Institutional Realities - Research Paper Example

?RUNNING HEAD: PROJECT A STRATEGIC PLANNING Option A: al Realities Mona McFadden HS 8114 Capella Address: PO Box 651, Converse Tx 78109 Telephone:             210-200-9338       Email: mona.mcfadden@yahoo.com Professor: Dr. Ellen Kearns Date: Annotated Outline Table of Contents. Describes the different sections of the paper and the page numbers. Abstract. This will describe the main analysis of the topic and the project examined. Introduction. Describes the information that will be covered in the paper and the relationship that the research paper will have to developing and creating a strategic plan. Specific Problem in the Acute Long Term Organization. This will look at research and theories that look at the acute long term organization. This will form a basis of the problems which need to be solved with the current strategic project. Specific Problems Defined. This section describes the specific problem in RHC as well as how this relates to various aspects that need to change within the organization. Strategic Planning Issue. This will look at the one issue that will be examined in terms of RHC and how this will be formulated for continuous planning and change within the organization. Theory of Constraint. Looks at the main problem associated with RHC in terms of the theory of constraint. Process Analysis Theory. This is the second theory which applies to the problems of RHC. Application of Strategic Planning. Looks at the mission, vision, plan and implementation of the strategy while defining ways to approach the main issues. Strategy of Continuous Organizational Improvement. Examines the ways to continuously approve with the implementation of the new strategy and expectations. References. List of resources used for this project. Annotated Bibliography Bryson, John. (2004). Strategic Planning for Public and Nonprofit Organizations UK: John Wiley and Sons. This book describes the strategic change cycle as well as how this is incorporated into non –profits and care systems. Not following this cycle is the main problem of the health care system, specifically because there is the need to respond to trends and to look at the situations that are a part of the culture and the community. Carr, Deborah, Dmitry Khodyakov. (2007). “End – of – Life Health Care Planning Among Young Old Adults: An Assessment of Psychosocial Influences.” Journals of Gerontology 62 (2). This article is used to examine the different approaches which are looked at in the long term acute care system. It can be seen that psychosocial influences create a specific impression about the care which is offered and creates gaps with the market and the desire to be a part of the main care system. This is one of the concepts which RHC needs to look at with the re-engineering of their program, specifically to change the quality care offered. Coleman, EA, C Parry, S Chalmers. (2006). “The Care Transitions Intervention.” Archives of Internal Care 57 (1). This article is used to describe the way in which care systems need to look at staff and employment training. It shows that a main gap that is associated with the care system is based on the misunderstandings that are a part of the care transition that occurs. Employees are expected to begin understanding the need to intervene and change the approach which is taken toward the long term care. Eskildesen, Manuel. (2007). “Long – Term Acute Care: A Review of the Literature.” Journal of American Geriatrics Society 55 (5). The article that is reviewed looks at the general issues of long – term acute care and how many are influenced by the specific needs that are in the facilities. Looking at the review of literature helps to define the issues ranging from cost control to the associations that are a part of the acute care. Ford, JD, AD Amelio. (2008). “Resistance to Change: The Rest of the Story.” Journal of Management 72 (3). This article is used to explain the difficulties with change and change management. The article will be used to explain the resistance to change and the way in which RHC needs to be able to identify and respond to this so a smooth transition of the process can be identified. Goldratt, E. M., & Cox, J. (1992) The Goal: A process of ongoing improvement. Great Barrington MA: The North River Press. This book will be used to explain how RHC can use a process of improvement with the projects, specifically by opening to communication and other attributes that are a part of change. This will help to build and complete the projects that are a part of the concepts of change. Griffith, J.R., & White, K. R. (2007). The well-managed healthcare organization. Chicago: AUPHA Press/Health Administration Press. This book will be used to identify the two main theories that are associated with health care organizations and what is needed to ensure that the programs are able to move forward in different terms so the right steps can be taken for higher quality management within a given organization. Rondeau, KV, Th Wagar. (2006). “Nurse and Resident Satisfaction in Magnet Long Term Care Organizations: Do High Involvement Approaches Matter?” Journal of Nursing Management 15 (6). This particular article will be used to describe the way in which long – care organizations work in terms of communication process and other applications to the nurse and residential expectations. This will combine with the understanding of how involvement changes the initiatives and the projects with approaches that ensure success within the internal organization. Scott, Vicky, Kristine Votova, Andria Scanlan, Jacqueline Close. (2007). “Multifactorial and Functional Mobility Assessment Tools for Fall Risk Among Older Adults in Community, Home Support, Long Term and Acute Care Settings.” Age Ageing 36 (2). This article will be used to understand the understanding of acute care settings and how there are several tools which are needed for complete success of the facilities. This will be combined with the understanding of the most pertinent issues that are associated with acute care settings. Shi, Leiyu, Douglas Singh. (2008). Delivering Health Care in America: A Systems Approach. UK: Jones and Bartlett Publishers. This book describes the nature of acute health care organizations and how there is a lack of systems that create higher quality among those in the organization. The main concept will be based on creating a system that is developed with response to the care and the quality which is now being defined in various facilities. Table of Contents Abstract……………………………………………………………………………………8 Introduction………………………………………………………………………………..9 Specific Problem in the Acute Long Term Organization…………………………………9 Specific Problems Defined………………………………………………………………13 Strategic Planning Issue………………………………………………………………….13 Theory of Constraint……………………………………………………………………..15 Process Analysis Theory…………………………………………………………………15 Application of Strategic Planning………………………………………………………..16 Strategy of Continuous Organizational Improvement…………………………………...22 References………………………………………………………………………………..24 Abstract Religious Health Care operates in a catchment area of 225,000 in the town of Middleville. The governing board of RHC hired a consultant to evaluate strategic performance. This hospital has a long term acute care facility on the premises. These acute care facilities are on the rise as the baby boomers take over the senior population. The long term care facilities however have not kept up with changes and cost control with the increase of patient expectations for quality care. This project will demonstrate a comprehensive approach to the issues needing to be addressed by RHC and its organizational management style and outcomes. This paper will apply the process analysis theory in the development of solutions for this facility. By using a process flowchart or process map from a process analysis theory identified in the research and applied to the strategic planning issue complicated issues will be easier to understand, thus allowing for the solution to become clearer in the research. A search of the literature, Internet, Capella Library, and other sources for process analysis, flowcharts, and mapping will guide the direction of the paper. Introduction This writer will analyze a specific strategic planning issue, problem, or concern in the acute long term care facility at RHC. This facility will be an example of many other long term care facilities as the issues here are closely related within the industry. The rationale for choosing this topic is in the overall organizational structure of this writer’s own healthcare organizations problems and how they affect the over all care of the resident. Cost control is number one in management’s opinion and the consequences of that decision are not addressed appropriately or adequately. Health plans working with nursing homes need to offer better payment models to alleviate some of the issues. In addition, quality care suffers, staff retention is high, medical treatment is lacking, moral is low and patient/family satisfaction is unfavorable. Care coordinators for the resident would be a good implementation in the representation of resident. This writer’s own long term care facility has many issues with updating changes required to address these issues. Those that are addressed are done in a crisis management criterion, simply putting out hot spots and not addressing long term goals. This project will provide an organizational process to develop a better system for acute long term care. Areas to be addressed in the paper are as follows: Specific Problem in the Acute Long Term Care organization The specific problems that are identified with the RHC are based on the defined issues that relate to acute long term care organizations. The main issue which most focus on are based on the psychosocial influences which are associated with the organization. If one is receiving long term care in a home, then it is believed that it is for extreme or end – of – life planning and is based on the need to prepare for complex situations. Most that decide to use care facilities are aware that the conditions won’t be able to change and that it is for preparation for the health outcomes and changes. This is combined with difficulties with how one approaches their health care, beliefs in what they should do anxiety and the need to foster decisions that are associated with the care. The blocks which are presented from this create the main problems with those who are required to receive the care but aren’t interested in the health plans and other aspects that are associated with the care facilities (Carr, Khodyakov, 2007). The psychosocial relationships that are attributed to the problems with health plans and willingness to receive specific types of help begin to accumulate because of the problems which arise with the long term care facilities. It is likely that the health of an individual begins to deteriorate after a given period of time. Unexpected deterioration of health is the most common problem with slow loss of mobility and control of basic bodily functions becoming more complex. The difficulties which begin to arise relate not only to the difficulties which occur with the facilities, but also change the individual health plans and the need to have specific costs associated with medical expectations and healing that is a part of the long term care. From the adults which receive help in the facility are also continuous problems because of the changes in health and the costs which are associated with this. When these begin to alter, it also creates differences and changes with the costs and leads to a loss of control from those that are receiving the assistance (Scott et al, 2007). The problems which arise among older adults lead to difficulties within the internal environment, specifically because of the combined problems of physical, mental and social aspects of the care. The transition which occurs with the care is one which requires several types of intervention to ensure that the individuals that come to receive assistance are able to transition to the continuous care. Skills and tools are required to assist with the transition which occurs and the potential issues which may rise from all three perspectives. The care transition intervention which is required is often not expected by the care coordinators and is overlooked with assistance. The difficulty which arises comes from responding to emergency situations while focusing on recovery from acute illness without providing specialized alternatives for transitioning into the different lifestyle and understanding how the health and cost can change. The care coordinators become limited because of the lack of intervention which is associated with the external environment and those that move to receive help (Coleman, Parry, Chalmers, 2006). The lack of transition planning of the care coordinators is followed by the industry of acute care and the changes which have recently been made. Acute care is known as a newer industry which is required to meet specific state and federal expectations while ensuring that there is health and well – being of the patients. However, there is little that has been examined in terms of what is required for the quality, outcomes, and the cost – effectiveness associated with problems which may arise. The lack of understanding within the internal environment has led to spiraling costs, attributes to deteriorating health that are not matched, unexpected costs and different levels of care that aren’t mandated or changed according to public policy issues that are associated with the care (Eskildsen, 2007). The complexities that relate to the unknowing aspects of long term acute care relate not only to the unknown issues, but also change with the overall effects within the internal environment. Nurses and residents are known to have a lower level of satisfaction when there is a sense of uncertainty, lack of policies and the inability to respond to given situations. When there is a higher level approach to what is needed, than it stops complexities from occurring. However, the ability to intervene with patients by care coordinators is often not able to take place. This leads both nurses and residents with the inability to receive the correct level of care. When an emergency situation does arise, then it creates an alteration in health plans and creates a loss of control with the costs. From this problem, is the inability to meet needs and respond in a manner which is positive. Most employees have stated that this cycle of not being able to respond until an emergency situation creates a feeling of alienation and helplessness. This is specifically associated with policies, inability to meet the needed quality and unknown factors which change the cost control and other factors within a given facility (Rondeau, Wagar, 2006). When looking at these specific problems, it can be seen that there is a direct relationship between the health care policies and foundations of the internal environment to the external environment. The need to receive specific levels of health care and health plans by patients is the main focus within the organization. However, this leads to cost control that is lost and the inability to respond in an effective manner through the care coordinators and those associated with the specific facilities. This is based on a lack of policies, inability to understand the quality that is needed and associations with the responses from the patients, which may resist specific types of care. These various elements combine together to create the main problems in terms of cost care, health plans, care coordinators and the quality of service which can be offered in the various acute health care organizations. Specific Problems Defined There are many areas needing addressed in long term care management. Cost control is a priority. Other issues that affect the quality of care and the profit margin are staff retention, moral, inventory control, proper medical treatments; prescription drugs for pain management, provider payment plans and overall resident/family satisfaction are only a few that will be addressed. Through interviews with different staff at RCH, several issues became apparent. RHC is undergoing a reengineering process and needs staff commitment and support. The facility has not shared the particulars with the staff of how the organization is doing; however, staff suggests two areas for improvement: patient/family satisfaction and provider satisfaction. This writer would add one other area, non-support from board members. Strategic Planning Issue The strategic planning issue addressed will be from the lack of support from board members and how this is changing the reengineering process that is a part of the staff and patient needs. The planning issue is one which is identified by a lack of communication and the inability to understand the needs and associations with both the staff and the patients. Since the board of directors is the main way in which the changes can be made, it is essential that the support is received and that communication processes are enhanced while the re-engineering process is implemented. The planning issue will be based on changing the main functions in the communication process between staff, patients, those planning the specific project and the board of directors. This will be combined with re-examining the needs of the process so that better acute care can be offered for better cost control and opportunities within the business. The main process which will be used for strategic planning will follow the strategic change cycle, as seen in figure 1. Figure 1: Strategic Change Cycle (Bryson, 2004). When looking at this particular model, it can be seen that the strategy, finance and business plan hasn’t been thoroughly identified with changing the cost control of the organizations. The objectives; however, have been implemented with re-engineering the amount of assistance which is given to individuals and the way in which they are able to respond to this. This is followed by specific areas of success identified, which is to mainstream the process that is used within the facilities. However, the ability to move forward with the change project is one which isn’t being implemented because of the lack of communication to staff and board of directors, which won’t allow the benefits and goals to be achieved for the last two aspects of the acute health care planning. Theory of Constraint Theory of Constraint (TOC) and bottlenecking are the main points Goldratt and Cox (1992) focuses on in the theory of why organizations miss the delivery of services in a timely and cost effective measure. Goldratt and Cox discussed flow as essential to the overall productivity of the process and flexibility is the ideal way to achieve this flow. All workers are an integral part of the total process; if one worker slows or stops, the process grinds to a halt and bottlenecks at this point (Goldratt, & Cox 1992). The Theory of Constraint will be examined as one aspect of solving the long term care problems. When looking at the acute health care facility, it can be seen that a re-engineering process is being used for better patient and employee satisfaction. However, this hasn’t been described to anyone and doesn’t have the support of the board of directors, meaning that the constraint of information can halt the changes made because of change resistance and other difficulties with the change process. Process analysis theory A key part of the planning process consists of understanding and reaching consensus on the benefits to be achieved. A guide is used to routinely and consistently make resource allocation decisions (Griffith & White, 2002). Griffith and White stated that a planning committee will affect “the short or long term, high or low risk, greater or less liquidity, and for or against certain missions and values” that will determine the shape of the organization (p.231). Application of Strategic Planning A planning committee will develop and oversee the proposals of strategic planning. The guidelines followed by the committee will assist in the determination of when an idea can be modified, deferred, or abandoned (Griffith & White, 2005). 1. Mission, Vision, and Plan The mission of the re-engineering process is based on providing greater satisfaction between patients and care coordinators at the health care facility. The vision is based on creating a stronger response to the health care received, ensuring high quality reactions to various situations and ensuring that the patients and the faculty is able to understand processes, procedures and alternatives that are associated with the long term care and facility. These different applications will create a set of different alternatives for those that are working within the facility. To change the level of satisfaction, there first needs to be a definition of the gaps that are in the health care center and what is causing the gaps. To begin the planning process, there needs to be greater communication between the faculty and board of directors as well as thorough examinations of the process and the gaps which are created. The re-engineering process after this point will consist of adding in tools and facilities that ensure higher quality and satisfaction among those that are using the facilities. 2. Benefit The benefit of implementing this specific plan is based on the ability to have a better internal environment, specifically between the employees and the patients that are receiving help. Defining the gaps in the current system and changing the level of quality that is a part of the health care facility ensures that there are many which will be able to move into a different way of working while ensuring that there is better consistency with the quality, cost control and other alternatives associated with the changes made to the organization. The ability to work first with detailing out plans and finding better communication is one which also will eliminate the change resistance that is currently a part of the facility. The board of directors is unwilling to accept the change while the staff is unaware of the changes which are being made. If there is a process of change management, then it will create a higher level of commitment and acceptance. It will also provide a new understanding of how the current system is leading to gaps and the inability to provide the proper level of health care to those that are in the industry. Re-examining the various aspects of the current system, opening the communication levels so there is a thorough understanding of what should change and looking at solutions for the plans of re-engineering will change the process that is currently being looked into (Ford, Amelio, 2008). 3. Market and Demand The gaps that are a part of every acute long term care facility comes with the inability to control costs, gaps in communication and the inability to understand what levels of care should be provided to those that are in need. It is known that the systems developed, specifically in terms of policies and expected job descriptions, change the amount of health care which one receives. If this isn’t offered in the right manner, then it can lead to difficulties among those that are a part of the health care system. The places which thrive in terms of acute long term health care are the ones which offer high quality care and which are able to work with specific circumstances to ensure that those who are receiving the care are able to have higher levels of satisfaction (Shi,, Singh, 2008). The re-engineering process that RHC moves through is one which can help to create a higher market and demand specifically by gaining a high quality reputation through the processes that are used. To ensure that this is able to happen, the system and planning will need to be developed with the ideology of creating a stronger level of satisfaction that spreads through word of mouth and among others that are based on the quality of care which is offered. The strategy which is taken should focus on re-defining this end goal and ensuring that the reputation of the company begins to move forward in terms of how the care is offered and what is expected with the health care in the facility. 4. Cost and Resources The cost and resources will be defined as follows: Re-examine the re-engineering process and what gaps need to be fulfilled within the facility. Work with the employees to find the main gaps that are a part of the system and which are leading to a lack of engagement with patients. Survey patients about the needed assistance and quality care that is within the facility Work with the board of directors with the re-engineering process to ensure that the gaps and changes can be made while driving in a larger market to those using the facility. Program initiatives 1: The main program initialized after these four areas of consultation will be based on mainstreaming the information in the facility while diversifying the processes used for assisting those who need assistance. Technology will be used to mainstream inventory and invoices, and which will help with payment plans. Program initiatives 2: The second program which will be initialized will be based on re-examining the policies and what can be offered in terms of care for pain and other options. Right now, the facility is based on providing assistance through emergency responses. Two new staff will be added specifically to help with pain management with all patients. Training and development of all staff will be inclusive of this program, specifically to offer more alternatives to assist those that are in need of pain management assistance. This will prevent larger problems, help with cost control and will raise the quality that is in the facility. 5. Finance The financial needs will first be divided by the needed programs. This will occur after the surveys are taken and approval is met by staff and the board – of – directors. It is expected that basic programs and training for the long term care facility will consist of a new invoicing program, options for medical treatment and a tracking system for the work that is done by employees, as well as a tracking system for what the residents are going through in terms of pain management and emergency needs. It is expected that these programs will range from $5,000 to $25,000. This will help to monitor and track expenses at a better rate and will estimate the cost control options, specifically through the emergencies and health plans which may arise. The financial needs for the two new staff will include an average of $50,000 per year for each of the new staff for $100,000 total. There will also be an average of $25,000 designated for the training and development of pain management assistance, both for the older staff and the two new staff that carry this designated role. The total amount needed for this program will be inclusive of an average of $150,000. 6. Timing, Implementation, and Evaluation (Griffith & White, 2005). The timing will first be based on the communication process to define what needs to be changed and how this will work with both the board – of – directors and the staff. The technology will be added in over a 6 month time frame, dependent on the most needed items for software as well as the customized alternatives. To further define this need, there will be consulting which takes place with the IT individuals designated for this job. The timing of the new staff and the pain management will take place within the 6 months to 1 year after implementing this system. This will be done to ensure that there is a stronger alternative for change management while allowing each of the employees to slowly begin to adapt to the new system and to the new expectations with pain management staff. Flowchart on process mapping Strategy of Continuous Organizational Improvement ? It is expected that the implementation of the new system, training of the employees and the additional employees will take at least 1 year to implement. However, the change in the strategy begins with the focus that is initiated with new communication levels. The communication process used will be combined with new and expected alternatives to keep the open communication. This will help to continue with defining the problems that are a part of the facility while ensuring that there is less resistance to the problems that are currently in the system. The communication will take the form of working with managers as well as holding meetings on a continuous basis, specifically to provide opportunities to individuals that are interested in looking at the various elements of the system. This can be combined with the implementation of the technology, with evaluations and feedback that will be given by several. It is expected that maintenance and continuous changes will be added into the new technology system and into the hiring of the two new employees. The second way in which the continuous strategic development will occur is through the training and development that will be opened through this project. The training will begin with the initiation of the new technology program. However, it is expected that this will be continuous with more career options and alternatives that are associated with the main growth of the corporation. By doing this, there is the ability to create a different response for those that are within the system while providing an evaluation that will lead to continuous growth and implementation of new programs with the care facility. The project and strategic plan is expected to be continuous with evaluations, open communication and team building that results from the main project. This will help to redefine the levels of quality while consolidating the different needs that are associated with the facility. References Bryson, John. (2004). Strategic Planning for Public and Nonprofit Organizations UK: John Wiley and Sons. Carr, Deborah, Dmitry Khodyakov. (2007). “End – of – Life Health Care Planning Among Young Old Adults: An Assessment of Psychosocial Influences.” Journals of Gerontology 62 (2). Coleman, EA, C Parry, S Chalmers. (2006). “the Care Transitions Intervention.” Archives of Internal Care 57 (1). Eskildesen, Manuel. (2007). “Long – Term Acute Care: A Review of the Literature.” Journal of American Geriatrics Society 55 (5). Ford, JD, AD Amelio. (2008). “Resistance to Change: The Rest of the Story.” Journal of Management 72 (3). Goldratt, E. M., & Cox, J. (1992) The Goal: A process of ongoing improvement. Great Barrington MA: The North River Press. Griffith, J.R., & White, K. R. (2007). The well-managed healthcare organization. Chicago: AUPHA Press/Health Administration Press. Rondeau, KV, Th Wagar. (2006). “Nurse and Resident Satisfaction in Magnet Long Term Care Organizations: Do High Involvement Approaches Matter?” Journal of Nursing Management 15 (6). Scott, Vicky, Kristine Votova, Andria Scanlan, Jacqueline Close. (2007). “Multifactorial and Functional Mobility Assessment Tools for Fall Risk Among Older Adults in Community, Home Support, Long Term and Acute Care Settings.” Age Ageing 36 (2). Shi, Leiyu, Douglas Singh. (2008). Delivering Health Care in America: A Systems Approach. UK: Jones and Bartlett Publishers. Read More