Application of Strategic Leadership and Future Delivery Models

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Applicationof Strategic Leadership and Future Delivery Models

Applicationof Strategic Leadership and Future Delivery Models

Hospitals have the mandate to ensure that they deliver the bestservices to patients. It is critical that measures are adopted to seeto it that the best patient outcomes are achieved. It is essentialthat as a given hospital strives to achieve the best patientoutcomes, the concern should be taken regarding the perception of therecipient of such services. Notably, it is essential that a mechanismis enacted that will serve as a benchmark to determine whether or notthe hospital is successfully executing its mandate. The HospitalConsumer Assessment of Healthcare Providers and Systems (HCAHPS) actsas a measure to determine how well a given hospital is doing inproviding services to the patients (Smith, Fondaw, Balls, Forrest,Ceballos, Khaled, &amp Solh, 2014). Vanderbilt Children’s Hospital(Nashville, TN) will be analyzed based on the HCAHPS scores toevaluate their effectiveness in service provision while assessing thepoints of weakness and providing strategic recommendations forimprovement.

HCAHPS Scores for Vanderbilt Children’s Hospital

Measures of Assessment

Vanderbilt Children’s Hospital

The State of Tennessee

National Statistics

Patients who reported that their nurses &quotAlways&quot communicated well

78%

80%

80%

Patients who reported that their doctors &quotAlways&quot communicated well

81%

83%

82%

Patients who reported that they &quotAlways&quot received help as soon as they wanted

63%

69%

68%

Patients who reported that their pain was &quotAlways&quot well controlled

69%

72%

71%

Patients who reported that staff &quotAlways&quot explained about medicines before giving it to them

62%

65%

65%

Patients who reported that their room and bathroom were &quotAlways&quot clean

62%

73%

74%

Patients who reported that the area around their room was &quotAlways&quot quiet at night

59%

67%

62%

Patients who reported that YES, they were given information about what to do during their recovery at home

87%

86%

87%

Patients who &quotStrongly Agree&quot they understood their care when they left the hospital

56%

51%

52%

Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)

75%

72%

72%

Patients who reported YES, they would recommend the hospital

81%

71%

71%

Analysis of the Scores

Vanderbilt Children’s Hospital has made significant strides inensuring that they offer the best services to patients. The scores donot indicate much variations because the hospital is operating in anenvironment composed of many different health care centers. Patientsare in agreement of the fact that both the nurses and doctorscommunicate well as they discharge their services. Vanderbilt had ascore of 78% for nurses communicating well compared to 80% responserecorded for the state of Tennessee and the country at large. The 2%margin could have a significant meaning considering the survey wasconducted at both the state and national level. Similar results arereported for the response of doctors at the hospital. However, thereis a disparity when it came to the accessibility of help by patientswhen they needed it. For example, a score of 63% is reported atVanderbilt Children’s Hospital compared to 69% and 68% of the stateand national scores respectively. It is evident that the patients arenot entirely served as soon as they need help when they come to thehospital. The Hospital scored 69% when it came to control of paincompared to 72% and 71% reported for the state and national levelsrespectively. It is a reflection of the fact that the hospital is notdoing so much well when it comes to efforts toward relievingpatient’s pain. Because the statistics at the state and nationalscores are high, it could mean that Vanderbilt Children’s hospitalis not doing well regarding the reduction of pain among patients.Patients indicate that practitioners do not take keen notice inexplaining the use of medication after their prescription. Vanderbilthas a score of 62% compared to 65% reported for both the state andnational statistics. Cleanliness in the hospitals is an issue ofconcern. Vanderbilt scored 62% compared to 73% and 74% reported forthe state and national statistics. It is a reflection of the laxityof the hospital in maintaining proper hygiene and sanitation for thepatients. Patient disturbance at night is an issue as indicated bythe low scores. 59% of patients report that the hospital is quiet atnight at Vanderbilt compared to figures of 67% and 62% at thenational level. The hospital has a score of 87% when it comes toadvice given to patients as they recover from home. It is aremarkable figure indicating that they care about the recovery ofpatients after being discharged from the hospital. However, thescores do not differ much from the state and national levels sincethey each have 86% and 87% respectively. The hospital is performingto the national standards when it comes to caring for patients afterdischarge. However, there was a sharp variance in students whostrongly agreed that they understood exactly how to care forthemselves having left the hospital. The Hospital scored 56% comparedto 51% and 52% reported for the state and national levels. Vanderbiltequally scored higher on a scale of 0-9 having attained 75% againstthe 72% by both the state and national statistics respectively. 81%of the patients admit that they would recommend Vanderbilt hospitalprobably because of the nature of services they were offering.

Comparison of Scores at Vanderbilt to Centennial Children’sHospital and Le Bonheur Children’s Hospital, Memphis

Measures of Assessment

Vanderbilt Children’s Hospital

Centennial Children’s Hospital

Le Bonheur Children’s Hospital, Memphis

Patients who reported that their nurses &quotAlways&quot communicated well

78%

81%

81%

Patients who reported that their doctors &quotAlways&quot communicated well

81%

84%

82%

Patients who reported that they &quotAlways&quot received help as soon as they wanted

63%

69%

65%

Patients who reported that their pain was &quotAlways&quot well controlled

69%

72%

73%

Patients who reported that staff &quotAlways&quot explained about medicines before giving it to them

62%

66%

65%

Patients who reported that their room and bathroom were &quotAlways&quot clean

62%

69%

71%

Patients who reported that the area around their room was &quotAlways&quot quiet at night

59%

67%

70%

Patients who reported that YES, they were given information about what to do during their recovery at home

87%

87%

87%

Patients who &quotStrongly Agree&quot they understood their care when they left the hospital

56%

55%

51%

Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)

75%

76%

75%

Patients who reported YES, they would recommend the hospital

81%

79%

77%

Comparison of Survey Response Rate

Measures of Assessment

Vanderbilt Children’s Hospital

Centennial Children’s Hospital

Le Bonheur Children’s Hospital, Memphis

Patients who reported that their nurses &quotAlways&quot communicated well

30%

29%

26%

Patients who reported that their doctors &quotAlways&quot communicated well

30%

29%

26%

Patients who reported that they &quotAlways&quot received help as soon as they wanted

30%

29%

26%

Patients who reported that their pain was &quotAlways&quot well controlled

30%

29%

26%

Patients who reported that staff &quotAlways&quot explained about medicines before giving it to them

30%

29%

26%

Patients who reported that their room and bathroom were &quotAlways&quot clean

30%

29%

26%

Patients who reported that the area around their room was &quotAlways&quot quiet at night

30%

29%

26%

Patients who reported that YES, they were given information about what to do during their recovery at home

30%

29%

26%

Patients who &quotStrongly Agree&quot they understood their care when they left the hospital

30%

29%

26%

Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)

30%

29%

26%

Patients who reported YES, they would definitely recommend the hospital

30%

29%

26%

The survey response rates vary slightly amongst the two hospitalsbeing compared to Vanderbilt. Centennial Children’s Hospital andLe Bonheur Children’s Hospital, Memphis have a response rate of 29%and 26% respectively compared to that of Vanderbilt which was 30%.The figures are an indication of the questions answered by thepatients that were used to compute the final HCAHPS scores.

Hospital Demographic Patient Population and Services Provided

Vanderbilt Children’s Hospital has established itself as areputable health care provider offering crucial services to patientswith a specialization on pediatrics (Matson, 2014). The hospitalserves patients from different divides. The hospital is diverseregarding the number of patients seeking services. Vanderbiltidentifies the concept of diversity as a fundamental aspect ofsuccess when it comes to the provision of healthcare. The Children’sHospital serves patients from four different counties. Notably, thehospital serves patients from counties including Davidson,Montgomery, Rutherford, and Williamson (Ching, Hays, Kaffenberger,Stephany, Luckett, Clayton, &amp Pope, 2014). 36.93% of the patientsare discharged from Davidson, 5.71% from Montgomery, 6.63% fromRutherford and 5.53% Williamson. Vanderbilt Children’s Hospitalcares for a population of about 100,000 patients (Lavery, Banwell,Liu, &amp Waldman, 2016). The hospital has a diverse ethnic andracial background. Out of the counties identified, Davidsoncontributes a greater percentage of the diverse population. 28% areBlacks, and 10% are Hispanic residents. However, Vanderbilt equallyserves a growing population of immigrants. Patients are served fromcountries such as Mexico, Asia, and Africa. Poverty rates are equallyhigh. The rates, however, differ from the three counties withDavidson reporting poverty levels of 17.7%, Williamson County with afigure of 5.5%. Further, 31% of children getting services fromVanderbilt Children’s Hospital are living in poverty. Thestatistics are of significance since it gives an overview of thepopulation demographics in the region.

Impactof Environmental and Community Factors on the HCAHPS Scores

CulturalDynamics

Cultural dynamics affect the HCAHPS scores that are determined forany given hospital. Cultural competency in the hospital determineshow well a particular health care provider can communicate with thepatients (Bernabeo, &amp Holmboe, 2013). A hospital that isculturally diverse is endowed with the ability to communicateeffectively with patients especially in cases of end-of-life care.Such patients need to understand exactly what is expected of them tohelp in their recovery. Because of the same, it becomes crucial forthe hospital to attain cultural competency as a way of ensuring thatthey can communicate effectively to patients from diversebackgrounds. Patients who are satisfied with the communication tendto give a positive mark in a survey being provided resulting in ahigh HCAHPS score.

EducationalDynamics

The literacy levels are of vital significance and can lead to agreater or lower HCAHPS score for a hospital. Attendance to patientswho are well-informed of the mandate of a given hospital means thatthey have high expectations on the nature of services being providedby the hospital. For example, patients present to the hospitalexpecting to be served in particular. If by chance, they are servedin a manner that is contrary to their expectations, based on theireducational knowledge, they can question such services and given anopportunity to participate in the survey the effects is a reductionin the HCAHPS score (Trzeciak, &amp Mazzarelli, 2016). Further,there is the aspect of personal awareness on care after beingdischarged from the hospital. It is expected that the practitionersshould explain to them how to continue with medication and care forthemselves. It is easier for knowledgeable patients to continue withself-medication after being discharged. They would find it simpler tounderstand how to care for themselves. If given the survey relatingto communication with the practitioners, the chances are that theywould give a positive score on the same. The effect is a high HCAHPSscore.

Socio-economicDynamics

The social and economic factors significantly affect serviceprovision in the hospitals affecting the HCAHPS scores. Hospitalsserving individuals with different socio-economic levels are likelyto encounter a variation in the health outcome. For example, servicesprovided could be affected by one’s overall income. Patients wholack a high income may not be able to access specialized treatmentthat will improve their outcome. Individuals accessing such servicesmay not be contented with the services they get resulting incomplaints that could eventually affect the HCAHPS scores of a givenhospital. The socio-economic dynamics lead to disparities in healthcare provision, a measure that ultimately affects the HCAHPS scores(McFarland, Ornstein, &amp Holcombe, 2015).

PotentialShort and Long-term Financial Impact on the Organization

HCAHPS scores are essential in the organization in determining thefinancial status of the hospital. The scores are a representation ofhow well the hospital is serving its patients. The scores have both ashort and long-term financial impact. For example, an organizationwith a high HCAHPS score has a great chance of getting referralsbeing brought to them. The short-term financial impact of such ameasure is that most of the consumers will have a tendency to seekservices from them. The effect is an increase in the overallfinancial standing of the firm. The long-term financial impact isthat the organization will benefit from grants and donations to helpthe organization continually provide better services to consumers.

PotentialImpact on Quality Outcomes

Quality service provision remains to be the ultimate goal of anygiven organization. Each hospital uses specific measures to helpimprove the services they are offering to patients. The HCAHPS scoresserve as an indicator on whether or not the hospital is diligentlyexecuting the mandate assigned to them. Vanderbilt Children’sHospital can use the scores to improve the quality of services thatpatients get. For example, the response provided by the patientshighlights areas that are underperforming as compared to the stateand national scores. Through the same, the hospital administrationcan enact measures that seek to improve on the identified areas. TheHCAHPS scores have a positive impact on the quality outcomes (Price,Elliott, Zaslavsky, Hays, Lehrman, Rybowski, &amp Cleary, 2014).

PotentialCause of the Hospital’s HCAHPS Scores

Various factors can be attributed to the HCAHPS scores. Thesocio-economic factors play a role in services that the patientsreceive. Patients would give a score based on such services. Forexample, because Vanderbilt serves a culturally diverse population,the chances are that each would respond differently to the surveyquestions based on how they are served and their expectations. Thescores are also influenced by the overall manner in which thehospital is helping the patient. A high HCAHPS score means that thehospital is executing its services as expected of them. However, in asituation where they are offering poor services, the chances are thatthey would receive a low mark on the survey questions that are asked.

OrganizationalStrategic Plan to Improve the Hospital HCAHPS Scores

Role ofOrganizational Change in Improving the Scores

The HCAHPS scores indicate that the organization is performing wellat some sections while underperforming in other areas as compared tothe state and national figures. The introduction of organizationalchanges especially in sections where there is underperformance iscrucial in addressing the problem affecting patients (Grol, Wensing,Eccles, &amp Davis, 2013). For example, 56% of the patients stronglyagreed that they understood how to care for themselves after livingthe hospital. A change in individuals heading the section in chargeof the provision of information regarding care could help improve thescores. It is because such individuals would see to it that awarenessis created regarding self-care after being discharged from thehospital. Change in the organizational structure would mean thatreforms are introduced regarding service provision, eventuallyimproving the HCAHPS scores.

Structure,Process, and Outcomes of the Strategic Plan

The first approach in improving the state is restructuringdepartments in sections where there was underperformance. Forexample, 62% of the patients of agreed that the use of medicine wasexplicitly explained to them. It could be essential to restructurethe pharmacy and nursing department such that the explanation of theuse of medicines after being discharged is done. Individuals headingsuch sections will ensure that patients are informed of the use ofmedicine after prescription. Further, they will be given anopportunity to ask for clarifications on what they have notunderstood. The outcome of the strategic plan will see to it thatpatients get an education on the use of drugs after being discharged.

Application ofEvidence-based Practice and Shared Governance in ImprovingOrganizational Quality

The incorporation of evidence-based practice in service provision hasbeen essential in addressing various issues that arise in a hospitalsetting. Improved patient outcomes have been achieved through theadoption of evidence-based practice (Melnyk, Fineout-Overholt,Gallagher-Ford, &amp Kaplan, 2012). Because of the same, it could beprudent to adopt the same mechanism in improving organizationalquality. Evaluating research focusing on quality improvement inhospitals could be essential. The suggestions presented in literaturecan be used to enhance the quality of services offered by thehospital. Further, the adoption of shared governance can be of helpin improving organizational quality through the inclusion of ideaspresented on the best way to provide services to the clients. Thestate of Vanderbilt Children’s Hospital can be improved byembracing findings of research while at the same time incorporatingshared governance.

Methods toIncorporate Concepts of Shared Accountability

Organizations have the mandate of ensuring that they conduct theiractivities in a transparent manner. Vanderbilt must make sure that asit executes the tasks assigned to it, the concept of sharedaccountability is embraced at levels. The first method to ensure theincorporation of accountability is to develop a culture oftransparency in all departments of the organization. Patients,medical providers, and the payers need to understand that VanderbiltChildren’s Hospital is an organization that executes its activitiesin a transparent manner. Further, it could be vital to introducepunitive measures against individuals perpetuating corruptactivities. Notably, medical providers must understand that there areconsequences for lack of accountability especially when it comes topayment for services being offered. Equally, the payers includinginsurance providers need to realize that if they are caught indealings that suggest engagement in questionable activities, they areliable for legal actions. A policy can be introduced that reiteratesthe need for accountability at all levels within the hospital.

Methods toIncorporate Technology Trends in the Healthcare

The sensitivity of services offered in the hospital negates the needto adopt the most recent technologies to help in their execution. Itis essential to locate the most current technologies and adopt thesame in the improvement of service provision in the hospital. Aproposal will be written to the hospital administration identifyingthe availability of a given technological advancement and the need toadopt it in the hospital. The proposal will be written explaining thebenefits of adopting the technology. Further, a program can beintroduced that aims at training the practitioners on the use of themost recent technological methods. Through the same, it would bepossible to ensure that the hospital adopts the technological trendsin improving service provision.

Methods toImprove Care Delivery concerning Quality, Cost, Access andPatient-centered Care

Hospitals have the mandate of ensuring that they deliver the bestservices to the patients. Improved care delivery should be centeredon empowerment and motivation of healthcare practitioners to deliverthe best services to patients. Mechanisms will be introduced withinthe hospital that aim at promoting staff commitment when it comes toservice provision. Notably, their perception regarding theimprovement of patient services will be adopted as a way of enhancingthe care provided to the patients. Further, mechanisms will beintroduced that aim at seeking the opinion of patients regarding howthey are being served. Their feedback will be used to improve thequality of care being provided to them. Accessibility to health careservices within the hospital will be guaranteed by introducingprograms that are commensurate with the income levels of thoseseeking services from the hospital. A flexible payment option will beavailable to ensure that all patients can get services without fail.

Methods toImprove Financial Stability

Financial stability at Vanderbilt Children’s Hospital is essentialin the running of operations. The limited finances make it difficultfor the hospital to achieve 100% efficiencies in the services thatthey provide. Because of the same, it is critical that other avenuesare sought to aim at improving the financial stability of thehospital. The hospital can diversify its operations and engage ininvestment activities that would increase their financial stability.For example, revenue earned from everyday hospital operations can bediverted to other investment ventures. Further, it could be vital tohave the hospital look out for donors to help facilitate theiroperations. It would be possible to gain financial stability at thehospital.

ImplementationPlan and Timeline for the Strategic Plan

Key Roles andResponsibilities of Stakeholders

Stakeholders have a fundamental role in the realization of the statedin the implementation plan. Stakeholders play the role of ensuringthat the sections identified as being problematic are addressedwithin the established framework. For example, health practitionershave the mandate of providing consistent quality services to patientswith the goal of getting the best outcome. Similarly, patients canprovide their opinion regarding the manner in which they are beingserved and point of areas that need improvement. Through the same, itwould be possible to get the best patient outcomes through acollaboration of efforts. Stakeholders have the mandate of ensuringthat each executes the duty assigned to them. Finally, the hospitaladministration can help improve services at the hospital by approvingproposals introduced including the adoption of technologicalequipment at the hospital.

StakeholderAccountability and Involvement

Stakeholder accountability and involvement in Vanderbilt Children’sHospitals can be improved by reiterating the fact that each has aduty to play when it comes to improvement of care at theorganization. I would remind them of the existence of a policy thatinsists on the need for transparency and accountability. Each of thestakeholders will be informed of the need to strictly observe theguidelines of the policy while at the same time understanding thatthere are repercussions for non-compliance. Further, awareness willbe created among the stakeholders to remind them of the significanceof their involvement in enhancing the hospital operations. It iscritical that they get to understand they have a vital role to playwhen it comes to the enhancement of the services being provided atVanderbilt Children’s Hospital.

TrainingNeeded by Staff to Implement the Plan

Adoption of new technological methods was suggested as one ofimproving service provision at the hospital. It could be essential tohave the organization train the staff on the use of such devices toimprove service delivery. Further, there is the aspect of adoption ofevidence-based research and shared governance to improve care. Healthcare practitioners need to be trained on how to employ evidence-basedresearch in service provision. Staff holding managerial positions canbe trained on governance to equip them with skills that enable themto provide sound leadership to the junior staff. Through the same, itwould be possible to achieve the objectives of the implementationplan.

Timeline forImplementation of the Plan and the Review Checkpoints to MeasureProgress

The realization of the identified implementation plan must bepreceded by the existence of a timeline. Vanderbilt Children’sHospital is a large healthcare organization. Strategies enacted maytake the time to realize considering the bureaucracies that areinvolved. Nevertheless, it is critical to have a timeline that willdictate the duration of time for realization of the identifiedobjectives. An eight-month period is enough to help realize thestrategic plan. However, each plan enacted will be checked on amonthly basis to ascertain the fact that activities are beingexecuted as scheduled. The monthly assessment will be used to measurethe progress of the entire strategic plan.

Evaluationof Success of the Strategic Plan

The strategic plan introduced needs to be evaluated to ascertain thatthe objectives identified are being achieved. Different mechanismscan be employed to see to evaluate the success of the strategic plan.The feedback from patients regarding the services being offered couldserve as an evaluation tool. The strategic plan introduced aimed atimproving quality care. Because of the same, it could be essential toget the opinion of patients regarding the services being offeredafter the introduction of the strategic plan. Also, staff feedbackcan serve as an evaluation tool to confirm whether or not thestrategic plan is on course for the achievement of the identifiedgoals. Measurement can be done through assessment of surveys such asthe HCAHPS scores. Assessment and analysis will be done on a monthlybasis through the eight months. A survey can be given to both thepractitioners and patients receiving the services to determine theiropinion on changes realized in the hospital.

Involvementof Key Stakeholders in the Evaluation Process

Stakeholders will be brought on board and asked to give their opinionregarding the strategic implementation plan. Each will be given aspecific checklist that would be used for evaluation based on theplans that had been introduced. For example, the adoption ofevidence-based practice can be evaluated concerning improved patientoutcomes. Stakeholders can be given the mandate of checking onpatient outcomes to ascertain that indeed there is an improvement inthe patient outcomes after the adoption of the concept. Stakeholderswill be reminded of the significant position they hold in theimprovement of the state of the hospital, and their participation iscrucial.

Communicationof Evaluation Results Internally and Externally

The communication of assessment results can be done internallythrough the use of memos. The results can be disseminated to relevantpersonnel for further action. The evaluation results can equally becommunicated through internal meetings organized by concernedofficials. Through the same, it would be possible to communicatefindings to the rest of the hospital personnel for further action.External communication can be done through the use of the hospitalnewsletter to inform the public on the overall state of the hospital.However, the hospital can equally communicate the results by takingadvantage of events such as trade fairs or conferences.

References

Bernabeo, E., &amp Holmboe, E. S. (2013). Patients, providers, andsystems need to acquire a specific set of competencies to achievetruly patient-centered care. Health Affairs, 32(2),250-258.

Ching, C. B., Hays, S. R., Kaffenberger, S. D., Stephany, H. A.,Luckett, T. R., Clayton, D. B., … &amp Pope, J. C. (2014).Pediatric chronic orchialgia: Patient population and patterns ofcare. Journal of pediatric urology, 10(5), 799-803.

Grol, R., Wensing, M., Eccles, M., &amp Davis, D. (Eds.). (2013).Improving patient care: the implementation of change in healthcare. John Wiley &amp Sons.

Lavery, A. M., Banwell, B. L., Liu, G., &amp Waldman, A. T. (2016).Hospital admission rates for pediatric multiple sclerosis in theUnited States using the Pediatric Health Information System (PHIS).Multiple Sclerosis and Related Disorders.

Matson, I. K. (2014). 23rd Annual Meeting Abstracts. J Pediatr,19(3).

McFarland, D. C., Ornstein, K. A., &amp Holcombe, R. F. (2015).Demographic factors and hospital size predict patient satisfactionvariance—implications for hospital value‐basedpurchasing. Journal of hospital medicine, 10(8),503-509.

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., &ampKaplan, L. (2012). The state of evidence-based practice in US nurses:Critical implications for nurse leaders and educators. Journal ofNursing Administration, 42(9), 410-417.

Price, R. A., Elliott, M. N., Zaslavsky, A. M., Hays, R. D., Lehrman,W. G., Rybowski, L., … &amp Cleary, P. D. (2014). Examining therole of patient experience surveys in measuring health care quality.Medical Care Research and Review, 71(5), 522-554.

Smith, T., Fondaw, M., Balls, J., Forrest, K., Ceballos, I., Khaled,Y., … &amp Solh, M. (2014). Improving hospital consumer assessmentof healthcare providers and systems (HCAHPS) scores in bone marrowtransplant inpatient setting. Biology of Blood and MarrowTransplant, 20(2), S126.

Trzeciak, S., &amp Mazzarelli, A. J. (2016). Patient Experience andHealth Care Quality. JAMA Internal Medicine, 176(10),1575-1575.

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