and software applications. These tools have been observed to support the decisions made in the facility. Information is relayed from one department within the shortest time possible. This requirement explains why the process of decision-making has been streamlined. The occurrence of never events is communicated instantly to the relevant officials in the organization (The patient experience, 2016). The next move is to ensure the right measures and procedures are implemented in an attempt to support the diverse needs of different clients.

Quality Assurance is an ongoing process at Houston Methodist. The six hospitals and research institutions forming the organization are always encouraged to promote the best practices. This approach is embraced in an attempt to deliver quality services. Stakeholders and patients are allowed to participate in the hospitals QA program (Houston Methodist, 2016). This strategy explains why Houston Methodist is one of the most revered healthcare institutions in Houston and across the nation.

Never Event at the Facility

The facilitys website does not include any case of a never event. The hospital has been embracing the most desirable approaches in an attempt to support the needs of its patients. The institution implements the best safety and quality measures whenever providing care to its clients. The QA department embraces desirable procedures to minimize the chances of recording a sentinel event. This approach explains why the organization has managed to prevent sentinel events such as medication errors (Salyer, 2014).

This institution undertakes numerous studies to understand the challenges facing many hospitals in the country. Such researches present new initiatives that can minimize never events. Houston Methodist learns a lot from the mistakes committed by employees in other health institutions. For example, a medical mistake was recorded in Indianapolis in 2007. The sentinel event occurred when three premature babies died after they overdosed with drugs (Childs, 2007, para. 6). Two of these babies were Demaya Nelson and Dawn Jeffries (Childs, 2007). The deaths occurred after nurses administered Heparin instead of Hep-lock (Childs, 2007, para. 7). This event shocked many players in the countrys health industry.

Lessons from Never Events

Houston Methodist has been studying similar events to implement appropriate preventative strategies. That being the case, the institution provides quality training and evidence to its doctors. Evidence-based ideas are used to empower more practitioners to make them competent providers of care. The QA department focuses on existing protocols and suggests new improvements that can improve its performance (Salyer, 2014). The hospital promotes research and implements the findings in different healthcare settings. This initiative is usually embraced to provide efficient care to more patients.

The hospital uses a system-wide approach to quality improvement and patient safety activities (Salyer, 2014, p. 14). The organization uses modern technologies and information systems to assess the health outcomes of many patients (Salyer, 2014). The next move is to improve various functions and activities in an attempt to prevent never events. Hospitals should copy the practices embraced by this organization to offer exemplary services. The role of QA should be embraced by healthcare facilities that want to transform the experiences of their patients.

References

Childs, D. (2007). Medical errors, past and present. ABC News. Web.

Houston Methodist. (2016). Web.

Military Credentialing. (2012). Healthcare quality assurance success story [Video file]. Web.

Salyer, P. (2014). Integration of health information technology to improve patient safety. Journal of Nursing Education and Practice, 4(6), 12-22.

The patient experience. (2016). Web.

Introduction

The purpose of the Learners Log Book (LLB) is to document the achievements of the learner in a central repository that will be considered as evidence on the effectiveness of the learning process. It is a monitoring tool that e-tutors use to report on individual learners progress, and it is a way of ensuring that learners:

• Are engaged in their learning process.
• They are experimenting by doing the tasks subscribed to them by the e-tutor.
• Avoid plagiarism because learners have to be engaged on a continuous basis, and the informal assessment can, therefore, be used to ensure consistency with the main formal assessment.
• Provide e-Tutors with the opportunity to get to know the learners evaluate them, and mentor them properly.
• There are templates that will reflect whether learners read, whether they understand, whether they assimilate the knowledge, whether they develop inquiry ability, whether they have the potential to conduct critical thinking, and whether they can reflect on the knowledge accumulated by relating to real situations.

The onus is mainly on learners to furnish the required information in the templates after each unit based on the Reading and Analyze Activity. After filling the information in the template, they need to e-mail it back to the e-Tutor.

e-Tutor will then comments on the work done and the involvement that takes place and give overall impressions on the learners at the end of the module.

Summary

The article by Monty L. Lynn and David P. Osborn describes the experience of implementing the Demings quality principles in the quality improvement program conducted by the management of Brazosport Memorial Hospital. The article can be divided into two main parts. The first part gives an overview of the Demings quality principles, including the history of their creation and recognition. It also presents a brief summary of the central themes and philosophies behind the approach. Finally, it evaluates the relevance of the principles, notes on its originality and structure, and compares them to their closest competitors, stressing its differences.

The second part gives a detailed description of the quality improvement process (QIP) implemented in the hospital, emphasizing the fundamental orientation towards the changes in managerial style rather than a standalone program, and outlining the three major components of the process. The first, quality orientation, was achieved through the formation of the quality improvement council and generation of the policies and definitions of quality.

Besides, the handouts with quality guidelines were used to promote a new approach among employees, who were also encouraged (but not pressured) to read the relevant literature. The second component, continuous process improvement, was the closest to the source material. It utilized the Demings approach of locating the opportunities for improvement, outlining the possible drawbacks, and eliminating the obstacles.

According to the authors, the process was applied throughout the hospital departments and was universally applicable. The process also included gathering feedback from the patients via a survey on a regular basis. The third component, total employee involvement, was reached by assembling quality-improvement teams aimed at achieving certain objectives. The article then describes the specifics of the staff education process. Finally, a detailed list of obstacles faced throughout the process is included, and some of the possible future challenges are projected.

Key Learning Points

The relevance of the quality improvement programs for the healthcare industry; the suitability and applicability of the Demings principles to the operations segment of health care; the limitations and challenges created by the inherent characteristics of Demings principles;

Relevant Statements to the Session

The quality improvement programs have long been established as a crucial component in the process of business development. Some of the approaches, such as Demings quality principles, are among the most recognized representatives and have been extensively used throughout the business world, reaching far beyond their intended scope. The article illustrates one such case, where the quality principles have been used as a basis for the management style used for QIP by the healthcare provider. In addition to the benefits extensively covered in the previous sessions, the article illustrates the limitations and drawbacks of such an approach, further expanding our scope.

Critical Analysis

The authors central implication is the applicability of the Demings quality principles to the management of the healthcare field. While very little specifics are given, the overall tone and the generalized claims made in the article suggest that the Brazosport Memorial Hospital administration is highly satisfied with the improvements in the outcomes and patient feedback and attribute it to the QIP in question. While there is little reason to doubt the latter assertion, the initial assumption needs to be approached critically before any specific conclusions can be reached.

First, the framework selected by the management was initially conceived for industrial application, which was promptly taken into account by the managers and reported in the article. The authors also stress that the implementation of the industry-oriented quality improvement techniques is becoming increasingly popular in the health care. However, at the time of the articles publication, 1991, the area of quality improvement was still far from maturity, and the field lacked proper assessment instruments and established criteria to obtain hard data on the success of any given program.

Currently, a growing number of scholars tend to view the industrial techniques only partially suitable for the fields such as healthcare which prioritize the patient outcomes and deal with much more complex criteria of quality. While the authors recognize this limitation, which can be seen from their claim that the implemented style was not fully consistent with the initial setup suggested by Deming and had necessary amendments, the described QIP still retains some of the drawbacks inherent in the principles not crafted for the healthcare.

The first issue is the concept of quality used by most of the industrial quality improvement programs. In most cases, especially in the case when the company is involved in production, the quality can be directly assessed, recorded, and documented. Most likely, the obtained data is also suitable for further statistical analysis, which is one of the approaches preferred by Deming. In other words, Demings principles are best implemented when the data is quantitative and can be properly processed to produce meaningful results.

On the other hand, the fields which deal with services often have difficulties assessing their quality. Health care is among the most prominent examples of such case. While certain outcomes are essentially binary in nature, such as the mortality rates, they comprise only a fraction of the total factors that should be taken into account. To further complicate matters, most of the assessed factors consist of several aspects, such as the state of the recovered patient, the possible complications, the initial accessibility of the service, and the financial side, among many others, each of which must be assessed separately.

As this can also be said about most of the other industries, it is reasonable to expect that the instrumentation necessary for the complete assessment is available. Still, the field of healthcare is arguably among the ones most dependent on the human factor and the customers perceptions, so sufficient degree of amendments is required to introduce the Demings principles as a management style.

Another concern is the focus on the customer feedback. The article makes it clear that the patient feedback is an important element of the QIP, as it involves the survey conducted twice a year to identify the areas which display the most signs of inconsistency and require change, as well as monitor the change of perspective among patients in the areas where the change has already been implemented. This is evident given the definition of quality developed by the council: the quality of the health care services is determined primarily by the expectations of the patients and community, among other stakeholders.

Such approach unintuitively excludes the clinical aspect from the list but allows for a more focused evaluation. It is worth mentioning that while different industrial quality improvement programs necessarily include the customer satisfaction into the evaluation process, the level of attention they pay to it varies, and may not be suitable for the industries that focus on services such as healthcare. Admittedly, Demings framework prioritizes it, which was probably the reason for making it a method of choice.

This assertion is further confirmed by the fact that this stage of assessment is noticeably more detailed in the article than any other strategy. Besides, the survey is an instrument with established credibility, developed by the reputable source, and thus is suitable for producing standardized results. Thus, while this particular innovation is laudable, it is still unclear to what extent such move can be attributed to the utilization of the Demings principles.

To conclude, the change in directions undertaken by the management of the hospital should not be underestimated. However, an appropriate question to ask is whether the Demings principles were responsible for the success. In essence, the principle was only partially applicable to the work done by the council and has taken a form of the guidelines for the managerial style rather than a set of techniques.

This is confirmed by the authors, who openly state that the Demings principles are unsuitable to the clinical aspect of quality, and can be extrapolated from the lack of specifics given in the example with the incomplete medical records. Both the training of the staff involved in the process and the organizational techniques demonstrated by the management do not require a specific style or the reliance on the certain doctrine. Coupled with the already established questionable suitability of the Demings approach to the healthcare field, it becomes clear that it only can be used with serious modifications.

In other words, while the article confirms the benefits of the Demings principles application as a kickstarting platform to initiate the change and take the necessary direction, it also shows that it has only limited applicability later in the process, once the most vital shortcomings, such as incomplete medical records, were addressed. The experience gained by the Brazosport Memorial Hospital team is valuable, but mostly as an illustration on what to address initially and which elements of the Demings approach should be incorporated into the dedicated healthcare QIPs once such developments take place.

Practical Implications

Despite the questions raised during the critical analysis, the article still offers information that can be used in a real business case. Primarily, the case study in question confirms the flexibility of the Demings approach. The principles have extensively been used in the industrial sector, and a sufficient number of cases confirms the benefits of using it. On the other hand, its adaptation by the service organizations remains comparatively limited. The steps taken by the management can serve as guidelines for further cases.

For instance, the hotel business, which is similarly focused on the delivery of services, may benefit from the similar strategy. While it is sufficiently different from the healthcare establishment described in the article, the differences actually create the advantages for the former. The main difference is the focus of the hotel industry on the customer satisfaction and the operational aspect, in contrast to the presence of clinical segment, which could not be managed by the Demings principles.

As a result, the possibility arises to create a unified approach for the whole business rather than introduce separate strategies and styles for each department. This already eliminates some of the challenges mentioned in the original article, such as the difficulty of introducing the information from the segment which does not operate under the said approach (and, more importantly, does not produce data which can be easily and seamlessly incorporated into the existing analysis) into the final result.

The hotel business can also utilize the quality improvement teams used in the hospital, especially considering the fact that the hotel setting has fewer possible complications, such as the complexity of the performed actions. In other words, while the nurses and physicians are predominantly engaged in clinical tasks, the hotel staff is focused on the operational side. As a result, it is expected that the complexities of team management will be comparatively minor and will not interfere with the organizations function or require additional managerial effort, as was the case in the hospital. Another notable practical implication is the possibility to use the list of the challenges, which is concise and detailed, as a guide in case a similar approach will be undertaken by another healthcare provider.

Learning Reflections

Several important lessons can be drawn from the critical analysis. First, the introduction of the quality improvement process in the area with little previous experience can yield noticeable progress. However, it may also pose several challenges, some of which may become a serious drawback in the long run, such as the difficulties in team management and the unexpected amount of resources and time required to implement change.

Second, the lack of appropriate evaluation tools may, in fact, result in misattributing the success to a specific method rather than to a more generalized effort directed at overseeing and managing a specific problem, as was derived from the analysis of the improvement with the incomplete health records example. Third, the amount of change required by the field of implementation suggests the benefits of the cumulative approach, where developing a new managerial style can be more efficient than relying on a set of established and trustworthy instructions.