Question

hat had a cen- ed role. The new practices, and an he medical center Case Study ... ntegrated delivery system that had LI When a large regional medical center became part of an integra tral board of directors, the medical center's board began to struggle with its revised role. T t clinics, multispecialty physician practices. organizational environment included several outpatient clinics, rved the organization since the medicale insurance entity. Many of the current board members had served to a certain way. The administration rigidly was built, and board activities always had been performed in a certa ions and routinely approved committee ren trolled board meetings. Board members did not ask questions a The reports covered topics such as the organization's financial sto inancial status and future financial plans, phys credentialing, care quality monitoring, new policies, and plans to lity monitoring, new policies, and plans for a new hospital. A new board member with a healthcare background was appoint pointed after extensive screening and a per sonal interview with the executive committee. She was not part of art of the local business power structure, and the administration was concerned that her annointment might not be a wise move. During her first be meeting, two very interestine renarts were given One report detailed some reengineering projects of these involved redesigning nursing staffing patterns. This redesign decreased the number of registered nurses (RNS), and replaced them with licensed practical nurses (LI'NS) and cerned nursing assistant (CNAs). The current quality report documented a very high quality of care and positive patient satisfaction surveys. Data excerpted from this report can be seen in the "1st Quarter" column of table 15.1. Given that this was her first board meeting, the new board member remained silent and did not ask questions. Table 15.1. Case study data Quality Performance Measure Medication errors Patient falls Cesarean sections Rate of vaginal births after C-section Healthcare Associated infections X-ray discrepancies Patient Satisfaction Measure Overall service Overall clinical Overall quality of service Food Overall cleanliness 1st Quarter 2nd Quarter 3.20% 10.42% 4.21% 8.56% 14.21% 17.87% 18.27% 15.72% 1.78% 4.85% 0.15% 0.21% 1 st Quarter 2nd Quarter 40.52% 20.74% 86.72% 70.82% 45.40% 22.34% 30.56% 32.54% 85.89% 83.26%

Answer 1

1. Overall the performance of the hospital declined dramatically following the implementation of a new staffing policy. It is evident from the data that the quality of the hospital services decreased. There is a 3 times increase in medication errors and 2 times an increase in patient's falls. Healthcare-associated infections have increased significantly from 1.78% to 4.85%. Another matter of concern is X-Ray discrepancies which have also increased since the new staffing pattern. From the image, it is inferred that patient satisfaction measure about overall service and overall quality of service have halved since the new policy in comparison with that of the older one. The overall cleanliness in the hospital has also decreased in the quarter following the new staffing policy but only marginally. In contrast with all other parameters or quality indicators, the patent has expressed increased satisfaction with food.

It is evident from the above data that overall hospital performance has affected adversely following new policy So, it is recommended that older staffing patterns must be brought back if the hospital wants to improve their quality in service. That is more RNs must be given charge of patient's care and infection control and LPN s and CNAs can be delegated to manage food services. Hospital cleanliness can also be given to be managed by LPNs and CNAs after an RN teaches them what is expected from their work and how can they achieve it.