Improving the Health Outcomes for the Patients with Type II Diabetes — A Focus on Harris County Hospital

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Improvingthe Health Outcomes for the Patients with TypeII Diabetes — A Focus on Harris County Hospital

DescriptionTarget Population

Thepopulation of interventional focus is patients suffering from type IIdiabetes in Harris County Hospital. The choice is informed by theprevalence of the type II diabetes and its adverse consequences.

Thestatistics on the issue are well documented and shows that theproblem is both a global and a local issue.American Diabetes Association (2014)observes that a global population of over 347 million people isdiabetic. The number of people succumbing to diabetes is alsoalarming, with the world losing an average of over 3.6 million peopleper year to the health conditions. Moreover,while the number of people suffering from diabetes is high, itsprevalence continues to rise each day, and it is projected to reach592 million by 2030 (Al Hayek, Robert, Al Dawish, Zamzami, Sam andAus, 2013). Al-Nozhaet al. (2014)note that the patients from the low-income families are the mostadversely affected, accounting for 78 percent of the deaths reportedacross the world.

Arange of factors, especially poor nutrition and the changes islifestyles, including the lack of physical exercises, drives thistrend. Indeed, as AmericanDiabetes Association (2014),urbanization and industrialization demand people to work tirelessly,depriving people the time for exercise. At the same time, the lessnutritious junk and fast foods are increasingly gaining popularity inthe market, and the population is increasingly consuming it at theexpense of the conventional, nutritious food. In light of thesecauses, the policy makers are charting various plans to address theprevalence of diabetes. At the heart of the strategies of dealingwith this issue is prevention and treatment modality.

Fornurses, the problem of diabetes management presents itself as anenormous challenge to tackle. It is noteworthy that mainstreamintervention practices have tended to heed, exemplified by thereforms in the treatment diabetes and introduction of self-managementprograms which are aimed at improving the effectiveness of treatment,but there is still more that needs to be done (AmericanDiabetes Association, 2014).

InHarris County, the situation is not any different. According toClark,Fradkin, Hiss, Lorenz, Vinicor and Warren-Boulton (2013),at least one in every ten adults visiting the facility is diabetic.The number of patients suffering from diabetes managing is high, andpopulation of victims succumbing each year has tended to remain moreor less the same, if not tending to increase. People reported tosuccumb to diabetic complication in 2015 was 924, a figure that doesnot differ significantly from the statistics of 2010, in which thecounty lost 921 people (Clark,Fradkin, Hiss, Lorenz, Vinicor and Warren-Boulton, 2013).Despite the introduction and sensitization on diabetesself-management among the patients over the recent years, theoutcomes are still poor (Clark,Fradkin, Hiss, Lorenz, Vinicor &amp Warren-Boulton, 2013).Certainly, the intervention for diabetes problem lies in effectivenursing practices, which implies the current organization practiceswill need to be reconsidered. In this regard, Harris County Hospitalwill need to be part of the process of finding solutions to thediabetes intervention within the communities it serves.

Measuresof the Outcomes


Theperformance indicator of the intervention for the hospital pacticeswill be based on the two outcome measures increased access tohealthcare and improved patient health focusing in minimizing fallprevention, pressure ulcers, CAUTI, CLABSI, HAI`S, pPatientsatisfaction, which have been noted to be problematic in thefacility.The healthcare access is significant because it is noted to be one ofthe constraints to effective diabetes management. AmericanDiabetes Association (2014)observes that about 37 percent of diabetic patients do not haveaccess to desirable healthcare. Some of the probable accounts to thisissue are the lack of lack of uninsured healthcare and culturalbarriers. Balamurugan,Ohsfeld, Hughes and Phillips (2013)considers this observation plausible, noting that many uninsuredpeople come from the low-income households, implying that therequirements of having them pay directly from the pockets is asignificant barrier to healthcare access. Moreover, the culturalpractices such as the Hispanic preferences for traditional healers totraditional healers limit the access to offers of reformedhealthcare. Therefore, as AlHayek, Robert, Al Dawish, Zamzami, Sam and Aus (2013)observes, seeking to improve healthcare access and measuring theoutcome will go a long way to improve diabetes management by 63percent. Indeed, these socioeconomic and cultural issues have beenevidenced in the case of the Harris County hospital and it istherefore one of the major impediments to the hospital interventions.The hospital serves different groups of people, including thehomeless who have little income to pay for equitable healthcare. Thehospital also serves communities such as the Hispanic, who tend toprefer the services of the cuendesmo (the traditional healer) to theservices that are offered at the Harris hospital. Therefore, part ofthe focus for the organization is to be proactive in helping addressthe challenges.

Onthe other hand, focusing on improved overall patient health is alogical indicator of the success of diabetes management. The improvedoverall patient health will be inferred parameters such as reducedhospitalization of the diabetic patients and hospital visits.Logically, only patients adversely affected by diabetes are likely tovisit hospitals or be admitted to hospitals many times. According toClark,Fradkin, Hiss, Lorenz, Vinicor and Warren-Boulton(2013),diabetic patients who characterize poor interventions are likely tobe admitted to hospital for at least 4 times a year, while the numberof hospital visits is over 9 times. Therefore, the target measure forHarris County Hospital would be to reduce the admissions to zero andhospital visits to less than 4 times a year.


Reducednumber of deaths and diabetic patients will be considered as theindicators of diabetes interventions. Ideally, theThe quality of ahealthcare intervention is often measured in terms of the reducedadversity of complications, especially in terms of reduced mortalityand infections, which are considered in this case. Interestingly,these measures correspond to two areas of interventions that is,treatment and prevention programs. The reduced death rates are anindicator of quality of treatment intervention wile reduced infectionis a measure of prevention quality.

Asearlier noted, the The number of people reportedto succumb to diabetic complication while under the care of theHarris County Hospital in 2015 was 92454, which does not differsignificantly from the statistics of 2010, in which the county lost921 531 people. (AmericanDiabetes Association, 2014).In this regard, part of the interventional focus for the hospitalwould should be to reduce the number of deaths as much as possible tobelow 400 by 201810.

Besides,the number of people in Harris County reported to be suffering fromDiabetes is also high. As was also noted earlier, at least one inevery ten adults is diabetic (Koprosk,Pretto &amp Poretsky 2014).Part of the interventional measure for the Harris County Hospitalmeasure for quality will be to lead other organizations serving thecommunity in reducing reduce the size of diabetic population. Atarget of reducing the number of diabetic persons to non-diabeticpersons to one to four is achievable.


Theaspect of patient safety has been highlighted to be particularlycrucial to diabetes management, especially in the self-caremanagement contexts (e.g. Ho,Leung, &amp Rabi, 2014).As Ho,Leung and Rabi (2014)Harris County hospital acknowledges that notes the self-managementprocess is demanding and requires patients to effectively deal withdiabetes kits on their own. The kit comprises of drugs and syringes,which have been reported to be risk factors for diabetesinterventions. Nevertheless, AlHayek, Robert, Al Dawish, Zamzami, Sam and Aus (2013)notes that medication errors remain one of the main challenges indiabetes management and are not only reported in self-caremanagement, but also in nursing interventions. Indeed, severalphysicians at the hospital have acknowledged this to be a commonproblem, which is linked several forms of errors The commonmedication errors includesuch as wrong prescriptions, overdose,under-dozing, wrong medication schedules, and wrongful use ofsyringes. Ho,Leung and Rabi (2014 The hospital statistics reveal that )highlight that medication errors are reported for 23 percent ofpatients on diabetic intervention programs. Of these medicationerrors, the wrong prescriptions, overdose, under-dozing, wrongmedication schedules, and problematic use of syringes accounted for23%, 21%, 19 %, and 4 percent respectively. Therefore, the measure ofthe patient safety for Harris County Hospital should be interested inreducing the rates of medication errors.


HarrisCounty Hospital It is widely contendedcontends that engaging humanresource is critical to increasing the work productivity (Parker,2013).In this regard, engaging nurses is of uttermost importance toeffective intervention of diabetes. Indeed, limited nurse engagementis cited one of the impediments to management of various healthcomplications, including diabetes. Mellor, Mathieu, Barnes andRogelberg (2012), explains that low morale and lack of work-lifebalance are notable consequences of low nurse engagement. Aninterview with the Nursesnurses at the Harris County Hospitalreveals that they happen to be particularly frustrated by the workpressure, coupled by the low compensations. Many nurses have tightwork schedules that deprive them to time to engage other lifeactivities. All these experiences hinder them from performing betterat work. This view is supported by theory X, which posits thatemployeeshave vested interests which they always strive to fulfill while atthe same time serving the organization. Therefore, managers need tosupport the employees in achieving these goals to be able to realizeproductivity. Harris Hospital County need to be proactive in engagingemployees. The measures of success of employee engagement will beimprovement in perceived work-lifebalance and satisfaction among the nurses (Poulose&amp, Sudarsan 2014). Therefore,Lack of employee engagement atHarris County Hospital has been associated with if employees are notengaged, the high incidences of turnover Ccall-outs,sick leave, low productivity, and low work satisfaction. Therefore,the institution needs to focus on these areas.

ProcessesDriving eachOutcome Measure


Increasedhealthcare access is essentially mediated by two factorssocioeconomic status and cultural barrier. As was earlier mentioned,a significant population of diabetic patients is limited from accesshealthcare because it is unaffordable to them. Interestingly, many ofthese people who visit the Harris County Hospital are members oflow-income families that and cannot meet the cost of healthcaredirectly from their pockets.

Onthe other hand, the cultural practices such as the Hispanicpreferences for traditional healers to traditional healers limit theaccess to offers of reformed healthcare. Therefore, the decisions toachieve the desired measures for Harris County Hospital will need tobe tailored towards the overcoming the socioeconomic barriers,especially increasing the insured health cover among the affectedpatients, and addressing sensitizing to over the underlying culturalbarriers.


Asone of the quality measures, the reduced number of diabetic deaths isdriven by effective treatment. In this case, treatment describes allthe deliberate efforts that are made by the healthcare givers andpatients themselves to manage the diabetic conditions and thisinclude hospital admissions, check-ups, prescribing drugs, andpatient self-management. The processes of reducing diabetic deathswill need to focus on these areas.

Reductionin the number of diabetic patients is driven by preventionstrategies, which include observing a balanced diet and exercising.AlHayek, Robert, Al Dawish, Zamzami, Sam, and Aus (2013) haveobserved that such lifestyle choices can contain the prevalence ofdiabetes by over 80 percent. Harris County hospital will need tofocus on the elements of quality to assure desirable outcomes inproviding intervention for diabetes.


Patientsafety primarily characterized by medication errors. The medicationerrors step from the processes on the side of the healthcareprofessionals, as well as the patients. The processes on theprofessional side that result in errors include wrong prescription ordiagnosis because of negligence or competence. Medication errors onthe side of the patient include overdose, under-dozing and wrongmedication schedules and are attributed to lack of knowledge orcomplacency (Clark, Fradkin,Hiss, Lorenz, Vinicor and Warren-Boulton, 2013).Therefore,increasing patient safetythe Harris County Hospital initiatives forthe target population will need to focus on addressing medicationerrors.


Employeeengagement, measured by perceivedwork-lifebalance and satisfaction among the nurses, is influenced by lowcompensation and stress related work overload (Lowe&amp Chan, 2013).Therefore, achieving desirable outcomes of these measures at HarrisCounty Hospital will need motivating employees through paymentincentives, making the work environment lively, assigning considerateroles, or training the staff to increase capacity to deal with theworkload (Lowe&amp Chan, 2013).

Additionalindicator to drive outcomes as part of the performance data scorecard

Patientsatisfaction with healthcare is one of the critical additionalindicators that nurse leader to monitor on a regular basis to driveoutcomes as part of the performance data scorecard. To achievepatient satisfaction, focus can be directed to reduced hospitalvisits and reduced healthcare expenditure. Since the patients are atthe centre of all healthcare interventions, seeking to understandtheir satisfaction rates on the healthcare process is crucial toenable practice and evaluate what is needed. Nevertheless, patientsatisfaction is a critical aspect when approaching the interventionsfrom patient-centered care (Clark,Fradkin, Hiss, Lorenz, Vinicor and Warren-Boulton, 2013).Therefore, the indicator is significant for Harris County Hospitalbecause it aligns practice with the needs of patient-centered care.

Advantagesof the performance data scorecard created in part A

Theperformance data scorecard created in part A has three notableadvantages it is an integrated system approach to intervention ofdiabetes, it conforms to the principles in balanced scorecard, and itis guided by research evidence.

Integratedsystem approach describes a method of studying or conceptualizingissues as an interrelated to each other (Lowe&amp Chan, 2013).In other words, integrated approach legitimizes the need to considervarious interrelated factors in addressing a problem. The currentperformance data scorecard is an integrated approach because itconsiders several practices linked to poor interventional outcomes.

Thebalanced scorecard focuses on four areas: financial, internalprocesses, customer, and learning and growth (Low&amp Chan, 2013).The aspect of finance is reflected in the discussions of how to fundeffective diabetes treatment and prevention. The Internal processesaspects are manifested in the discussions on how to engage the nursesto increase productivity. Customer element is seen in the discussionof evaluating the outcomes based on patient perspectives, whilelearning and growth is evidenced in the discussion on how to improvethe knowledge capacity of nursing interventions.

Lastly,the performance data scorecard is justified by research-basedinformation in all cases. It has relied on literature informationtouching on different areas such as diabetes prevalence, death, andpoor interventions that are critical to interventions, backed bystatistics. These should be integrated in Harris County Hospitalinitiatives of dealing with the diabetes.

Trendsin healthcare related to employee engagement.

Theevolution of the world has been accompanied by various challenges forwhich organizations are now struggling to keep abreast. Thesechallenges have compelled organizations to focus on differentstrategies to enhance productivity. In particular, Contrary to thepast in which mechanistic approaches that overlooked thepsychological needs of employees were dominant, contemporaryorganizations have embraced the humanistic approach that acknowledgesthe motivational needs of employees as antecedents of productivity.Healthcareorganizations have acknowledged the criticality of the situation andare striving to embrace measures to support employees throughmotivation. HarrisCounty Hospital should embrace Organizationsare using various forms of motivational techniques, including the useof participatory leadership styles and use of financial incentive formotivation.

TheRelationship between employee engagement and healthcare quality

Differentsources acknowledge the need for organizations to strive and fulfillthe psychological needs of employees to increase overall organizationproductivity. Indeed, the need to acknowledge the psychological needsof human resource has been orchestrated by concerns of alarmingstatistics of stressed and dissatisfied employees, which is oftentranslated to poor organization productivity. Indeed, The literaturebroadly discusses workplace stress, anxiety, and dissatisfaction anissue of concern that needs to be addressed. For example, Lowe andChan (2013) have noted workplace stress is now a serious impedimentto organizational productivity and employee wellbeing, and this arelargely linked to lackof autonomy, job insecurity, job satisfaction and increase in thecost of living, which stress employees and reduce productivity(Mannion,Davies &amp Marshall, 2012).Thisviewpoint has now been acknowledged by a number of theorists andresearchers, who have avowed existence of a link between individualperformance, organization productivity, and individual’s balancebetween work and life (Mannion,Davies &amp Marshall, 2012).Harris County Hospital should strive to support its employees basedon these points.

Currenttools to provide nurse leadership with data regarding employeeengagement

Thecurrent tools within the Harris County Hospital organization do notadequately provide nurse leadership with sufficient data regardingemployee engagement. Three weaknesses have been noted, and theseinclude limited scope of focus, overemphasis on performance andquality measures and being essentially mechanistic in nature, ratherthan humanistic. Indeed, as noted by Mannion,Davies &amp Marshall (2012),employee engagement, when done, is only focused on fosteringproductivity, rather than improving the welfare of the employees.Therefore, part of the reform process will be addressing thisweakness.

Aplan to improve employee engagement using the performance datascorecard

Inlight of poor employee management practices in the organization, anemployee engagement plan will need to be developed based on theperformance data scorecard. The goal of the plan will be to improveemployee engagement to satisfactory levels characterized byself-ratings scores of employee satisfaction of over 7 points on thescale of 1 to 10. Strategies of employee engagement will include theuse of the havinga participatory leadership style, motivating employees and improvingthe work conditions, and training and development

Theevaluation programs at Harris County Hospital will be conductedregularly for each month to identify what might be needed to improveemployee management practices. The evaluation will involveinterviewing employees about the success of the interventions andmaking general observations about employee practices. The employeeengagement reforms will be implemented for one year, assessing theoutcomes before further recommendation can be done.

Leadershippractices aimed at improving employee engagement

Successfulemployee engagement is hinged on various leadership practices,including having a participatory leadership style, motivatingemployees and improving the work conditions, training anddevelopment, which have not been seen at Harris County Hospital(Lowe,2012).The essence of having a participatory leadership style is to make thedecision-making process open for contribution to all stakeholders.Motivating employees boost their morale and makes them to becomecommitted to realizing organization goals. Improving work conditionssuch as through allocation of tasks also motivates the employees toimprove productivity. Training and development increases thewillincrease capacity of the employees at the Harris Hospital County todeal with work challenges by equipping them with knowledge andskills.

Thesuggestion by Lowe(2012)on the use of innovative and unorthodox approaches to employengagement is perhaps the most fascinating insight that Harris CountyHospital should adopt. The use of unorthodox motivation technique isan interesting innovation. Currently, many organizations are goingextra miles to motivate employees in various ways, for instance,holding impromptu dance parties or dressing up as chipmunk tomotivate employees. Some organizations have also allowed employees tocome at work in jeans or even wear high school uniforms. Otherexamples of unorthodox motivation techniques include providingemployees with unusual benefits such as providing insurance for petsand allowing employees to ride scooters to their offices. Maceyand Schneider, 2014)suggests that approaches are particularly suitable for the generationY employees. Therefore, Harris County Hospital Should consideradopting such innovative techniques to motivate its staff.


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