Cooper Green Hospital like any other health care facility serving the indigent population is faced by several problems that interfere with their service delivery to the community. Some of these problems include; poor staffing, lack of funds, lack of resources, overwhelming number of patients, lack of workers motivation, poor service delivery Swayne, Duncan, & Ginter, 2006() Poor staffing is a big challenge since the ratio of medical personnel to patient is far beyond the required limit. This has a real impact on the quality of services being offered and some of them may end up not acquiring the services on time. The staffs are on daily basis overstretched in their services and failure to have a smooth flow of service delivery might lead to disruption of services at the facility.

Due to the understaffed nature of Cooper Green Hospital, the staffs lack the necessary motivation they need to work effectively and efficiently. The staffs are forced to work long hours with no proper resting shifts in between them. They are also hardly given any incentives and work benefits such as insurance benefit so to boost their work effort. Some of the workers lack insurance benefit since they are considered not eligible according to the federal guidelines; therefore they do not have the luxury of visiting a physician's office. These workers cannot give all their effort into their work because they have many other issues worrying them such as their families' health. The hospital management is also frustrating the workers since they cannot even ask for a days of their jobs when sick for fear of losing their jobs. So these poor working conditions really has massive effect on the quality of care and service provided to the indigent population.

Poor service delivery is also an issue, the medical practitioner at the facility are not patient centered, in that they do not have the capacity to have a one on one session with the patient to the patient's satisfaction. The patients are treated even without proper examination and analysis done on them. There is very poor patient -- doctor relationship and this has an effect on the service delivery Swayne et al., 2006()

Lack of sufficient resources is also a serious issue affecting healthcare delivery at Cooper Green Hospital. The hospital was in 1998 changed to Cooper Green Hospital from the previous mercy hospital which was built in 1972. The hospital was started with a bed capacity of 319 inpatient beds and this was a number arrived at as a result of the epidemiological study using the number of indigent case reported at the county hospital during the mid-1960s. This shows that the capacity and resources found in the hospital has greatly been overstretched over the years due to the ever increasing population. The hospital lack enough bed space, facilities to conduct a one on one examination with a patient and equipment for doing the various specialized tests. All these become a major challenge towards the service delivery by the hospital.

The hospital experiences financial problems which greatly interfere with the service provision at the hospitals. Cooper Green Hospital was started on a mission "to provide quality medical care to the residents of Jefferson County, regardless of their ability to pay." The hospital finds it hard to sustain itself from the ever increasing budget and low funds allocated to them. The hospital has in the past been faced by media and public's negative publicity concerning their poor quality services, therefore, this has made the hospital not to be able to attract patients with private insurance whom with the funds acquired from the insurance claims, help the hospital to fund part of their budget Swayne et al., 2006.

Due to this financial constraints, the hospital has been thriving to cut the overall expenditure, through a stringent budget-cutting program which entails; taking beds out of the services, personnel lay-offs, elimination of some services which are not common and expensive, and lastly, postponing of the major improvements and investment.

The population of the indigent people fails to seek for prompt medical attention wherever they fall sick for fear of not being able to afford. Their poverty nature, coupled by lack of awareness amongst them has made the hospital to encounter challenges because some of the cases brought have progressed to serious complication which may require specialized health care which is not readily provided at the facility. Lack of awareness has led to the hospital's community care plan being greatly underutilized because the population living near the facility still has to go a great distance to arrive at the hospital while they could have acquired the same services there. This has...

Though the community care plan clinics were started to offer patients health services at their local neighborhoods at a local quarterly minimal fee, it is still struggling to sustain itself since patiently are hardly utilizing them.
Ways that the Community Care Plan will improve the health status of the community

The community care plan is meant to improve the health status off the community through various ways, they include; service delivery would be faster, act as a preventive facility, offer routine medical services, reduce the overall expenditure of the patient when seeking medication and inter-sectoral collaboration with other stakeholders to improve the community's health Montesano, 1995()

Through the initiation of the community care plan clinics, patient will have the opportunity to receive health care services at their disposal and since the population being served by the clinics is not as huge as that of the Cooper green hospital, they are to receive faster medical services, and they would not have to go through traffic and long waiting lines at the hospitals. Therefore, the community health status will be improved because they will be at ease of accessing the clinics for any check-up.

The community care plan clinics will also act as preventive centers. They are to be the immediate link with the community therefore, they will have the capacity to detect the spread of an infection, hence responding promptly by treating those who have symptoms and vaccinating the others members of the community at risk wherever necessary. The hospital will also act as a surveillance of diseases for the community, and this makes them to be highly prepared for seasonal diseases.

The community care plan clinics are to assist the community through offering them regular routine checks which would facilitate proper detection of disease before their spread. This would in turn save the patient and the hospital money which would have been required to treat the patient if the diseased would have progressed to serious levels which needs specialized care Swayne et al., 2006()

With the plan that the patients should pay a minimal monthly premium for unlimited service guaranteed the patients and the community that they will be able to receive quality care from qualified personnel instead of the rampant use of non-physician providers as a way of cutting cost.

The community care plan will work with other players in the medical field towards improving the health of the society. These other players include the individual health care providers, local governments, public health agencies, purchasers of health services, community-based organizations, health care organizations, employers, schools, and faith communities. One of the activities that such stakeholders can assist the clinics is through initiation and implementing the community wide social change Diwan, Shugarman, & Fries, 2004.

This will ensure that the community takes charge of their lives so as to reduce the most prevalent health cases.

Factors that point to the need for change by Cooper Green Hospital

Cooper green hospital has had a decline in the quality of their service delivery over the years and this has made them not to be able to attract clients with private insurance. There is need to have some major transformation in different sectors within the hospital. The following are the factors that point for change in quality delivery at the hospital.

First, the hospital initiated the community care plan, but since its inception, the clinics have been struggling to attract the community to embrace their services. Some of the factors that have led to this low utilization of these clinics include lack of awareness of their function and existence. Therefore the hospital should create mechanisms where the patients visiting them can be referred to their various neighborhood clinics for further check-ups, to avoid congestion at the hospital Diwan et al., 2004()

The hospital's huge queue waiting for services implies that they need to improve both their infrastructure and their staffing capacity. These changes would encourage their clients to visit the hospital more often and with the increase in staff to patient ratio, the staffs will be motivated to give all their best since they will not be overwhelmed at work by the huge turnout of patients daily.

The hospital's bad image by the media concerning the quality of health services they provide had led to few private insured patients attending hence low…