Category: Hospital

In the modern healthcare system, many financial and organizational processes define the quality of care and satisfaction of all stakeholders, including the medical staff and patients. The success of a hospital may be evaluated by assessing its revenues which usually come from patients out-of-pocket payments, private insurance companies and their reimbursements, and government billing. Revenue cycle management is a financial process in health care that includes all transactions necessary to cover all caring elements starting from registration and ending with additional follow-ups. Billing and collections are the two primary steps in the revenue cycle that introduce vital patient data, payment liabilities, and points of care. If some billing or collections mistakes occur, incomplete or wrong information leads to unpredictable losses, high costs, care changes, and even physical harms that constrain hospitals revenues.

Hospitals revenues are thoroughly examined at the end of every year by creating financial reports and comparing the achievements of different facilities in the same area. Medical encounters between a healthcare provider and a patient have to be properly identified and explained, and the revenue cycle management process is applied to cover all the necessary transactions. Medical billing is a step to submit patients or health insurance companies claims and get paid for services. The creation of a unique and definite billing system reflects the work, services, and charges for care (Schaum, 2018). As soon as billing regulations fail or contain wrong information, there is a risk of losing large sums of money. Today, many patients prefer out-of-pocket expenses, and hospitals cannot put pressure on individuals when they prefer other healthcare facilities because of personal reasons. As a result, one billing mistake results in patient turnover and the inability to get maximum revenues (Medical Billers and Coders, 2019). The same errors provoke additional problems in a working process like service delays or the creation of poor informative background in a treatment process.

Patient collections is another step in the revenue cycle process when patient balances are determined, and payments are gathered. Not many individuals can pay for their care upfront, rising new deductibles and debts. To solve problems and answer questions concerning the quality of care, some hospitals create specialty registries to collect data (Schaum, 2018). However, poorly trained and unprepared staff cannot apply their properly, and patients continue refusing beforehand payment, questioning the financial stability of hospitals (Medical Billers and Coders, 2019). These mistakes constrain hospitals revenues by the necessity to work with negative margins and demonstrate low revenues every year. Incorrect patient information requires not only corrections but prevents the continuation of other care processes. Healthcare providers cannot copy information and use it in other medical records, additional time and resources are spent, and no space to enlarge revenues is observed.

In conclusion, understanding financial processes in the healthcare system are obligatory for many purposes. Revenue cycle management depends on the possibility to predict billing and collection mistakes because they constrain hospitals revenues financially and organizationally. If a mistake occurs, a patient could change a hospital without covering the work that has already been done, meaning that a hospital should lose money. When the time to solve a mistake comes, a hospital should hire an analytical team and get ready for additional money costs. Finally, the prediction of similar billing and collection mistakes requires training, which equals losses in time and money.

References

Medical Billers and Coders. (2019). Top 5 challenges with healthcare revenue cycle management. Medicalbillersandcoders.com.

Schaum, K. D. (2018). It takes a team to obtain reimbursement!Advances in Wound Care, 7(11), 349-353.

Introduction

Budgeting is a plan of income and expenditures. It is a forecast by an organization on the expected revenues and expenses and, it is measured against the actual financial operations after a specified period. It is a plan of action written in monetary terms. A budget is a key to financial management in any organization. It is a very important function for the management of hospitals depending on the changes in funding and the competition faced by other hospitals. For healthcare organizations, their plans should be based on the mission, policies, and financial plan of the whole health system. They should be able to measure if the plan has been achieved and, establish any variations arising. Since these institutions mostly depend on reimbursements from the government and other organizations, they should be able to plan well for these funds and account for them after some time.

The senior management should liaise with the managers to develop a culture of accountability. The managers of the departments should be able to manage their expenses and their budgets should reflect the cost-cutting and revenue maximization measures. It should be made clear to the managers that their performance and salary reviews at the end of the year will be measured against how well they are able to meet their budgets. This is because, besides being the goal of the institution, it is also a managerial requirement. The management is required to monitor any variances that occur and be able to come up with and implement corrective actions (Clark, 2005, p. 5)

Budgeting is important in healthcare financing to ensure that there is an optimum allocation of resources. The departments in these institutions are many and each of them has to be planned for and, the finance department should understand the flow of funds in the institution. A budget acts as a tool of communication in the institutions. The departments are able to come up with their budgets, which are forwarded, to the finance department for compilation. It shows the needs of the organization, the expected expenses, and revenues and this simplifies the running of the hospital. They also enhance the control measures since the organization is needed to carry its operations guided by the budget and any loopholes that might lead to misuse of funds are monitored.

It is a tool that ensures that all the monetary transactions are monitored and that all the expenditures and receipts are verified by transaction receipts, bills, and financial statements like the cash flow statements, income and expenditure statements, and statements regarding any other financial transaction. Health care institutions will also get opportunities that are arising. They can present their budgets to people and companies who might be willing to fund them because the plan clearly states their deficits. They also save a lot of time when making financial decisions because they refer to their budget. Any extra money will be easily noticed and it can be used for the development of other projects. The decision-making process is made easy and thus, the running of the institution is enhanced.

Types of budgets

There are various types of budgets for healthcare institutions. The master budget includes all the major budgets for the hospital. These are capital, operating, long-range, program, and the cash budget.

Capital budgets

These are budgets prepared to portray the costs of the assets of the hospital and the services offered. They show the expected revenue and expenses in each procedure and how these costs are expected to be paid back. This is a plan for long-term investments in new products, machinery, and any researches that might be carried out. Hospitals have high capital costs because of the equipment required and, they prefer to lease instead of buy them.

With the advances in technology, these costs increase when they plan to purchase new equipment. These are like the CT scanners, installation of IT in the hospital and, MRT machines among others.

Purpose

The major purpose of capital budgeting in hospitals is to enable them to realize and prioritize the capital projects based on the expected returns to the organization. The capital budget gives the projects selected and, the returns expected from them. It ensures that the hospital obtains the assets, which are essential for the provision of quality service. Developments in the health sector are catered for and this ensures that the hospital is able to cope with the increasing competition in this sector. The management is able to evaluate its long-term investments since any equipment or new discoveries are an asset to the institution. It ensures that the allocation of resources to the proposed projects is done in the most profitable way. By evaluating the internal rate of return, the profitability index, net present value, and the annuity, the capital budgets are formulated to ensure that the returns to the organization are maximized (Steven & Christina, 2001, p. 7).

The effects of the capital budget on the cash flow of the hospitals are not much. This is because the assets purchased are to improve the services offered and they may not have a direct impact on the cash. Even with new equipment, the cash may remain the same but the services offered will be of high quality. However, they have a great impact on the future of the hospital. This is because the capital equipment obtained will remain an asset of the hospital in the end. The services offered will be of high quality with the use of new equipment and this will enable the hospital to maintain and attract customers.

Operating budget

This is a plan of the day-to-day operations of the hospital for the period covered by the budget. If the expected revenues exceed the expenses, it shows that a profit is expected and vice versa. The profits generated are used by the management to replace and repair the equipment, which is old and worn out and, to expand the range of services provided to enhance the healthcare quality. It budgets for the revenues expected from bills, Medicare, and other insurers. The operating costs in the routine operations in each department are planned for in the budget.

Purpose

These cater to the goods and services that are offered in the hospital. They are able to plan for the expected revenues, which will be obtained, and the associated expenses. In addition, the salaries and wages are determined since; the operations of the hospital should be able to maintain its staff. The management will use it for their laid strategies. They are able to run the operating plans in the short run and the long-run strategies, which are set to be achieved. The needs of each department are evaluated depending on this plan to ensure that their daily operations are monitored. It is also useful for the staff to realize that there is revenue attached to their departments and the decisions on the staff are made depending on the budget. They cater for overtime and casuals to ensure that the expenses incurred are according to the plan.

Since the operating budget involves the running of daily activities in the hospital, it greatly affects the cash flow. For the operations to run cash will be needed and this means, that the budget mainly focuses on how much revenue is expected to be raised and the expenses incurred. The operations that are planned for could have a major effect on the running of the hospital if they are not approximated properly. The effect of the operations budget on the future of the hospital is not much. This is because it covers the operations of a specific period may be for one year. The operations in one period may differ from those in another period. Nevertheless, if it is a part of the long-range budget, it will affect the future of the hospital.

Cash budget

This is a prediction of the cash flows expected based on the other budgets. It is an estimation of the receipts and withdrawals in the institution over a given period. It portrays all the cash effects on the plans and, if there are any insufficiencies, the budgets can be modified. In the hospitals, the cash is expected to have risen from the services offered to individual patients, the government, and other funding institutions. It is prepared after all the other budgets.

Purpose

It shows the financial status of an institution and if there are enough funds to finance the planned projects and operations. This gives the management a projection of potential problems and this gives them a chance to take the necessary action. They show whether a surplus or a deficit is expected and hence, the management is able to know how to utilize the surplus or how to handle a deficit. It plans on the cash required by each department and how much to borrow to cater to the deficits.

The cash budget deals with the financial terms of the hospital. Therefore, it totally affects the cash flow since it is a plan of where to get cash to finance the daily operations. The sources of cash need to be reliable to ensure a continuous flow and they must be properly planned for to avoid unnecessary uses. The effect on the future of the hospital is not much since the expected cash has to be planned for each year. But the cash flow should be reliable to ensure that the operations of the company are run efficiently.

Long-range budgets

These are the plans covering a long period of time maybe three, five, or the next ten years. It is used by the hospital to achieve long-term goals and they include what must be done each year to achieve these goals. These are plans toward the achieving of the hospitals vision and where they want to be after a certain period of time. Plans have to be made on what is required to be achieved in each year and the progress should be monitored from time to time.

Purpose

These budgets assist the institutions in building a sense of commitment in the future to ensure that it does not remain in one place over a very long period. The hospital is able to develop long-term goals so that they do not only focus on day-to-day life, and plans which are always attainable within one year. It assists in the preparation of operating budgets based on the overall purpose and many operational budgets will assist in achieving the long-term plan. They are used to achieve the mission and vision of the institution through strategic plans where specific and broad objectives and strategies are incorporated together (Steven & Christina, 2001, p. 6).

Long-range budgets affect a certain amount of cash in each financial year. Since they are long-term, they will not directly affect the cash flow but they will only need to be allocated some cash during operational budgeting. They affect cash flow through operational budgets since they are part of the operations each year. They affect the hospitals future since they are projects, which will generate long-term benefits for the company. If they end as planned, they will enhance the operations in the hospital and they will improve the quality of services offered.

Program budgets

This is a budget on specific projects where new projects or existing ones are evaluated instead of planning on the associated revenues and expenses from all the projects. The programs to be undertaken are determined depending on their importance. How to achieve these programs is the main concern like, if an advanced laboratory is required, it will be needed to have its plan. Once decisions are made and the evaluation of the programs is made, the expenses and revenues will be put in the operating budgets.

Purpose

The main purpose is to be able to make a decision. The specific programs are determined and the management makes a decision depending on the evaluation. Since they run for more than a year, they are not made as part of the operating budget but, treated as a special budget. They are used to ensure that new programs are formulated to enhance the development of the hospital.

The program budgets affect the cash budget of the hospital and in turn the cash flow. They have to be allocated some cash in each financial year. Once they are allocated the planned cash, they do not affect the cash flow for the rest of the year. However, they greatly affect the future of the hospital because they are programs, which aim at improving the services offered in the future. They will improve the operations of the hospital once they are completed and could lead to a rise in the cash flow.

Budgets could also be classified as fixed, flexible, and variable. Fixed budgets are based on the annual volumes of activity. These could be based on the number of patients attended to, the inpatient and outpatient volumes; tests carried out, or based on any other activity, which is carried out on daily basis. For flexible budgets, they are based on a certain range that is, there is a high or a low range of production capacity. A variable budget allows for control that relates to the production generated.

For any organization to exist, it must have a cash flow that is reliable. This is because its operations will need cash to be executed. The health care institutions will need to ensure that they have the cash to finance the programs, projects, research, and development and to maintain the workforce. Most of the institutions are catered for in national budgets and other funding institutions fund them. The money from their patients also adds to the cash generated and, they should ensure that they maintain quality service to cope with the increasing competition in the sector. The cash generated from the services offered determines the future of an institution and thus, it is important that the hospitals evaluate their inflows and outflows. They should take corrective measures to ensure that they are not having deficits so that they continue being in business.

Conclusion

Therefore, healthcare institutions should have budgets like any business organization. Whether they are profit-making or non-profit making, they should have budgets mostly annually. These will be produced when they need funds from their donors to show how much amount they have as deficits. A budget will also enable the hospitals to come up with investment projects and acquire equipment, which is modern to ensure that they develop. It is very essential for any firm to have a budget to ensure that they plan for their funds and have away, which they can measure whether they are on the right track.

Reference List

Clark, J. (2005). Improving hospital budgeting and accountability, Healthcare Financial Management. Web.

Steven, A. & Christina, M. (2001). Budgeting concepts for nurse managers, Philadelphia: Saunders.

The Republic of Malta is a small three-island archipelago country located in the Mediterranean Sea. Consisting of a population of just over 500,000 people, the country is one of the smallest ones, maintaining a close sense of community. In the context of mental health, there is only one operational psychiatric hospital currently. Furthermore, mental health has been greatly stigmatized in Maltese society, leading to poor treatment and ongoing problems. A recent 2019 publication of a national mental health strategy for Malta demonstrates first steps in shifting perspectives, both socially and economic investment into psychiatric care. This paper investigates the application of the national mental health framework at the Mount Carmel mental health hospital and organisational elements and changes that have been applied.

Mount Carmel Hospital was opened in 1861, named after a Catholic legend and famous altarpiece in the Valetta Church, as Our Lady of Mount Carmel remains one of the most widespread devotions in Malta (Agius et al., 2016). It remains the only hospital with in-patient psychiatric and mental health care in Malta after the closing of the psychiatric unit at Mater Dei Hospital in 2020, and the construction of a new mental health hospital is completed in 2025. Mount Carmel is more than 160 years old, resulting in the hospital being significantly outdated, both in terms of physical infrastructure and its facilities due to relative lack of investment from the government (Calleja, 2021). The facility is large with multiple wards ranging from regular care to juvenile or elderly patients to incarcerated or special needs patients. Unfortunately, wards are being closed down for refurbishment without reopening due to lack of financing. However, the total bed capacity at the hospital is over 200 beds. Mount Carmel offers both in-patient and out-patient mental health services (Pace, n.d.).

Until recently, mental health has not been a priority in Malta. Despite having a free and developed public health system and government commitment to social protection, mental health has historically and culturally been viewed with a stigma. Mental health care provision is under the same organisational system as general health, but only 9% is allocated to psychiatric care. Most of the services are through the free national health service, but private entities do exist on the island (Galea & Mifsud, 2004). However, physical and mental health have been viewed as dichotomy, separated by artificial barriers, stress differences and support stigmatization. The disregard for mental health services can be seen in the very poor state of Mount Carmel hospital (Times of Malta, 2021). To date, there is a lack of comprehensive statistics regarding mental health prevalence and illnesses occurring on the islands. Among European countries, Malta has one of the highest numbers of psychiatric beds per 1000 population (Lia, 2017).

In 2012, the Mental Health Act was passed in the Maltese legislation that sought to reflect the latest changes in knowledge, medical and social developments regarding mental health. It also created a new position of the Commissioner for Mental Health as a monitoring and governing body. It is the first legislation in Malta providing rights to users and carers in the mental health sector and guarantees that those with mental health problems are considered full citizens (Buttieg, 2012).

Under the first Commissioner John Cachia (2012-Sep. 2021), gradual changes began to be implemented as outlined by the Mental Health Act and his own vision. The country is in the process of reforming, renovating, and enhancing it s mental health services. In accordance with latest research, a greater emphasis is now shifting to community services and resources, through small local mental health facilities or help centers, alongside with building a new fully financed and developed psychiatric hospital (Grech, 2016). It is largely due to Cashias efforts that mental health issues became more visible and discussed in Maltese society, emphasizing the shortcomings of the services and evident gaps in the countrys system. The relationship between society and mental health remains delicate, but there is significant progress (Times of Malta, 2021). Despite these advances, Malta severely lacks human resources in terms of mental health professionals to address the countrys needs (Lia, 2016).

As the COVID pandemic with subsequent lockdowns began to have profound effects on mental health, the Mental Health Strategy was launched in 2020. It is part of the overall health strategy for the community which is critical. The publication demonstrates that the government has embraced the notion that there can be no health without mental health, with the need for integration of all health services (Times of Malta, 2021, par. 5). It reflects the developments of recent years and processes and goals targeted by the government in mental health care provision. Overall, the strategy seeks to uphold values such as autonomy, dignity, and rights of people with mental health, recognizing the need for equal opportunities and access to appropriate healthcare. The strategy is meant to guide the implementation of investments and reforms to the mental health system in the country. Its central tenet is resilience, that of individuals, organisations, and communities making them stronger and empowering the population. The strategy also seeks to identify and focus on the wider social factors leading to mental disorders or affecting their perception or treatment (Office of the Deputy Prime Minister Ministry for Health, 2019).

Therefore, the adoption of this National Mental Health Strategy is a result of various influential factors and years of work by mental health advocates.

The theoretical framework selected to review the implementation of the mental health strategy is PESTEL. The PESTEL analysis for Mount Carmel hospital after adopting the framework can be seen below:

Initially, staff was sent out a newsletter announcing that major changes were arriving to the organisation and asking for patience and collaboration. Managers were called in for training and meetings. Eventually it became known the hospital plans to introduce changes consisting with the Mental Health Strategy. The CEO along with management staff chose to use Kotters Eight Step Change Model to guide the change management process. At a large staff meeting, the CEO presented a passionate speech, identifying gaps in the current system and outlining the benefits of adopting the new framework, fulfilling the first step of create a sense of urgency (Kotter, n.d.). For the second step, build a guiding coalition, the management team brought in experts who along specifically selected representatives from each position (physicians, nurses, management, etc). This group presented their insights to contribute to effectiveness of changes in the hospital. With the third step, a strategic vision was formed alongside initiatives. These were already outlined in the Mental Health Strategy, such increasing quality and access to mental health services. The fourth step was communicating the vision and garnering support, which was largely accepted. Most staff in the hospital wanted the best for the patients and realized the poor state that the facility was in, needing change.

The fifth step was to remove obstacles. This consisted of removing any negating elements or unsustainable practices. It was made sure that organisational processes and structure meet the vision, so new standards were established in how patients are received, treated, and discharged. Those that resisted change were encouraged while those who supported it were endorsed. For the sixth step, short-term wins were created by seeing an improvement in patient satisfaction scores after implementation and the general mental health treatment approach seemed more efficient. Finally, the seventh step is consolidating gains, management sought to collect employee feedback on the experiences with the new changes, the reflections helped most realized that significant steps have been taken to improve the hospital, and as more funding will come in via the framework, the physical conditions of work and patient treatment will improve as well. The eighth step of Kotters model will be discussed later in this paper in the context of organisational culture. In the context of the Mental Health Strategy implementation, the Mount Carmel Hospital also sought to work with the government, local communities, and organisations such as the Maltese Association of Psychiatry, to both, gain expert guidance on internal changes but also work collaboratively on one of the main components of the National Strategy, which is community outreach and mental health services. Analysing the Mental Health Strategy in retrospect and how it was implemented, the policy inherently sought to encourage and improve collaboration when it comes to mental health service provision or general societal work on the topic. It is vital to improve care across boundaries to enhance care. It is important to consider on of the primary aims of the strategy which is to remove any artificial barriers between physical and mental health. Therefore, no matter what is being treated, physical or mental health, patients seek to receive responsive and holistic care. Fragmented health system treat patients problems in isolation resulting in poor outcomes. However, working across organisational and even specialty boundaries bridges traditional divides improve patient experience and does not overburden professionals (Coughlan et al., 2020).

Strategic leadership was critical in the adoption of the National Strategy, both from an organisational and management point of view as well as the cultural changes. The Mount Carmel Hospital CEO Stephanie Xuereb oversaw the implementation and took strategic lead in making concrete changes to the hospital. The management team with Xuereb at the help sought to develop a plan that would bring about cultural and protocol changes for the whole organisation while reconfiguring the mental health services network in accordance with the National Strategy. Xuerebs priority is to make tangible improvements in patient care across the mental health spectrum, making it patient-centred and easily accessible (Azzopardi, 2021). For healthcare organisations, strategic leadership typically involves setting and working towards them, with an emphasis of increasing quality of services, efficient workflow, and managing the hospital so that it is on a sustainable trajectory (Ogamba & Nwaberiegwu, 2020).

Healthcare is constantly changing, but despite this familiarity, navigating change and change management is an extremely complex endeavour. The changes arriving with the adoption of the Mental Health Strategy for Malta were extensive, through frameworks, protocols, training, and general attitudes. The presence and actions of strategic leaders at this time is crucial for the success of change management implementation (Riwo-Abudho, Njanja & Ochieng, 2012). Xuereb undertook various strategic actions. First new performance goals were developed and introduced, alongside a performance appraisal process. These goals were not the basics expected in healthcare such as reducing readmissions but focused on building up the framework of the National Strategy, such as focus on cross-care coordination, when possible, effectiveness of patient communication, timeliness of receiving care (Betancourt et al., 2017). Meanwhile, management is optimising processes, including standardising based on evidence or protocols. Strategic leadership also has to evaluate and consider human resources, training or hiring for various positions to meet certain performance criteria and organisational goals (Figueroa et al., 2019).

Guided by the Mental Health Strategy, the management team at Mount Carmel Hospital sought to bring a culture change to the whole organisation and reconfiguring the mental health services framework. The primary focus will be in improvement in patient care, which has been one of the main complaints in recent years from both patients and experts alike. The organisation will reorient towards a person-centred model of care. The staff and their dedication to provision of care is leading the cultural change, with an emphasis on building therapeutic relationships instead of the restrictive form of care practiced with mental health patients before (Azzopardi, 2021). Mount Carmel Hospital recruited professional experts to facilitate the organisational and cultural change. Training is one method that is being used to provide staff with skills and knowledge on how to better treat, interact, and respect mental health patients. The objective is to reinforce core values of Mount Carmel Hospital which was trust, integrity, and respect, while also adopting an outcome-focused perspective (Azzopardi, 2021). The patient-centred focus as well as a holistic approach to mental health provision will be the hospitals strategic and cultural mantra going forward.

The culture present at Mount Carmel Hospital initially was counterproductive to the strategy framework being adopted. The culture was very conservative, deeply embedded into outdated policies and sometimes views of mental health. The focus of care was more on the process and protocols rather than building relationships with patients. Some questionable and potentially unethical practices were present such as tying down patients without necessity. It was and still partially is, a culture synonymous with the sociocultural perspective of the population as a whole, stigmatizing mental health and approaching patients as people that are hopeless and unable to take care of themselves or their condition. This meant that adopting the framework undertook a change in perspective and understanding about mental health.

As mentioned previously, the organisation underwent a process of change under Kotters model, which greatly helped to implement some of the elements of the framework. However, the last step of anchoring changes in corporate culture is perhaps the most challenging (Kotter, n.d.). An organisations culture is extremely complex, comprising of interweaving values, roles, processes, communications, and assumptions. Shifting a culture is long-term large-scale approach, because if only one aspect is changed, even if there is progress for a while, eventually the other elements will drag the stuts quo back down. An effective means to shift culture is through leadership that sets a vision, alongside management which produces tools to fulfil this vision with the help of staff. Finally, the last pockets of resistance to change can be coerced through power, but that should be rarely and carefully applied (Denning, 2011).

The Mental Health Strategy for Malta 2020-2030 is a comprehensive strategic document meant to guide development and governance of mental health services in the country as it grows from relative infancy to widespread community presence. This paper discussed the implementation of the National Strategy framework at the oldest and only in-patient psychiatric hospital in the country, Mount Carmel Hospital. Evaluating the implementation through the SWOT theoretical framework, it was generally a positive outcome for the facility. It required significant changes in its internal organisation, functions, and structure, but it provided a foundation of opportunities to grow in terms of service delivery and sustainability of the hospital.

Reference List

Azzopardi, K. (2021) All complaints taken seriously, investigated  Mount Carmel Hospital CEO responds to criticism, The Malta Independent.

Agius, M., Aquilina, F.F., Pace, C. & Grech, A. (2016) Stigma in Malta; A Mediterranean Perspective, Psychiatria Danubina, 28(1), pp. 75-78.

Betancourt, J.R., Tan-McGrory, A., Kenst, K.S., Phan, T.H. and Lopez, L. (2017). Organizational change management for health equity: perspectives from the disparities leadership program. Health Affairs, 36(6), pp.10951101.

Calleja, C. (2021) Infamous Mount Carmel must be tackled, say mental health professionals, Times Malta.

Coughlan, C., Manek, N., Razak, Y. and Klaber, R.E. (2020). How to improve care across boundaries.BMJ, 369.

Denning, S. (2011) How Do You Change an Organizational Culture?, Forbes.

Figueroa, C.A., Harrison, R., Chauhan, A. and Meyer, L. (2019). Priorities and challenges for health leadership and workforce management globally: a rapid review. BMC Health Services Research, [online] 19(1).

Galea, S. and Mifsud, J. (2004) The mental health care system in Malta. International Psychiatry, 1(5), pp.1113.

Grech, A. (2016). Epidemiology of Serious Mental Illness in Malta  Consequences for developing a new psychiatric hospital and community psychiatry.Psychiatria Danubina, [online] 28(Suppl-1), pp.108110.

Kotter. (n.d.) The 8-step process for leading change.

Lia, E.S. (2017) A snapshot of psychology in Malta, the smallest country in the EU.

Office of the Deputy Prime Minister Ministry for Health. (2019) A mental health strategy for Malta 2020-2030.

Ogamba, I. and Nwaberiegwu, C. (2020) Persistent challenges to healthcare systems and the role of strategic and collective leadership. British Journal of Healthcare Management, 26(12), pp.15.

Pace, P. (n.d.) Mental health services, Malta.

Riwo-Abudho, Njanja & Ochieng, 2012) The role of strategic leadership during change. KCA Journal of Business Management, 4(2), 48(68).

Times of Malta. (2021) Mental Health in COVID times.

A hospital-acquired pressure injury (HAPI) is a localized injury of underlying tissue or skin that some patients suffer during their stay in a hospital. HAPI is typically a result of prolonged immobility of patients, leading to unrelieved pressure upon bony prominences. In combination with shear, this pressure is linked to other variables such as age, perfusion, nutritional status, hematological measurements, sickness severity, and diabetes (Rondinelli et al., 2018). Despite the recent decline, the number of patients who acquired pressure injury during their stay is still over a million in the USA (Tschannen & Anderson, 2020). The development of HAPI increases patients risks of dying during the hospital stay by 2.8 times and dying within 30 days after leaving the medical facility by 1.69 (Tschannen & Anderson, 2020). Additionally, hospital-acquired pressure injury is accompanied by substantial pain and suffering, delayed functional recovery, as well as extended time for healing and hospital stay (Tschannen & Anderson, 2020). Even though much research has been done on the subject, HAPI remains a significant issue for elderly patients and a costly challenge for hospitals.

During the patients time at the hospital, the primary care for them is provided by and the responsibility of the nurse practitioners. Since pressure injuries are proven to be preventable, the early recognition of the modifiable causes of the development of HAPI and taking corrective measures can stop the progression of the disease (Rondinelli et al., 2018). As such, working directly with patients enables nursing professionals to identify the symptoms and stop pressure injuries from developing. Failing to assess and prevent HAPI in patients accurately can lead to a severe impact on their lives and delay the healing process (Rondinelli et al., 2018). Furthermore, slow healing results in even longer hospital stay, which in turn facilitates the worsening of HAPI and increases healthcare costs.

Within the framework of the assignment, for constructing a PCIOT question, each of its elements is further identified and described. The patients suffering from hospital-acquired pressure injuries are typically considered to be the older generation. The injury is acquired during their prolonged stay in a hospital, affected by their immobility, nutritional status, and sickness severity. One of the evidence-based solutions that can be applied to reducing the rates of acquiring and developing pressure injury in elderly patients is the minimization of shear and friction. It can be achieved by using low-friction slide sheets and air-assisted transfer devices, reducing the risk of skin injuries. Another solution for HAPI prevention is the appropriate usage of pressure redistribution surfaces, such as pressure-reducing mattresses. The outcomes of these measures can be evaluated by calculating and comparing the rates of HAPI development in patients. The time frame involved in the evidence-based practice initiative can be set to a year.

As a result, the PCIOT question can be constructed as such:

• P = elderly patients within the risk of developing a hospital-acquired pressure injury
• I = minimization of shear and friction
• C = usage of pressure redistribution
• O = reducing the rates of HAPI development
• T = a year
• PICOT Question: In elderly patients with the risk of acquired pressure injury during the hospital stay, how effective is the minimization of shear and friction compared to the usage of pressure redistribution surfaces in reducing the rate of HAPI development a year?

References

Rondinelli, J., Zuniga, S., Kipnis, P., Kawar, L. N., Liu, V., & Escobar, G. J. (2018). Hospital-acquired pressure injury: risk-adjusted comparisons in an integrated healthcare delivery system. Nursing research, 67(1), 16.

Tschannen, D., & Anderson, C. (2020). The pressure injury predictive model: a framework for hospitalacquired pressure injuries. Journal of Clinical Nursing, 29(7-8), 1398-1421.

The paper concerns a dispute between Elmwood Hospital and the Concerned Community Coalition (CCC). Elmwood is a private hospital operated by a board of trustees that used to cater to a white, middle-class community up until ten years ago. It is currently undergoing financial strain due to the expanding low-income neighborhood. This neighborhood is represented by the CCC and demands that Elmwood appropriately addresses local medical needs. Although the director is sympathetic, his primary aim is to ensure the hospitals institutional strength by increasing research opportunities and building new facilities that incentivize the present staff to stay rather than go elsewhere.

Elmwood Hospital has legitimate, rewarding, and expert power over the CCC. While the CCC is merely a coalition of residents protesting for change, the current board of trustees has legitimate power over the hospitals resources and future projects (ORGL 370: Conflict and Negotiation: Week Five). Furthermore, they can reward the CCC by providing much-needed medical assistance if they terminate their sit-in. Elmwoods staff of doctors and nurses have high levels of skill and knowledge that can potentially solve CCCs issues of infant mortality, tuberculosis, and lead poisoning, which grants them expert power. Elmwood should leverage its expertise and resources to negotiate a favorable deal with the opposing group.

The Elmwood board and director should lead the negotiation with the following points. Firstly, the board should demonstrate its superior negotiating position to the CCC by establishing its legitimate and expert power. Secondly, they should point out that the hospital is a privately owned institution with no obligation to serve the community. Thirdly, they should prove that the heart research facility and nurse residence are beneficial for the CCC. If the present professionals cannot be retained with such incentives, there will be no one to help the residents anymore. In general, Elmwood must display its power and demonstrate how fulfilling its plans will also benefit the local community.

Work Cited

ORGL 370: Conflict and Negotiation: Week Five. [PDF]

Introduction

The modern increasingly complex environment gives rise to numerous concerns related to the efficiency, improved outcomes, competitiveness, innovativeness, etc. Drastic alterations in methods used in different spheres of activity precondition the shift of priorities from traditional to new approaches which are characterised by the enhanced productivity. Moreover, the extensive implementation of technologies contributes to the creation of the digitalised society which handles enormous amounts of data. Under these conditions, knowledge becomes the fundamental organisational resource of the 21st century which is used to acquire a competitive advantage and create the basis for the further evolution (Zangiski, Lima, & Costa, 2013).

At the same time, an outstanding significance of the source stipulates the high demand for methods to gather and process information that could be used to promote companies further rise and ensure their leading positions. In this regard, a set of practices aimed at the investigation of particular spheres of knowledge to elaborate an efficient approach and obtain a sustainable competitive advantage becomes crucial for all modern organizations regardless of their nature. The given paper focuses on the comprehensive investigation of knowledge management (KM) as a science that helps to acquire, process, and share knowledge regarding the King Faisal Specialist Hospital & Research Center in Riyadh. The choice of the organisation for the investigation is preconditioned by the scope of activities performed within this unit, peculiarities of its functioning, and its perspectives for the further development. The work consists of the introductory paragraph, which outlines the main aspects of the research; background, which describes King Faisal Specialist Hospital & Research Center in Riyadh and its general characteristics needed for the better analysis; body part which delves into the main operations of the unit, its strengths, weaknesses, and analysis of KM; recommendations related to the further improvement of its functioning; concluding paragraph that summarises all ideas presented in the paper.

Description of Organisation

King Faisal Specialist Hospital & Research Center in Riyadh (KFSH&RC) was created in 1975 by King Khaled Ibn Abdulaziz Al Saud (KFSH&RC history, n.d.). The organisation of this medical unit was preconditioned by the increased need for a high-quality care among local people. In such a way, a modern and well-equipped centre was established. From 1973 to 1985 KFSH&RC was administered by the Hospital Corporation of America (HCA) (KFSH&RC history, n.d.). It was preconditioned by the lack of experience and competence demanded to manage such projects. However, in 1985 in accordance with the Royal Decree, a national team of specialists undertook the responsibility for the administration of the given healthcare unit (KFSH&RC history, n.d.). Nowadays, it is a successful and innovative project which is also referred to as General Organization (Gen. Org.). It encompasses a wide array of medical services along with academic facilities. Therefore, it remains the most innovative and efficient unit in the area providing needed care to people living in close and distant regions. Moreover, it cultivates cooperation with other medical units across the state and world to acquire knowledge and promote enhanced outcomes. Regarding these peculiarities, KFSH&RC becomes a perfect object for the investigation as KM is fundamental for its functioning and further growth.

Size and Composition

At the moment, KFSH&RC has about 18,000 employees who work in different departments such as:

• academic and training affairs;
• nursing affairs;
• medical and clinical affairs;
• King Fahad National centre for children;
• research centre division;
• administrative services (King Faisal Specialist, n.d.).

Therefore, it is managed by the board of directors consisting of chief executive officers (CEO) who monitor the functioning of different departments and their further development (Organization structure, n.d.). A strict delegation of duties and distribution of responsibilities contribute to the units improved functioning and enhanced problem-solving. The primary organisational objectives of KFSH&RC include the provision of the high quality tertiary health care to people across the state; establishment of high standards for care delivery in Saudi Arabia; conducting of specific research related to health and treatment outcomes; cooperation with other medical establishments within the country and abroad to enrich knowledge and elaborate new efficient approaches; participation in education programs to prepare outstanding specialists who will cultivate a new culture of care delivery (Organization structure, n.d.). Therefore, the scale of goals presupposes appropriate organisation structure. That is why KFSH&RC has its departments in Riyadh and Jeddah with over 720 consultants in different spheres working there (King Faisal Specialist, n.d.). In general, the units organisational structure could be considered sufficient.

Scope of Operations of KFSH&RC

Regarding the above-mentioned information, KFSH&RC offers a broad range of services to patients who have diverse medical problems. Therefore, the tendency towards the increased complexity of medical issues along with the appearance of new health problems preconditions a high need for particular facilities and operations that could help to meet diverse individuals needs. That is why the unit demonstrates the tendency towards a further rise. At the moment, KFSH&RC has 1089 beds in Riyadh and performs about 12,899,525 laboratory tests per year (KFSH&RC history, n.d.). Therefore, the average number of radiology procedures is about 262,150 (Quality & patient safety, n.d.). Over 7000 patients are accepted, and 13,834 major surgeries are performed (King Faisal Specialist, n.d.). The given statistics demonstrate a significant scope of practice peculiar to the unit.

There are also several areas of specialisation. KFSH&RC deals with about 30% of all cancer cases in the country and provides care to 70% of children who have different types of cancer (Organization structure, n.d.). That is why annual showings of chemotherapy and radiation sessions remain high: 69,383 and 30000 correspondingly (King Faisal Specialist, n.d.). The hospital also conducts numerous studies to investigate the issue and provide patients with better treatment. KFSH&RC handles the largest transplant program in the region aiming at assisting patients who need this operation and improving outcomes (Research programs, n.d.). The Organ Transplant Centre of the hospital is the only unit that could offer invasive donor hepatectomy. The hospital also deals with cardiovascular diseases performing high-risk open heart surgeries and using mechanical heart assist devices to attain better results (Areas of research, n.d.). KFHS&RC runs the Fetal Diagnosis and Therapy program which is the only program of this sort in the Arab world (Areas of research, n.d.). It offers health procedures to patients who need interventions to improve their state of health. The hospitals scope of operations includes interventional radiology to treat cancer, medical genetics to investigate immune deficiencies, and neurosciences to work with brain tumours and other health issues related to the sphere (Research programs, n.d.). Therefore, it becomes evident that the unit has a broad scope of operations needed to meet patients requirements and evolve.

Knowledge Definition

Applying the basic aspects of KM to investigate the case, it is essential to determine the type of knowledge that is peculiar to KFHS&RC. Therefore, considering the nature of the unit, the presence of both explicit and tacit forms could be observed. These types of knowledge are crucial for the evolution of the healthcare sector as they guarantee the comprehensive investigation of crucial aspects and improved data transition (Cardoso, Meireles, & Peralta, 2012). Explicit forms could be found in results of numerous research projects conducted by the unit, reports, medical journals and government recommendations about treatment methods and technologies use (Cardoso et al., 2012). This kind of knowledge is crucial for education as it is used to create a theoretical framework and prepare specialist who will possess relevant information related to the healthcare sector and who will be able to apply theoretical knowledge about different processes in practice. Nevertheless, a tacit form appears among experienced practitioners like neurosurgeons or cardiac arrest specialists who possess a particular experience and could use it to make crucial decisions (Gonzalez & Martins, 2014a). It could be compared to intuition that is found in individuals minds. There are several ways to share this knowledge like academic conferences or other meetings where specialists can demonstrate their experience and explain their decisions.

Knowledge Acquisition

Having determined the form of knowledge peculiar to KFHS&RC, it is essential to determine the ways the unit gathers the needed information. First, the process of knowledge acquisition could be defined as the intra-organisational activity that facilitates the creation of both tacit and explicit knowledge and integrates it at the organisational level or the use of external sources to obtain new information and suggest it to the staff (Gonzalez & Martins, 2014b). Therefore, the process benefits from the high motivation to learn among employees and contribute to the further investigation of different spheres (Gonzalez & Martins, 2014a). In this regard, KFHS&RC cultivates a specific working culture which is aimed at learning and research by encouraging specialists to do their best in the given sphere. As stated above, the hospital conducts numerous studies in different areas to enrich its knowledge related to the leading medical issues and problems. For instance, the existing Cardiovascular Research Program is focused on the improved comprehension of molecular genetic and epigenetic mechanisms that regulate cardiovascular diseases (Areas of research, n.d.). Its main goal is to uncover new mechanisms responsible for the increased blood pressure or heart failures as it remains the leading cause of death in the Kingdom and world.

There is also the Stem Cell and Tissue Re-engineering Program that delves into the molecular and cellular mechanisms of stem cell biology to create innovative ways of their these cells therapeutic use in diverse clinical areas like spinal cord injuries, cardiovascular, neurodegenerative, renal and autoimmune diseases, and all types of cancer (Areas of research, n.d.). Moreover, results of the research could be used to engineer living organs for patients who need transplantations.

The Research Center also engages in collaborative research and practice with best institutions internationally to assist its specialists in acquiring tacit knowledge by watching how other health workers make decisions or treat patients who have complex cases. In general, regarding the KM approach, KFHS&RC creates the environment that is beneficial for knowledge acquisition and its further use.

Knowledge Retention

Knowledge retention is another crucial aspect of KM. It could be defined as the process of organisational memory formation (Gonzalez & Martins, 2014a). It means that all relevant pieces of data become processed and stored in particular memory systems, physical or mental ones (Hunter, 2016). Knowledge is preserved as values, standards, and beliefs that are related to a certain organisation, its culture and structure (Lee, To, & Ty, 2013). Moreover, acquired knowledge could be applied to the majority of processes and activities performed by the unit. Regarding the KFHS&RC, it devotes much attention to the implementation of information that comes from research programs which are supported by the unit. In general, the hospital managed to create an efficient system where each element provides data for the efficient functioning of other ones. Complex patients cases serve as the basis for numerous investigations pursued in the research centre. At the same time, results of these studies are implemented into the practice to attain improved results and assist patients in their recovery. The given approach could be considered as an efficient one as it guarantees high knowledge retention and its use with practical purposes. Moreover, the unit participates in numerous conferences and other events aimed at the improvement of knowledge related to a certain sphere.

Knowledge Sharing

Therefore, KM also includes knowledge sharing which is the process of distribution of information acquired from different sources between crucial agents to create new knowledge and contribute to the further development of a unit (Lee, Kim, & Kim, 2012). The efficiency of the given activity depends on numerous organisational factors that cultivate knowledge transfer and create the appropriate environment which is needed for the evolution of sharing culture, expertise developed by individuals, motivational aspects, and the further use of technology to improve outcomes (Pandey & Duta, 2013). Regarding the KFHS&RC case, an aligned system of knowledge sharing could be admitted. As noted above, the unit has a solid research base and conducts numerous studies in different spheres.

Theoretical results of these investigations are suggested to specialists during conferences, briefings, meetings, and particular educational programs for them to discuss these findings and consider appropriate ways to their implementing to practice. Moreover, the hospital creates numerous opportunities for health workers from the Kingdom to participate in various programs aimed at the improvement of their knowledge. In such a way, it contributes to the enhanced distribution and sharing of information. Using acquired knowledge in this way, KFHS&RC creates the ground for the further evolution as these very pieces of data cultivate improved understanding of critical health issues among the staff. As a result, their workers enhanced competence contributes to the appearance of a new perspective on a particular problem and numerous studies devoted to its investigation.

Strengths

The peculiarities of KFHS&RCs functioning mentioned above demonstrate that the unit has several evident strength. First, it encompasses a wide array of activities starting from care delivery to patients in different states and ending with research in numerous fields to attain improved outcomes. This model contributes to the improved KM as its crucial elements like acquisition, pretention, and sharing are given significant attention. Conducting diverse investigations, the unit guarantees the enhanced relevance of its theoretical framework and supplies its workers with the information essential for their growth. Second, the hospitals activities aimed at the implementation of findings into the practice could also be considered a significant advantage as they promote knowledge sharing and cultivate the improved comprehension of current issues which are topical for the healthcare system. Finally, KFHS&RCs technological infrastructure includes the most innovative devices and becomes another strength that provides the unit with an opportunity to work with the most complicated cases.

Weaknesses

The in-depth investigation of the hospital demonstrates its innovative character and advantageous position it holds in the region. At the moment, it is the most prominent medical centre in the area which delivers care to all patients in the Middle Eastern region. However, its main weakness is the comparatively short story of observations. KFHS&RC was established at the end of the 20th century. For this reason, the unit just enters the phase of its rapid growth. The majority of problems are related to this fact. In several cases, the lack of experienced specialists could be observed as the centre has to ask for the international assistance. Moreover, the scope of its research work is narrow which is reconsidered by the peculiarities of the local demand for care and the most frequent health issues that are reported.

Opportunities

Despite several weaknesses outlined above, KFHS&RC enjoys numerous opportunities available for it at the moment. The fact is that its outstanding technological infrastructure and solid financing could help to establish new projects devoted to the further research and investigations in different fields. Moreover, the already existing programs provide information related to different health issues which could be used to improve KM by acquiring, storing, and sharing new knowledge. That is why the further evolution of the unit could be predicted. Therefore, at the moment, there is no alternative in the region which means that KFHS&RC remains the only organisation which could help people suffering from diverse health problems. The growing level of demand becomes another factor that stipulates excellent opportunities for the further evolution and appearance of new departments and research projects.

Recommendations

In general, a sufficient use of KM could be admitted regarding the hospitals functioning. It means that KFHS&RC introduces numerous practices to create the environment that cultivates efficient approaches to knowledge acquisition and distribution. At the same time, there are still multiple opportunities for the further improvement. One of the recommendations is to foster international relations and create research projects together with similar institutions from other states. This method will help to collect new data and provide specialists with innovative methods of treatment that are used in different states. Additionally, the hospital could consider using specific organisational patterns and software to structure all gathered information and provide it to specialists on their demand. It will obviously improve KM within the unit and promoted improved outcomes related to educational activities. Finally, areas of the future research should be prioritised for health workers to acquire information that will help them in to conduct new studies at the high level.

Conclusion

Altogether, King Faisal Specialist Hospital & Research Center in Riyadh could be considered an outstanding health unit that combines the provision of tertiary treatment with significant research work. For this reason, KM becomes crucial for its functioning. The comprehensive investigation of the case demonstrates that the hospital recognises a crucial role knowledge acquisition, retention, and sharing plays in the modern world and devotes attention to these aspects cultivation by creating a specific environment and engaging specialists in research work.

References

Areas of research. (n.d.). Web.

Cardoso, L., Meireles, A., & Peralta, C. (2012). Knowledge management and its critical factors in social economy organizations. Journal of Knowledge Management, 16(2), 267-284. Web.

Gonzalez, R., & Martins, M. (2014a). Knowledge management: An analysis from the organizational development.Journal of Technology, Management, and Innovation, 9(1), 131-147. Web.

Gonzalez, R, & Martins, M. (2014b). Mapping the organizational factors that support knowledge management in the Brazilian automotive industry. Journal of Knowledge Management, 18(1), 152-176. Web.

Hunter, B. (2016). The power of KM: Harnessing the extraordinary value of knowledge management. San Francisco, CA: Spirit Rising Productions.

KFSH&RC history. (n.d.). Web.

King Faisal Specialist Hospital and Research Center. (n.d.). Web.

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Zangiski, M., Lima, E., & Costa, S. (2013). Organizational competence building and development: Contributions to operations management. International Journal of Production Economics, 144, 76-89. Web.

Best Practices to Improve Tufts-NEMC Non-clinical Outcomes

Tufts-New England Medical Center (Tufts-NEMC) was sinking in debts and losses and thought it would be nice to seek a merger with other Medical Centers to alleviate the fiscal challenges in 1994 (Ingols & Brem, 2016, p. 452). After Tufts-NEMC continued to sink in monthly losses and there was no cash in hand to run the organization, it resolved to dissolve the merger and carry its burden.

Managed care contracts are between healthcare providers and medical facilities to offer services and care at a lower cost. In the U.S., healthcare insurance enters into managed care plans with healthcare providers to maximize profit by increasing the volume of services while offering them at affordable prices. Therefore, Tufts-NEMC increased services and profitability by opening managed care contracts (Ingols & Brem, 2016, p. 459). Zane assessed the mission ahead of her and set about determining the credibility of senior staff. Those that had experience and expertise like Deeb Salem and Scotland, she appreciated while replacing others. For instance, she fired the senior president of strategy and vice president of fundraising and development. They were replaced by a network-building expert outsourced from Partners and Deb Taft from Dana Farber, respectively (Ingols & Brem, 2016, p. 459). She was also known for picking great minds in administration. Deborah Joelson, senior vice president for market development and planning, appreciates, together with her colleagues, the transparent and honest character of Ellen (Ingols & Brem, 2016, p. 460). The CEO held a series of town meetings throughout the night and day with the physicians and other staff revealing the financial facts, targeted growth initiatives, and general topics she considered worthy of their knowledge.

Reasons Why the Proposed Best Practices will Yield the Desired Improvements

Ellen Zane helped Quincy stand on its legs and acquired a myriad of expertize working in the Healthcare industry for over three decades. She is expressed as a non-physician female CEO with the required mix of management skills to salvage Tuft-NEMC from the prevailing adverse economic, political, and social challenges. She had also demonstrated passion in preserving patients and physicians relationships and that of the community and the hospital. After Zane brought BDC Advisors consulting group and sat with Scotland, she realized that the company was losing close to $6 million a month and not $3 million had earlier informed during entry (Ingols & Brem, 2016, p. 458). It also came to her attention that the hospital did not have two years of cash on hand but ten months.

Cost and Revenue Implications for the Organization of the Proposed Best Practices

Maintaining the clinical excellence, teaching, and research branches saved Tufts-NEMC recruitment and induction cost because it reduced staff turnover rate.

Return on investment and net income determines the financial facet of a balanced scorecard. In the case of Tufts-NEMC, dissolution of merger terminated cycles of monthly losses. Secondly, Sale of real estate earned the hospital capital to run it past ten months. Staff changes was also a financial game changer in saving the organizations losses by paying for performance and value.

Customer Service and Satisfaction Drivers Present

Managed care contracts are a cheaper and more affordable healthcare financing model. The insurer negotiates on behalf of the patients who are clients to both parties of the contracts. Community involvement makes people feel honored and trusts that their feedback will lead to positive change in their concerns. Improve the working condition and set out standards and ethics that show respect for the clientele. When Ellen realized that many community doctors were not referring patients to Quincy Hospital, she reached out. The physicians replied that the parking lots had been closed by the ongoing construction (Ingols & Brem, 2016, p. 456). Boost the morale of the staff through timely remuneration even during hard financial times. A merry workforce will always offer satisfying service and have improved and quality performance.

Assessment Methodologies for Organizational Success and the Timeliness, Effectiveness, and Efficiency of Services after the Change

Tufts-NEMC ought to have a touch with the Beacon Hill and Mayors office. Political goodwill is necessary to ensure that the organizations interests are taken care.

One of Ellens cost-cutting and efficiency initiatives was to sell real estate. The proceeds from the transaction would improve the capital base and pay some debts. When Ellen Zane was hired as the new Tufts-NEMC CEO, she spent substantial time on Beacon Hill to ensure that political offices recognized their existence and presence in Boston. Customer satisfaction is the clearest external indicator of improved performance, effective, timely, and efficient services. Customer satisfaction implies indirect advertisement, marketing, and profitability. Employees are a rational factor trade, and thus, ought to be treated with caution for optimal performance. When employees are poorly remunerated and have unpleasant working conditions, they get demotivated and underperform (Koys, 2001, p. 101). Whenever they get better working conditions, they resign to take advantage of the available opportunity, increasing the turnover rate.

Specific Measurements for Assessing Post-Change Organizational Success

The success or failure of any profit-making entity is determined by its revenues and costs.

The three measures are related, and whenever one suggests a failure of the entity, the management should apply mitigating measures to return it to the path of sustainability and success. However, success is a journey, not a one-day event (Hurley & Estelami, 2007, p. 186).

Rationale for Selecting the Measures Discussed

Without profitability, the organization stares at a dark and unpromising future. Therefore, for profitability is a visible and big determinant of firms level of success.

Customer satisfaction shows willingness of the clients to buy the services and recommend the providers to others seeking it. Thus, free marketing strategy and it has capacity to edge out other competitors.

Employees are in a mission to score their personal goals, and hence, when they lag behind their counterparts in other organizations because of poor working conditions they shift to greener pastures.

Bibliography

Hurley, R. F., & Estelami, H. (2007). An exploratory study of employee turnover indicators as predictors of customer satisfaction. Journal of Services Marketing, 21(3), 186, 199.

Ingols, C. & Brem, L. (2016). Case study 5 Ellen ZaneLeading change at Tufts/NEMC. In Cawsey, T. F., Deszca, G., & Ingols, C. Organizational change: An action-oriented toolkit (3rd ed.), (pp. 448479).

Koys, D. J. (2001). The effects of employee satisfaction, organizational citizenship behavior, and turnover on organizational effectiveness: A unitlevel, longitudinal study. Personnel psychology, 54(1), 101-114.

Summary

Maintaining an efficient administrative structure of a healthcare organization is a challenging process. The specified issue has become particularly complicated for the Texas Health Arlington Memorial Hospital, which has been expanding and, therefore, requires a change in its administrative approach. Currently, the organizations mission, vision, and philosophy are geared toward improvement and patient-oriented care, which can be considered sufficient premises for change. However, the introduction of more effective communication channels will be needed to ensure that decision-making among managers and staff members aligns with the core standards of the hospital once THAMH expands.

Keywords: hospital, administrative structure, mission, and vision

Introduction

When evaluating a healthcare institution, one would typically seek the characteristics that reflect the efficacy of healthcare management and the performance of the staff in order to pass judgment. Indeed, issues such as the percentage of positive outcomes, the frequency of follow-ups, and the quality of care delivered to inpatients represent essential criteria for evaluating a healthcare facility. However, understanding the administrative framework in which the decision-making and core values are grounded is also central to deciding whether the hospital can be considered trustworthy and high-quality. Despite the presence of certain administrative issues, the Texas Health Arlington Memorial Hospital can be considered exceptionally efficient due to the strong values behind its mission and the adherence to robust ethical principles.

Examination

Texas Health Arlington Memorial Hospital (THAMH) is a well-known healthcare organization in the U.S. and one of Texass largest and most influential. THAMH Known as exceptionally high-performing, the healthcare organization in question is navigated with the help of a set of robust and patient-oriented ethical principles and standards. Remarkably, THAMHs mission is fairly simple, being geared toward improving health rates and quality of life for community members regardless of their ability to pay (Texas Health Arlington Memorial Hospital, n.d.). Similarly, the organizations vision centers on promoting improved health management and developing a healthy community: Vision: To partner with you for a lifetime of health and well-being (Texas Health Arlington Memorial Hospital, n.d.). The focus on collaboration is particularly remarkable since it prioritizes patient-nurse communication. Finally, the organizations values, integrity, empathy, and collaboration, prove that THAMH has a sufficient ethical foundation for administrative decision-making (Texas Health Arlington Memorial Hospital, n.d). Overall, the organization seems to function based on essential ethical principles that are typically actively promoted in healthcare.

The stakeholder- and, primarily, a patient-oriented approach that THAMH promotes in its mission, as well as the emphasis on partnership and ensuring continuous development articulated in THAMHs mission, aligns with its current approach to administration. Specifically, the organizations administrative functions include organizing and delivering essential healthcare services, as well as controlling their implementation and the quality thereof (Chletsos & Saiti, 2019). Furthermore, supervision of the hospital staffs performance and the management of information within THAMH are included in the range of core administrative tasks (Galetsi et al., 2020). Finally, one should mention coordinating collaboration and communication with other relevant organizations with which THAMH partners in order to improve its performance and tend to the needs of its community members with greater efficacy (Galetsi et al., 2020). The specified functions reflect the organizations commitment to its patients and other stakeholders and its focus on continuous learning and improvement.

Strengths and Limitations

Similar to any healthcare organization, THAMH implements its principles in a manner that is supposed to achieve the best outcomes yet is also constrained by several limitations. Enumerating the strengths that the THAMHs current administrative approach contains, one should give credit to the management of patient communication and patient relations within the organization. Specifically, THAMH has received multiple praises for its patient-oriented strategy. Due to its unwavering adherence to its policies concerning patients, THAMH has encouraged its staff to be attentive and caring toward each client individually, addressing specific needs thoroughly (Kennett-Hensel & Payne, 2018). As a result, the implementation of its mission and vision is impeccable in the THAMH setting.

Furthermore, the hospital administration should be credited for the emphasis on promoting collaboration with other healthcare organizations and services. The experience-sharing opportunities and the chance to acquire innovative technology are crucial for THAMHs proper management of its administrative and healthcare-related tasks. Furthermore, the current policies stemming from the hospitals mission, vision, and philosophy allow hiring competent experts and exploring new solutions concerning technology and evidence-based research (Augustsson et al., 2019). The specified outcomes are vital for exerting administrative control over change within the organization and directing it toward incremental innovation (Augustsson et al., 2019). Therefore, the current administrative approach toward managing and implementing the hospitals core functions leads to THAMHs continuous improvement.

However, the framework that THAMH has been implementing has several limitations. For instance, the fact that controlling an increasingly large organization is gradually becoming quite difficult should be seen as a significant impediment. Specifically, due to the consistent rise in the number of staff members and patients, THAMH needs to revisit its leadership approach by changing it toward a more laissez-faire framework. Thus, individual staff members will gain more independence in the making patient- and care-related decisions, which will advance the process of providing care (Kennett-Hensel & Payne, 2018). Furthermore, it has been reported that the organization has been experiencing issues with team management, which can also be seen as an extension of the leadership problem described above (Texas Health Arlington Memorial Hospital, n.d.). Nonetheless, improvements are expected to occur with the introduction of a more effective and functional leadership approach, specifically in relation to governance and decision-making.

Care Delivery System

In turn, the care delivery system within the organization deserves closer attention. Currently being seen as moderately satisfactory, the care delivery system still needs adjustments due to problems in tending to all needs of the target population. Specifically, several patients have reported poor healthcare services, particularly in relation to surgery and further recovery (Texas Health Arlington Memorial Hospital, n.d.). The described issues suggest that there might be a problem in managing information within the hospital and administering the relevant treatments to patients. Therefore, the concerns regarding the management of data, specifically its sharing, transfer, and processing, need to be resolved as an administrative issue. Specifically, changes in the existing data management infrastructure must be made with the introduction of more effective tools.

Furthermore, compliance with the established standards of EHR implementation must be checked constantly. It is no secret that many healthcare experts have been having issues adjusting to the EHR system and working within it (Kao et al., 2020). Several studies show that the specified problems have been noticed in the administrative framework of numerous healthcare facilities (Kao et al., 2020). Therefore, to enhance the care delivery system within the organization, one must revisit the implementation of the EHR standards within the hospital setting. Specifically, healthcare experts adherence to the EHR requirements and the respective principles of data management must be evaluated. Furthermore, tools for personal communication between healthcare staff members must be incorporated into the THAMH system. With the introduction of hands-off communication devices into the target setting, administrative processes will be carried out with greater speed and dexterity.

Outcomes and Measurements

It is presumed that the introduction of an administrative approach that will encourage a more flexible standard for decision-making will lead to better administration of core tasks. In addition, the focus on the coordination of staff members actions so that they could align with the core goals of the hospital and its mission and vision will be required. The focus on quality management and improved cooperation, along with the promotion of collaboration with other organizations, will have to be approached from the perspective of improved communication. Specifically, the organization will need to introduce additional communication channels that will allow better data management.

To assess the efficacy of the proposed change, one will need to determine the levels of the hospitals performance in regard to task implementation. Specifically, compliance with the set action plan and the objectives associated with managing public health issues, introducing innovative health management solutions, and collaborating with other healthcare facilities will need to be assessed. The extent to which the existing goals set for the THAMH are completed will serve as the main measurement criterion for determining the success and overall efficacy of the selected administration strategy. Despite being a minor adjustment, the offered solution is expected to lead to a noticeable change in the quality of administrative management of THAMH.

Conclusion

While Texas Health Arlington Memorial Hospitals approach cannot be considered flawless due to communication concerns, the organizations value system, as well as its mission, vision, and corporate philosophy, provides the fundament for the effective management of patients needs. Granted that the complexity of the hospitals structure may imply difficulties in managing the core administrative processes, a robust ethical framework for decision-making based on THAMHs mission and vision allows for high performance quality. Thus, the safety and well-being of THAMHs patients remain a priority, with core strategies geared toward improving clients experience and quality of life. Overall, THAMHs administrative approach can be considered successful in maintaining the principles of patients beneficence, safety, and autonomy.

References

Augustsson, H., Churruca, K., & Braithwaite, J. (2019). Re-energizing the way we manage change in healthcare: the case for soft systems methodology and its application to evidence-based practice. BMC health services research, 19(1), 1-11.

Chletsos, M., & Saiti, A. (2019). Strategic management and economics in health care. Springer.

Galetsi, P., Katsaliaki, K., & Kumar, S. (2020). Big data analytics in the health sector: Theoretical framework, techniques and prospects.International Journal of Information Management, 50, 206-216.

Kao, D. P., Trinkley, K. E., & Lin, C. T. (2020). Heart failure management innovation enabled by electronic health records.Heart Failure, 8(3), 223-233.

Kennett-Hensel, P. A., & Payne, D. M. (2018). Guiding principles for ethical change management.Journal of Business and Management, 24(2), 19-45.

Texas Health Arlington Memorial Hospital. (n.d.). Guidestar.org.

Texas Health Arlington Memorial Hospital. (n.d.). Welcome. TexasHealth.org.

Introduction

Taking on quality improvement initiatives is more crucial than ever for healthcare systems sustained survival to prosper in a more difficult healthcare environment. To maximize the benefit to their company, health systems must, however, take on the appropriate projects at the proper time. Thus, the paper aims to discuss the ways to improvements in patient outcomes, cost savings, payment optimization, and general patient satisfaction.

Discussion

One of the methods is to enhance patient outcomes and cut costs by extending pharmaceutical care medication therapy management (MTM) to a set of patients insured by a shared-risk contract. The analysis shows the distinct, beneficial influence of the pharmaceutical therapy management plan on patient outcomes after using MTM for six months (Tinker, 2022). This program is effectively reducing the overall cost of care. Additionally, over 50% of hospital deaths are related to sepsis, a major cause of death in the United States (Tinker, 2022). Early detection of sepsis can be difficult since the patients bodily response displays a spectrum of vague symptoms that postpone identification, diagnosis, and treatment, increasing fatality rates. Mission Health, the sixth-largest health system in North Carolina, developed a comprehensive data-driven strategy to address this issue by facilitating early sepsis diagnosis and standardizing sepsis treatment (Tinker, 2022). Mission Health received insights regarding sepsis performance using that strategy and evidence-based alerts to spur improvements.

One of the most crucial methods to enhance the general patient experience is to promote effective communication. Patients who feel their problems are heard and recognized are more likely to react to therapy than those who do not. It is crucial to urge healthcare professionals to communicate more effectively to enhance their bedside manner (5 innovative ways to improve patient care, 2019). Making eye contact, communicating empathically and compassionately, and abstaining from using medical talk by describing procedures and diagnoses in words the patient can comprehend are all examples of this.

However, buyers in many nations are increasingly attempting to make the most use of the existing healthcare resources due to rising prices. Providers are looking for changes across the board in the care continuum to provide more cost-effective healthcare. They may be able to improve patient outcomes while cutting costs by embracing the entire patient journey (Montag, 2017). In addition, the hospitals can provide more flexible insurance programs that could cover many procedures.

Conclusion

Overall, several methods are helpful for the quality growth of the hospital. The promotion of effective communication is one of the most important strategies to improve the overall patient experience. Additionally, implementing MTM for six months demonstrates the distinct, positive impact of the pharmaceutical therapy management plan on patient outcomes. Improving the results through the early detection of sepsis and optimizing payments and insurance contributes to hospital enhancement.

References

5 innovative ways to improve patient care, cost efficiency. (2019). SCP Health. Web.

Montag, B. (2017). 7 ways to improve patient outcomes in the new world of value-based care. Health Management. Web.

Tinker, A. (2022). The top seven healthcare outcome measures and three measurement essentials. Health Catalyst. Web.

Introduction

This paper is based on the Patton Fuller Community Hospitals Annual Report for the year 2009. Physicians work at the hospital and own it too. They also govern the hospital together with the CEO and CFO. Despite sitting on the board, the CEO and CFO have no voting rights. This hospital aims at making a profit from its operations. The hospital obtains most of its revenue from in-patients rather than outpatients.

In the current year, the hospital took on additional debt. This debt was issued at an adjustable interest rate. Thus, the CFO has had to create a contingent liability in the financial statements in case the debt interest increases. PFCH has some investments that performed poorly this year. The loss has been recognized in the financial statements. On the up side, the hospital will receive some funds from a deceased benefactors estate. The auditors report was unqualified.

Audited vs. Unaudited Financial Statements

Patton Fullers audited and unaudited financial statements are similar except for one line item. The expense Provision for Doubtful Accounts had been understated in the unaudited accounts.

This was adjusted in the annual report. Prior to the adjustment, the Statement of Revenue and Expenses indicated that the hospital had met its goal of profit-making and made $689,000. Unfortunately, after the adjustment, the hospitals profit was reduced to a loss of $373,000. Net profit was overstated by double the amount. Clearly, the hospital is doing quite badly financially (Atrill, 2011).

This increase in provision for doubtful debts also affected the Balance Sheet. The amount under receivables was adjusted downwards. To complete the double entry, retained earnings were also adjusted downwards. This difference is material as it can affect a decision made based on the financial statements. Supposing the financial statements were not audited, they would have misled readers to believe that the hospital was profitable.

Revenue and Expenses

Patton Fuller obtains its revenue from patients who use its services. Most of the revenue is from inpatients. However, in the current year, some third parties have been introduced. They will cover the patients hospital fees, but at a different rate than the normal. They are likely to pay less than the patients owe. This is the reason for the $1,000,000 adjustment.

The Balance Sheet shows the amount of receivables owed to the hospital by patients. PFCHs receivables are approximately 20% of revenue. The hospital needs to improve is debt collection. The fact that the revenue will now be received from a third party has affected Financial Reporting.

It has resulted in the increase of the allowance for doubtful debts (Barrow, 2011). The major expenses are Salaries, Benefits, Physician, and Professional Fees. It is possible that the physicians are paying themselves at a rate higher than the market rate. However, Professional fees are fixed and unavoidable.

PFCH has organized its revenue into three different categories. Net Patient Revenue is obtained from the hospitals core business, while investment revenue is obtained from its stocks and other assets. Expenses are organizes by function.

Conclusion

Financial reporting provides useful information for investors and management to use in decision-making. The integrity of Financials can be increased by subjecting them to an audit. In the case of PFCH, audit adjustments reduced the supposed profit to a significant loss. The hospital should consider allowing management professionals to sit in the board and have voting rights. This might improve its financial management and lead to profit making.

References

Atrill, P. (2011). Financial Management for Decision Makers. Chicago: Prentice Hall.

Barrow, C. (2011). Practical Financial Management: Key Financial Statements Tools of Financial Analysis Business Planning and Budgeting. New York: Kogan Page.