Developing organizational policies
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DevelopingOrganizationalPoliciesandPracticesnewhwm.docxRunning Head: DEVELOPING ORGANIZATIONAL POLICIES AND PRACTICES 1
DEVELOPING ORGANIZATIONAL POLICIES AND PRACTICES 12
Developing Organizational Policies and Practices
Patricia Virgil
Walden University
NURS 6053
7/24/2020
Analysis of a Pertinent Health Issue/Stressor
The rising cost of healthcare has made it difficult for hospitals to provide quality care during the Covid-19 pandemic. According to recent reports from the World Health Organization (WHO), the number of individuals without insurance coverage has risen steadily by approximately 1.9 million people from 2017 to 2018 (Papanicolas, Woskie, & Jha, 2018). Additionally, the uninsured rates increased from 7.9% to 8.5% during the same period. Subsequently, health insurance premiums have soared, thus affecting access to quality care, particularly for low-income earners (Balak & Tisell, 2020). The purpose of this paper is to identify how the high cost of healthcare is making it difficult for hospitals to combat Covid-19 and ensure that local organizations prepare well by formulating effective strategies, sharing resources, and motivating healthcare providers.
National Healthcare Issue/Stressor
Jackson North Medical Center, located in North Miami, Florida, is a 382-bed acute care center, serving the community of North Miami Beach and south Broward. According to the chief executive officer (CEO), Carlos Migoya, the healthcare organization, has continued to face numerous financial challenges associated with the rising cost of providing essential medical services to uninsured patients (Jackson Health System,.n.d.). The hospital is currently struggling to provide medical care to Covid-19 patients despite the government’s efforts to reduce of treating Covid-19 patients under the Families First Coronavirus Response Act (FFCRA) which was passed in March. The federal act did not solve the financial problem at Jackson North Medical Center because most of the patients are either uninsured or underinsure. Some of the patients in the hospital have not yet cleared their medical bills. In 2016, patients at Jackson North Medical Center failed to clear their medical bills which accumulated to 884 million dollars (Lipscomb, 2018). The financial struggle at Jackson North Medical Center are making it hard for the hospital to provide quality care to Covid-19 patients as well as to protect the staff from the disease.
Informational Summary
Papanicolas, Woskie, and Jha (2018), evaluates the impacts of ever-increasing healthcare costs as one of the factors affecting US healthcare delivery and clinical systems. The report provides a comparative evaluation of the United States healthcare compared with other developed nations—Japan, Australia, Canada, Netherlands, and the UK (Papanicolas, Woskie, & Jha, 2018). The multiple-payer approach and the non-existence of effective cost-sharing policies limit access to quality healthcare. Williams, Walker, and Egede (2016) suggests that as far as the provision of healthcare service for the uninsured is concerned, some provisions in the affordable care act aimed to increase access to care can make health coverage more affordable.
On the other hand, Crowley, Daniel, Cooney, and Engel (2020) examines the challenges facing the American healthcare system. Currently, the United States is the only wealthy country that has not attained universal health coverage (Crowley, Daniel, Cooney, & Engel, 2020). The healthcare system is still inefficient, unsustainable, inaccessible, and unaffordable to most Americans (Crowley, Daniel, Cooney, & Engel, 2020). The high cost of providing medical services which has been a persistent issue in the American healthcare system is now acting as an obstacle to providing quality healthcare to Covid-19 patients (Ziran & Opry, 2020).
Other organizations are coping with the financial pressure associated with providing healthcare to Covid-19 patients by rationing their services. Some hospitals across the US have cancelled non-emergency procedures so that they can focus all the resources to treat Covid-19 patients who are in critical condition. The organizations are recommending home care for patients who are not in a critical condition (Ziran & Opry. 2020).
Strategies
The strategies explained in both articles were cost sharing and developing a single payment system. One of the articles attribute the high cost of providing medical care to lack of collaboration among hospitals. The article proposes that hospitals should collaborate to reduce the financial burden of treating patients with contagious diseases. (Papanicolas et al., 2018) proposes that healthcare institutions should collaborate by sharing information and facilities.
(Crowley et al., 2020) proposes that healthcare institutions should work together to provide healthcare to Covid-19 patients. The article recommends that hospitals which are close to each other should share resources such as hospital beds and rooms, and healthcare providers if one hospital is overwhelmed and the other is not. One of the major hindrances for healthcare providers is the lack of PPE equipment, and a hospital with excess PPE can lend them to another hospital. In order to tackle the issue of shortage of PPE equipment, Crowley, Daniel, Cooney, and Engel (2020) propose that health facilities within the same region should collaborate to raise funds to order for the PPE equipment as a single organization ( Crowley et al., 2020).
The major drawback of the strategies proposed above is that they can result in unequal sharing of resources. Hospitals with less Covid-19 patients might be less active interested in joining hands with hospitals that have been overwhelmed. Jackson North Medical Center would incur more losses if it committed its limited funds in merger with other hospitals which were not fully committed to share their resources (Crowley et al., 2020).
Developing Policies and Procedures
The first competing need impacting Jackson North Medical Center is the inadequacy of nursing staff. There is a high turnover of nurses and a constant need to utilize expensive agency or travel nurses to fill the short staffing gaps. These short staffing gaps make it difficult for the healthcare providers at Jackson North Medical Center to provide quality care to Covid-19 patients. Jackson North Medical Center can decrease these costs by finding strategies to retain their existing nursing workforce. Some strategies that can be implemented to increase retention are incentive plans for education, opportunities for growth and development within the organization, and rewarding staff for longevity and service excellence. Such empowerment opportunities are linked to satisfaction and reduced turnover (Perry, Richter, Beauvais, 2018).
The second competing need impacting Jackson North Medical center is the need for updated modern medical equipment and testing devices along with expert trained staff who would be able to maintain quality care, thereby saving cost. One of the objectives of the Jackson North Health system is to make healthcare more affordable while simultaneously increasing healthcare quality and reducing unnecessary spending (Isola, & Reddivari, 2020).
The policy within the Jackson North Medical Center that may influence the staff shortage is Policy 1.010. The policy which is noted as “Priorities for patient care” explains that patient care delivery is prioritized appropriately to reduce the impact on patient caused by staff shortage (Jackson Health System, n.d.). Jackson North Medical Center should cope with the staff shortage during this Covid-19 pandemic by giving priority to patients in critical condition, this move will help the hospital to utilize the available staff to attend to patients.
The ethical consideration associated with policy 1.010 is, high administrative costs which adversely affects the ability of healthcare organizations to secure adequate staffing, to provide efficient care to patients. At Jackson North Medical Center, due to a commitment of absorbing the cost of healthcare services to the underinsured or uninsured, this can lead to increased expenses for the organization, thus affecting the acquisition of additional staffing. Increased cost of providing healthcare services poses a challenge in balancing the procurement of medical services and the provision of essential healthcare services (Aitken, Chaboyer, & Marshall, 2019). Working in a facility with a high turnover of nursing staff is associated with increased emotional burnout among existing nurses and other healthcare professionals.
The strength of policy 1.010 is that it ensures that delivery of healthcare services is not delayed by staff shortage at the hospital. An ethical consideration is still required when providing healthcare to patients. Jackson North Medical Center has a strategy for coping with the staff shortage. This strategy favors nurses at the hospital because it helps them to fulfill their duty of providing patient care.
The ethical challenges of the policy is the ability of the nurses to control themselves. Jackson North Medical Center demands all nurses to follow rules, procedures, and other bearings. However, the hospital cannot coerce nurses to observe self-control they are making moral decisions. For example, the ability to impact patient outcome relies on several strengths, each of these strengths must be considered in order to impact patient outcomes in an ethical manner (Parker, 2007).
Policy 298 is the policy that can influence the shortage of equipment within Jackson Health System. Policy 298 is "The Medical Equipment Management" (MEMP). The MEMP is "designed to assure proper selection of appropriate medical equipment to support safe patient care and treatment and environment"(Jackson Health System, 2013, 100-200 section). In relation to the Covid-19 pandemic, policy 298 can supply the units with an adequate supply of infusion pumps and ventilators to the units. Policy 298 also includes an emergency procedure which that explains the course of action prevent harm to patients in case of equipment failure. The procedure includes the contact of the appropriate administrative staff to call when there is an issue with spare equipment and repair services.
Ethical considerations for MEMP in policy NO. 298 is the quality of care that patients receive. The limited supply of equipment at the hospital can delay service delivery and result in poor patient outcomes. However, the limited medical supplies should not hinder the delivery of healthcare services to patients. Nurses should come up with innovative solutions which are ethical to promote patient safety.
The strength of policy 298 under MEMP is that the hospital has a strategy for dealing with equipment shortage. There are qualified staff in the hospital who are tasked with determine whether available equipment can be modified to serve a different purpose without compromising patient safety. The policy also ensures that there is a backup equipment in case there is a malfunction or an equipment breaks down.
The ethical challenges facing MEMP in policy 298 is ethical decisions which nurses have to make. This challenge is being witnessed as the hospital is trying to cope with the Covid-19 pandemic. Nurses are being forced to make moral decisions by deciding who will receive healthcare first due to shortage of funds to purchase enough PPE. Healthcare workers face a moral challenge on a daily basis when they are selecting between right and wrong health practices when caring for patients and themselves (Maguire et al., 2020).
Balancing the workload and hiring qualified nurses will balance the competing needs for workers and they are also recommend for Jackson Health System to ensure staff adequacy. Balancing the workload will reduce the pressure on the few staff at the hospital and it will also keep them motivated. Another effective strategy is to attract and retain well-qualified nurses who have experience and can work in adverse conditions without compromising the safety of patients. "The lack of well-qualified nurses has been considered as one of the most important barriers to achieving effective healthcare systems" (Rivaz et al., 2017, pp. 1–4).
The policy that can balance the competing needs for patients is to ensure that they are satisfied by giving them better products and services. The key factor of the competition in healthcare is the potential to supply a better component in reducing healthcare costs. Majority of the patients with comorbidity issues are either insured or underinsured insurance. It is important to understand stake holders who include providers, payers, employees, and patients. Improving healthcare services ensures that patients are satisfied and this contributes to the growth of the hospital (Rivers & Glover, 2008).
The policy that can balance the competing needs for resources is ensuring that there are sufficient resources to implement policies. This can be achieved by having a team of qualified leaders and a great administration team. The article, "Hospitals Can't Improve Without Better Management Systems" states that "leaders at good hospitals around the country are working hard on cutting waste and added cost and improving the quality of care and patient satisfaction" (Toussaint, 2015, para. 1)
Conclusion
In conclusion, it is paramount to note that medical costs are some of the drivers of healthcare service provision. The rising cost of healthcare, affordable insurance, and updated medical equipment impact the competing needs at Jackson North Medical Center. The health facility has strategized on practical approaches to address the challenges of insufficient financial resources to meet the administrative costs. The management of risks associated with medical equipment, including responding to adverse incidents, should also be undertaken within a corporate framework (Luxon, L.2015). The creation of active policies, practices, and ethical frameworks is crucial in dealing with the identified challenges in this selected healthcare facility. The acquisition of new and updated medical equipment will ensure seamless processes in the administration of healthcare services (Balak & Tisell, 2020).
References
Aitken, L., Chaboyer, W., & Marshall, A. (2019). Scope of critical care practice. Critical Care Nursing, 1234-12377.
Balak, N., & Tisell, M. (2020). Healthcare Economics. Ethics in Neurosurgical Practice, 73.
Crowley, R., Daniel, H., Cooney, T., & Engel, L. (2020). Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care. Annals Of Internal Medicine, 172(2_Supplement), S7. https://doi.org/10.7326/m19-2415
Isola S, Reddivari AKR. (2020). Affordable Care Act (ACA) In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549767/ Jackson Health System. (2020, July 23). Jackson Health System. Retrieved from, Jacksonhealth.org/patients/financial assistance/#gref
Jackson Health System. (2013). Medical Equipment Management Plan [Policy No. 298]. www.jacksonhealth.org
Jackson Health System. (n.d.). JHS Policies: 1.010 Priorities for Patient Care. Retrieved June 24, 2020, from JacksonHealth.org
Keeley, C., Long, T. G., Cineas, N., Villanueva, Y., Bell, D., Wallach, A. B., Mendez-Justiniano, I., Jackson, H., Schwartz, D. B., Jimenez, J., Salway, J. R., & Boudourakis, L. (2020). Staffing Up For The Surge: Expanding The New York City Public Hospital Workforce During The COVID-19 Pandemic. Health Affairs. https://doi.org/10.1377/hlthaff.2020.00904
Leggat, S. G., Karimi, L., & Bartram, T. (2017). A path analysis study of factors influencing hospital staff perceptions of quality of care factors associated with patient satisfaction and patient experience. BMC Health Services Research, 17(739). https://doi.org/10.1186/s12913-017-2718-x
Lipscomb, J, (2018, September 9). Uninsured and indigent patients cost Jackson Memorial Hospital 884 Million dollars a year. Retrieved from, https://www.miaminewtimes.com/news/uninsured-and-indigent-patients-cost-jacksonmemorial-hospital-884-million-a-year-10701676
Luxon, L. (2015). Infrastructure - the key to healthcare improvement. Future hospital journal, 2(1), 4–7. https://doi.org/10.7861/futurehosp.2-1-4
Maguire, B. J., Shearer, K., Mckeown, J., Phelps, S., Gerard, D. R., Handal, K. A., Maniscalco, P., & O’ Neill, B. J. (2020). The Ethics of PPE and EMS in the COVID-19 Era. Journal of Emergency Medical Services. https://www.jems.com/2020/04/10/ethics-of-ppe-and-ems-in-the-covid-19-era/
Papanicolas, I., Woskie, R. L., & Jha, K. A. (2018). Health care spending in the United States and other high-income countries. Jama, 319(10), 1024-1039.
Parker, F. M. (2007). Ethics: The Power of One. OJIN: Online Journal of Issues in Nursing, 13(1). https://doi.org/10.3912/OJIN.Vol13No01EthCol01
Perry, S. J., Richter, J. P., & Beauvais, B. (2018). The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health services research, 53(6), 4943–4969. https://doi.org/10.1111/1475- 6773.12997
Rivaz, M., Momennasab, M., Yektatalab, S., & Ebadi, A. (2017). Adequate Resources as Essential Component in the Nursing Practice Environment: A Qualitative Study. Journal of Clinical & Diagnostic Research, 11(6), 1–4. https://doi.org/10.7860/JCDR/2017/25349.9986
Rivers, P. A., & Glover, S. H. (2008). Health care competition, strategic mission, and patient satisfaction: research model and propositions. Journal of Health Organization Managment, 22(6), 627–641. https://doi.org/10.1108/14777260810916597
Toussaint, J. S. (2015). Hospitals Can’t Improve Without Better Management Systems. Harvard Business Review. https://hbr.org/2015/10/hospitals-cant-improve-without-better-management-systems
Williams, J. S., Walker, R. J., & Egede, L. E. (2016). Achieving Equity in an Evolving Healthcare System: Opportunities and Challenges. The American journal of the medical sciences, 351(1), 33–43. https://doi.org/10.1016/j.amjms.2015.10.012
Ziran, B. H., & O'Pry, E. K. (2020). Proposal of a new shared payment model for healthcare financing in the United States: a hypothesis. Patient safety in surgery, 14, 17. https://doi.org/10.1186/s13037-020-00242-w
