Middleville RHC The author of this report is to look at the theoretical test case and associated statistics of a medical facility known as Middleville Regional Health Care. They are one of three hospitals serving a community of about 350,000 people. The statistics of Middleville have been provided as well as the details about its two competitors in the same metropolitan area. There are a couple of issues in play that the author of this report will address. First, there will be an explanation of the governing board's role in their overall strategic initiatives, the determining of its responsibility and its overall involvement in the same. Second, evidence-based management will be used to determine whether the actions chosen are yielding the results that they could or should reveal. Third, there will be an analysis of the aforementioned statistics of the three facilities in the area, including Middleville. Fourth, there will be a discussion about the pursing and possible implementation of advanced technology systems. Finally, there will be an addressing of the challenges Middleville has been facing including the recruiting and retaining of nurses at their facility. While Middleville could be in much worse shape, it is fairly obvious that they need to be careful about some of the things going on now and what ostensibly faces them in the future.

Analysis

Before getting to the main questions of this report, there the details that the author of this report must work out as far as being a consultant for the hospital. As described by the assignment, the four main areas of focus will be in human resources, information technology, financing and marketing. First off, three performance measures that can be used to assess the performance of the hospital are as follows. First, there is the amount of expense per patient seen, whether it be OP visit, admission and so forth. These levels should be as high as they need to be to deliver proper and full levels of care to patients but they should not be exorbitant or otherwise out of phase with reality. Second, there needs to be a monitoring of the amount of beds available as compared to the outpatient and inpatient visits that are encountered so as to make sure that there are enough beds to meet demand including at the busiest and trying times. Lastly, there needs to be an assessment of whether mistakes made due to records management practices. This should look at whether use of methods other than electronic medical records (EMR) are more prone to mistakes than the EMR usages themselves and there should also be an assessment and identification of mistakes that have nothing to do with EMR and/or are because of lack of proper training. Of course, the general opinion held by many is that EMR is the wave of the future and that any point of resistance against that is simply wrong. Even so, there are those that say that EMR creates new problems but the consultant for this report simply does not believe that. If wielded correctly, EMR is always going to be superior to physical records alone and there are multiple reasons and manifestations of this fact. In terms of ranking, EMR would actually be the most important, bed/patient ratio and then expenses. Again, the amount of money spent should always be a distant second to making sure the patient is being taken care of unless there is obvious waste and the like going on (Ubel, 2014).

The role of the governing board in the entire process is obvious and easy to see. The governing board is the primary and highest groups responsible for planning the hospital's future over both the short-term and the long-term. Indeed, the issues being discussed are very forward-looking and it is important that they make the right choices. Indeed, they would delegate a lot of responsibility to other people but it will be their heads on the chopping block if the choices being made were faulty ones. If the problem were to become dysfunction with lower people, that would deflect a lot of the responsibility but the leaders have to step in when things are going awry. In one way or another, the governing body is where the "buck" stops. As such, their involvement should be very advanced. They would presumably dictate from the top down and the people that answer to them would proliferate the marching orders and things to do to the lower levels. Even so, those orders come from the...

First, they should look at expenses per bed and expenses per patient. It should be noted that the number of beds that Middleville maintains is quite high as compared to the other two hospitals in the area when compared to admissions. However, OP visits and births are much higher for Middleville as compared to the other two hospitals. However, it is something worth looking at. Second, there needs to be an identification of all errors made and the underlying reason or mistake for each. Leaving the mistakes in one pool without finding the underlying cause of each miscue leads to problems going unaddressed and perhaps the wrong processes or people getting the blame. Finally, expenses to patient ratio (variable/non-fixed expenses in general) need to monitored.
In looking at the statistics for the three hospitals, a few things come to light. First, it is very noticeable that Middleville has many more beds than the other two locations and it is not really close. Indeed, there is nearly a two-hundred bed gap between Middleville and Brierfield and a 225-bed gap between Middleville and Greystone. Middleville is in the middle of the pack when it comes to actual admissions as Brierfield has 4,000 more and Greystone has three thousand less. The census for Middleville is first by a long-shot and the same is true of OP visits. Middleville is also nearly double the closest competitor when it comes to births. When it comes to expenses, Middleville is second out of three but they are only five thousand dollars behind the number one location, that being Brierfield. Greystone is a distant third with $80,000 but their admissions, census, OP visits and births are all far behind (if not very far behind) the other two locations in question. In terms of remaining competitive, the hospital should keep expenses low, modernize the records technology that is in use and otherwise run an efficient location that still ensures that all patients are getting the proper and full amount of care that they need.

As far as Middleville pursuing an EMR system over the next five years, there are a few things that they should keep in mind. First, they should make a "big" jump if they are very far behind the technological curve. If they are not close to "modern" with their EMR practices, they need to get there. If they are close to being in the right place, then an incremental update is probably enough. Over all, it is better to be ahead of the curve and "future-proof" as compared to embracing a technology arc that is not getting widespread acceptance or not being as modern as is possible with the current options. This segues into another point. There are a lot of vendors and options out there and they are not created equal. Whether it be the overall standard being used or the vendor extending the option, the Middleville hospital needs to make sure that the EMR option they use has a firm future and that it melds properly with all relevant industry standards as well as the other systems that the EMR system will need to integrate with. Indeed, the best option is to keep the overall number of vendors and companies to a minimum but there will always be some need for cross-platform integration and this requires third party standards that everyone adheres to. For example, Java is a wide-spread computer language but it is not limited to one company. Many different devices by many different companies use Java to at leats some degree. As such, having them be able to "talk" to each other is much easier than it would be if one was using Java and one was using Microsoft C# (HealthIT.gov, 2015).

As part of doing proper due diligence, the Middleville hospital should create a request for proposal (RFP) from companies that would be most likely to have the resources and forward-thinking technology to get done what Middleville wants done. When assessing each proposal, there needs to be a look at how "future-proof" each option is, how modern the current iteration of the implementation would be at the time it is done and how stable the vendor might happen to be. For example, Middleville should be much more apt to use a vendor Microsoft, GE or Oracle rather than a startup, a firm…