Project in Inter Professional Team Development and Organizational Leadership

¶ … Organizational Leadership and Inter-Professional Team Development

This paper aims at analyzing business practices, reimbursement impact, regulatory needs and patient centered care in health care units.

In the modern society, patient-centered care has become prevalent and has been embraced by top providers in the industry, ranging from regulatory agencies, policymakers, research bodies and donors. This shift (from physician to patient-centered) can be traced back to the Institute of Medicine's report of 2001. The report identified the patient centered care as one of the leading factors that constitute high quality care. This meant that the patient centered care was the only method that could be used to create a satisfying patient experience, important for providing quality care. The emphasis here is on value versus volume that was in place even before affordable care act came into effect. Many health care providers have been forced to factor in their plans the patient centered care models, in which the greater share of risk is shouldered by the facilities. However, the ever changing conditions necessitate that revenue should be managed differently to ensure delivery of quality services to the patients. The delivery of the services should consider accuracy and timeliness. A successful processing operations should comprise of a well defined monitoring process as well as skilled manpower (Gocan, Laplante & Woodend 2014). The claims processing and revenue cycle will vary and mainly depend on the mark up of the healthcare organization and the billing model in use, the hospital, the health system as well as the physician practices.

Patient centered care is simply a healthcare setting where the patients are encouraged to be actively involved in their own care. It depends on the environment, which is supposed to ensure that the patient is comfortable. The staff should be able to meet the emotional and spiritual needs of the patient. The patient centered care model has the following attributes: a culture that encourages and supports the staff to remain sensitive to the needs of the patient as he continues to stay in the hospital. It should include an appealing interior and architectural design that makes the facility to have a "homelike" environment, which encourages the patients mobility. In addition, it should allow the family members to get involved in the care process. There should be space for both social activities and solitude. In addition, it should lay more emphasis on the patient as well as family education. It should also recognize that nutrition is an important aspect of health care. It is a source of pleasure and should be comfortable and familiar to the patient. It should also include the family members in the caring process.

Patient and Family Centered care Organizational Self-Assessment tool" PFCC for healthcare organization.

Description of the health care setting used in the PFCC

Medical center Hospital system (MCHS) is a non-profitable regional acute care center with 402 beds, level II, Trauma Center. It is located in West Texas (Permian Basin) and serves 130,000 people from the 17 surrounding countries. This is one of the most comprehensive health care providers in the region. Founded 65 years ago and has grown from a facility to a family health care that delivers a broad range of medical services to the residents of West Texas. The hospital serves the communities with a comprehensive care and has created more points for health care needs. Over 60 years ago, citizens of this area realized the importance of establishing a hospital. They started by providing quality health care to neighbors by founding a medical center Hospital (MCH) which was meant to serve the health needs of the residents of Permian Basin. Since then, the facility has grown into a family of advanced health care center. The new MCHS has enabled the facility to provide a higher level of comprehensive care and has availed more access points to people in need of health care.

This center was once a small 85 bed community hospital that grew to become a teaching and a medical center facility in the region. The facility caters for family and patients of all age groups. When you visit MCHS, as visitor or a patient, you will get employees who provide a safe and a friendly caring environment that supports the vision of the facility that is recognized as a premier health care facility in the region. It has a team of caregivers comprising of people who are well-known in the community. These are the people whose care and can be trusted to meet the set health care standards and needs. As a facility, MCHS respects the diversity and holds the patients important in all the decisions it makes.

B.1. Using The PFCC Tool to Describe The Strengths and/or Weaknesses Of The Organization For Each Domain.

Operations / Leadership

MCHS statement of commitment to families and patient focuses on providing convenience and affordable healthcare. It has expanded access care by building and constructing clinics in the Odessa area. There has been concerted effort to encourage wellness and good health in Ector County. Ector County has about 208 of the total 237 Texas counties. The area is affected with obesity with one out of three people suffering from obesity. It is for this reason that MCHS has developed multiple community programs meant to encourage residents of Ector County to focus on healthy eating habits and understand the available options (Servixces 2014). The weakness for this domain is that the operations and the leaderdship of MCHS are not customized to tackle the primary health issues facing the local community. As earlier discussed, the main health concern in the county is obesity, but there is no evidence that the hospitals operations are designed to accommodate obesity and there is no evidence of the leadership taking concrete effort to ensure the same.

Mission and Vision Values

MSHS's vision statement is that the facility is a community-based teaching organization committed at providing quality health care. Its objective is to provide quality health care and improve on the wellness of the Permian Basin area. Its vision is stated as " to become the premier source of health and wellness" Among its values is the word I CARE meaning that the facility is committed to its integrity, customer centered, accountability, excellence and respect (Medical Hospital System, 2016). The mission and vision values focus on the customer, but their weakness is that they both don't capture the employees of the hospital who play a critical role in the delivery of healthcare services. As a result, it is possible that the employee/healthcare providers might feel disenfranchised therefore affecting their morale and ultimately, the success of the healthcare facility.

Advisors

MCHS participates collaboratively with families and patients in a variety of committees such as Quality and patient safety on MCHOdessa.com, Stroke committee, Rapid Action Improvement Process, Quality and Patient and safety council and Rapid Action Improvement process Methodology Committee. It has volunteers who participate in quality rounds in their respective floors assigned to them. The community members are part of advisory boards and safety committee that makes decision on the equipment to buy. There are several areas where the family and the patient are involved and their input is considered by the hospital committees. The only identified weakness concerning advisors is that there is no identified guideline on advisory role and there is no a balance and check system to ensure that any advise given is put into serious consideration. This means that, there is no one accountable on whether advise given is factored into decisions or not.

Quality Improvement

MCHS is all about quality and could be used as a guiding principle and serves as a foundation on which the healthcare network is built. The facility shares many of its accomplishment with the community on its own website. MCHS has been awarded accreditation since it has demonstrated compliance with the Joint Commission's with the National standards for safety and quality in healthcare in hospitals.

The Joint Commission Seal of Approval ensures that MCHS is family and patient centered. It approves programs such as strokes program, advanced certification in inpatient Diabetes bariatric Program and certified Bariatric Surgery. The goal of Quality and Patient safety Council Project Team's goal is to oversee authority for quality issues and improve the institution's activities.

The only established weakness for this domain is that there is not a clear system that qualifies improvements. Ordinarily, improvements are done to accommodate a given shortcoming; in this case, MCHS doesn't seem to have a clear systems on how and why improvements are implemented.

Personnel

The family and the patients are involved in the process of hiring new employees as well as staff development. The community members and volunteers sit on the Human Resource committee where they take part in orientation and train the volunteers to assist in various areas. Performance appraisal defines the expectations or behaviors that are consistent with the family centered concepts. They also collaborate with family and patient centered concepts. They also articulate on the importance of collaborating with the patients and family members at all levels of care. Also, they provide a variety of support opportunities for the staff including (Family centered counseling and mentoring programs)

Despite the above strengths, the community doesn't participate in the hiring process as well as orientation of nurses. The nurses must complete the orientation positions descriptions. This is despite the psychological implications of orientation is acquainting a newcomer to, among others, the organizational culture of the institution.

Environment and Design

As a facility, MCHS has come up with a positive impression that welcomes patients and family members starting with hospital's clinics and parking lot up to the main entrance. The positive impression extends to the main reception area. It also covers the information desk as well as the entrance to specific units such as emergency department. The hospital and clinics' interior design and architecture rely on features such as color, lighting, aroma, and art, views of nature, proportions and texture to help create a supportive or healing environment. The signage is well done, educates or informs the patients since it uses the language of the community served.

Health care providers are able to share and communicate relevant information to the families and patients. The patients and the families are given timely and accurate information to help participating in family care as well as decision-making. a number of portals have been created to encourage patients and family members to make use of the safe clinician's emails. The families and patients are all encouraged to make use of the resource rooms discussed in this paper.

The major shortcoming identified is that, currently, the patient and families do not participate in educating the clinicians. This therefore could translate to contravention of the institutions objective, as the current situation prevents a thorough understanding of the patients by the clinians, from the point-of-view of the patient.

Diversity and Disparities

The facilities employee home page has an interpreter and the list of all the employees who have had the opportunity of attending the interpreter classes and who are also utilized as interpreters. Available also is the spotlight MARTTI a line that allows one to access interpreters on a 24/7 basis. In addition, a list of super user on the home page helps alert the staff of the shift when each interpreter worked. In the community, the family and the patient are allowed to seek medical assistance and ask questions.

If they do not know where to get the drugs at the cheapest price, the MCHS will help to navigate the family and patients through the health care system and access the right provider when they need to do so. The navigation services offered do not cost money. The community Health nurse navigators are trained as registered nurses help the patients and the families navigate through the system to ensure that they receive community resources even when discharged. . The idea is to assist families and provide educational information that enhances the ability for the families and patients to make the best choices for themselves. The community nurse navigator therefore, focuses at making quality health care affordable and accessible to the community.

The weakness for this domain is that there are no clinicians from the local and native communities and there is no effort from the institution to improve on the situation. Even though the institution has tried to cover the natives health needs by training non-natives on the various aspects concerning natives healthcare, a clinician from the natives community has a positive psychological effect on the native patients. Some of the efforts suggested could include special scholarships or training for native promising students.

Charting and Documentation

The patient and family members are encouraged to register through MCHS so that they can obtain access to the paper. They receive instructions when they are admitted to the facilities on how they can get access to medical records (Medical Center Hospital System, 2016). The shortcoming established for this domain is that at the time, there is no access for patients or families chart.

Care Support

At the facility, the families are treated as part of the care staff and so are allowed to stay with the patient on a 24/7 basis. The rooms have loveseats that can be folded into a bed and used by the family. Patient and families get support and even apologies for inadvertent/systemic error and harm. When the patient has been harmed, there is an elaborate procedure that should be followed while the family is encouraged to participate in talks and evaluate the report with nursing staff. This shows that the patients and the staff are considered part of the team and help the teams to set goals for patient. The patient and the families are treated with respect, listened to, and cared for. The patient and families are listened to and treated as stake holders in any care given to the patient. Moreover, the family is encouraged to take part in the patients care transition. MSCHS treats pain as the fifth sign. Here, the level of the pain is first placed in the patient's board and reassessment done before the embarking on pain medication.

If the pain cannot be controlled, the Facilities' policy is to refer it to a pharmacy to help in the pain management. Currently, families have the freedom of choosing to stay with the patient during response but receive support from the nurses, the clergy, and the administration.

Despite the above strengths, it was established that the family and the patient are currently not able to activate any rapid response systems, which is a major weakness for this domain given some healthcare conditions like pain requiring rapid response through an emergency system.

Identify one area of improvement from the weaknesses identified in part B2.

Patient and families (PF) are presently restricted from activating rapid response. They cannot turn on the rapid response system; only hospital staffs are allowed to do so. During rapid response times, patients and families are assisted by the hospital nurses, the administration and members of the clergy. PF do not serve at this point as faculty for the clinicians or educators. They do not take part in hiring of nurses or their orientation procedures. Only the junior volunteers are allowed to do so. I did not come across a single policy or procedure that was directed at the management. Some areas require involvement of patient and family with regard to their contribution in the hospital management committees. In Rehab's assessment, it was discovered that quality reports were not timely; hence negatively affecting MCHS financially. Inability for PF to activate rapid response, not participating in orienting nurses, and not being involved in some areas of management are identified as the most important areas for improvement.

C.1. Strategy to Increase Patient-Centeredness in the Organization

The following approach provides the fine details on how to enhance family and patient centeredness in an organization by working to improve one of the areas pointed out.

The identified gap is the Centers Medicare and Medicaid requirement for quality reporting with regard to the timeliness of submission. Quality indicators, when submitted help in enhancing the outcomes for patient and family. Benchmarking against leading regional and national organizations presents the opportunity for Rehab to adjust and improve the data collection process and care delivery. The indicators for quality are transmitted to Medicare and Medicaid that pursues purchasing based on value and quality PF care. The Patient Protection and Affordable Care Act directs the reporting procedure. Timeliness of reporting of quality indicators affects reimbursement, and is essential to the organization. CMS avails quality data available for public scrutiny and affords the health facility a chance to review their data before making it public (Servixces, 2014).

C.1.a. Applying the Strategy (Change Theory) to Address the Chosen Weakness.

Change theory involves a lot of dynamism in thinking and is a process. It seeks to clarify the initiative even as it seeks to make it transparent too. It is draws a lot from strategic planning. It is evolved in a participatory process over a period of time. It is made through a rigorous and logical process that is often slow, painstaking as it is rigorous, but helps meet the standards of quality test demanded by the stakeholder. As a result and given the urgency for the purposed imporvment, this strategy will involve a system theory thus, it is not essentially a change of the system, but rather realignment of the system to accommodate the desired changes. The implementation of the strategy shall be through introduction of the relevant systems, institutional policies, and personnel to support activation of rapid response by PF, involvement of PF in clinicians orietenation, and in management areas where they are not currently involved.

C.2. The Financial Implications of Implementing This Strategy

Implementation of the system theory is sure to require financial investment especially in infrastructure and personnel. For example, in ensuring healthcare services are patient-centered, structural change is required in the various non-compliant process as well as qualified personnel. These two will require financial investment. It is estimated that, full implementation of this strategy will require about USD5,500, based on similar previous strategies in similar institutions (Lingard et al., 2014; Gocan et al., 2014; Osula & Ng, 2014). The immediate financial implication for implementing the strategy is a dip into the hospitals funds. This investment will align the organization for competitiveness and attract more customers therefore, the long-term financial implication is increased profitability and with time, the change investment will make return. It is estimated that, if the institution was a for-profit enterprise then within seven months after implementation of the strategy, the organization would breakeven.

C.3. Evaluating the Effectiveness of the Strategy.

Continuous evaluation of performance: there will be specified targets that constitute measurable values. These will facilitate the process of tracking results progressively so as to ensure that the strategy works effectively. If the results reflect a lag in performance, there is time to increase the resources needed to make it effective, readjust operations, or pursue other corrective measures. Usually, the adjusted approach is not as effective as he original, as it consumes extra resources. Continuous evaluation enables one to decide whether to continue implementing the strategy amid the changes or come up with a new approach that will work better.

Review effectiveness through assessing the achievement of objectives

Once the strategy has been implemented, it is possible to check and establish its effectiveness by looking at the extent to which the goals have been attained. If the strategy either did not attain the intended objectives or used more resources than originally intended, one must establish the areas of weakness in your strategic plan. Sometimes, the results from a strategic plan may fall below expectations if the approach was not in tandem with the strengths and weaknesses of the company or whether the set objectives were unachievable; in any case, the completion of any strategic plan sets up an organization in a complete new situation . A review allows oneto progress if the plan is effective or still progress but with some changes in the original plan (Lingard et al., 2014).

Establishing a team that works across the disciplines

The members of the multidisciplinary team will incorporate the perspective payment coordinator, Director of Rehab, Case Manager, Charge nurse, Nurse Liaison, Quality improvement Director and the Infection Control Coordinator .

The Goals and Scope of Operations for the Team

The team is mandated to ensure that all quality indicator results are collected and submitted to the relevant agencies in a timely fashion. The team will comprise;

Director of Rehab who will review all quality indicator reports and make sure there is compliance in completions and reporting.

The perspective Payment Coordinator: Check the charting appropriateness before submission of IRF to CMS. They should ensure the completion of the quality indicators basing on the diagnosis of patients and their functionality.

Nurse Liaison: recheck the quality indicators that influence preadmission.

Case manager: they should audit the discharge plan to make sure that appropriate indicators are completed.

Charge Nurse: Check the records for patients so as to make sure that there is daily charting of the appropriate quality indicators.

Acute Care Infection Control Coordinator: They submit part of the quality indicators to the National Health Safety Network.

Quality Improvement Director: they oversee all the quality submissions to make sure that they are timely.

D.1. Cultural Diversity within the Team Supports Patient-Centered, Culturally Competent Care

I will outline the importance of diversity in teams for the support of patient care. There is diversity all around. If people can accept, appreciate and welcome their differences, such diversity can be an asset. The act of appreciating and accepting differences means being able to value diversity among people. Instead of trying to correct, ignore or even dismiss our differences, it helps the team to create an environment that empowers people irrespective of their ethnic or cultural differences. Managers carry the responsibility to utilize resources efficiently and responsibly. They do this with the full understanding that there is a cost to recruiting, training, retraining, retaining, or even relocating staffs. Research reports indicate the importance of the nurses' attitude towards diversity in the delivery of quality service in health care environments. There is no doubt that future staffs will be increasingly diverse. Leadership teams will try to be employers of choice; hence creating room for more diversity. They face the challenge of establishing a working environment that is culturally friendly to everyone. A diverse team presents a rich mix of ideas that can improve service delivery. Usually it does not matter whether one is a member of the senior team or not, or even whether they are young, old, experienced or inexperienced. Such a team makes maximum use of individual strengthens while still respecting their cultural differences (Roussel, 2013).