Self Management Education Program Diabetes

Running head: AYM SERVICE PLAN BRIEF

AYM1 SERVICE PLAN BRIEF

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Service Plan Brief for

[Barbour Diabetes Self-Management Education Program]

Date

[Your Name and Credentials]

Western Governors University

Service Plan Brief for Barbour Diabetes Self-Management Education Service

Service Idea (suggested length 2–3 pages)

The proposed service idea is a diabetes self-management education program to be implemented in Barbour County, Alabama. According to the Center for Diseases Prevention and control, 34.1 million American adults aged 18 and over (13 percent of the population) have diabetes, with the highest prevalence reported among those aged 65 and over (CDC, 2020). The CDC identifies diabetes as the seventh leading cause of death in the US, accounting for approximately 270,000 deaths (crude rate of 83.1 per 100,000 deaths) annually (CDC, 2020). Diabetes management is multifaceted and complex, with many patients struggling to cope with the high self-care levels required for effective diabetes-control (Fenwick et al., 2013). A key barrier to effective diabetes-management is lack of knowledge on self-care activities. Studies have associated diabetes self-care education with better diabetes-management, improved health outcomes, and reduced mortality (Zhang & Chu, 2018; Fenwick et al., 2013).

According to the CDC, Alabama has the third highest prevalence of diabetes in the US; yet over 60 percent of the state’s counties do not have a licensed diabetes education program. This plan proposes the development of a diabetes self-care education service in Barbour County in southeastern Alabama. Only one of the 13 counties in the southeastern part of Alabama, Houston, has accredited self-care education programs.

The service will serve diabetes patients in Barbour and the neighboring counties, equipping them with health education on nutrition, self-monitoring of glucose levels, and adherence to medication (Zhang & Chu, 2018). The program will provide educational sessions lasting between 30 minutes and 1 hour to groups of between 10 and 15 patients during their routine visits to Barbour Medical Center. Each participant will attend a minimum of 5 education sessions, where face-to-face instruction, pictures illustrating food choices and portion size, and education materials on coping with stress and foot care will be provided (Mash et al., 2012). The program aims at improving knowledge levels of diabetes patients and empowering them to minimize complications, thus improving their quality of life.

Market Analysis

The target population is the 610,000 diabetes patients living in Alabama (American Diabetes Association, 2014). Potential referral bases are the 44 medical centers across Barbour and its neighboring counties. The proposed program faces competition from the 62 diabetes education programs accredited by the American Association of Diabetes Educators to offer health education services across Alabama (Alabama Public Health Department, 2019). In the southeastern part of the state however, there are only six diabetes education service programs, all of which are located in Houston County, forcing residents in the upper counties such as Barbour to travel across several counties to access diabetes education services (Alabama Public Health Department, 2019).

SWOT Analysis

Strengths

Weaknesses

Qualified personnel – the initiator is a certified nurse leader with postgraduate qualifications, working with licensed diabetes educators

Limited coverage - The service focuses on diabetes education only, ignoring other co-occurring chronic conditions such as kidney failure

The program is designed to make use of a variety of educational strategies, including face-to-face instruction and take-home flip charts with pictures

The service is yet to be licensed by the American Association of Diabetes Educators, denying it national recognition

The service is to be based within the Barbour Medical Centre, the most popular hospital among diabetic patients in the county, which ensures a regular and huge flow of clients

The hospital-based setting and group instruction limits the ability to have a closer interaction with the person, caregivers, and family members

The program will rely on donor funding to offer low-cost education services given that incomes are generally low in the rural counties

The location within a rural area could limit access and client flow, differently from services located within the city centers

Opportunities

Threats

The media’s growing interest in the promotion of health and prevention of chronic illness presents a promising avenue for growth

The proposed education program faces a lot of competition from the six diabetes education programs in Houston County

There are only six diabetes education centers in southeastern Alabama, all of which are located in Houston, forcing clients to travel long distances for services

There is growing emphasis on integrated models of care, posing a threat to a single service such as diabetes-management alone

Alabama has one of the highest diabetes prevalence rates in the US, which ensures a vast target market for the proposed service

Changing government policy such as Budget cuts to Medicaid pose a threat to the program’s operation as most patients in rural counties such as Barbour depend on the same to seek care. Budget cuts to Medicaid thus pose a threat to the program’s sustainability

There are no other diabetes education programs in the counties surrounding Barbour, which presents opportunities for future expansion

Technological advancement and the growth of telehealth platforms makes educational services available at the touch of a button, reducing the need for physical visits

The service’s main strengths are its subsidized prices, qualified personnel, and the use of a wide range of education strategies to serve wide-ranging client needs. These strengths make the program highly relevant to the needs of the rural population. However, its location is also the source of its greatest weakness as the potential market is significantly small relative to the urban centers. The program will use its qualified staff to offer the best possible services in a bid to encourage them to refer other clients. The large number of diabetes patients in the state offers promising opportunities for expansion, but the six diabetes education services in the southeastern area pose a significant threat to expansion. In this regard, the program will market itself as a low-price service to build a greater appeal among low-income earners.

Service Plan Feasibility (suggested length 2–3 pages)

Cost-Benefit Analysis

Category

Description of the Service Plan Costs

The Organization

Purchase of capital office equipment including computers, furniture, and printers

Licensing costs – expenses incurred in obtaining operating licenses from the Association of Diabetes Educators

Rental costs and general maintenance costs

Operations

Administration costs such as fuel, printing papers, telephone

Marketing and advertising costs

Annual license renewal costs

The Client/Patient

Incentives/giveaways for participants

Purchase of education materials such as flip charts

Client follow-up costs such as travel expenses incurred on home visits to identify why a client stopped attending sessions

The Staff

Training costs

Salaries and wages

Staff incentive programs

Technology

Initial hardware and software purchases

Set-up costs such as cost of installing new software and carrying out upgrades

Research and development costs

Category

Description of Service Plan Benefits

The Organization

Achievement of national recognition and ability to serve clients throughout the state

Contributing to better diabetes-management for 100 patients annually

Reduced mortality from diabetes

Operations

High levels of operating efficiency with minimal wastage of resources

Information about the program reaches a wide market in Barbour and the surrounding counties, increasing reach

The program earns a positive reputation from compliance with regulations

The Client/Patient

The incentives drive more and more clients to complete their education sessions

Better understanding from clients owing to the use of diverse teaching strategies including pictures

Proper follow-up is done to ensure that more than 50 percent of participants complete their sessions

The Staff

High performance from the staff and increased efficiency

low staff turnover and absenteeism rates, ensuring effective service delivery

Staff are kept motivated and fulfilled, and maintain their loyalty

Technology

The program makes use of the best available software and hardware

Work progresses smoothly with minimal technological hitches that affect efficiency

The program moves at par with trends in technology, ensuring high levels of efficiency.

Risk Assessment

Risks

Overall Results and Strategies for Minimizing the Risks

Financial Risk - the cost of losing money on the investment (ASHRM, 2011)

The probability of occurrence is low given the low levels of competition in the southeastern area. To minimize this risk, the program will diversify its sources of income - for instance, seek donor funding to complement client fees. There program will also maintain an emergency fund – a certain proportion of profits will be sent to the emergency fund every year to cushion against unexpected losses

Human capital risk – loss of human resource investment due to absenteeism and high staff turnover (ASHRM, 2011)

The risk is relatively high owing to the program’s location in a rural area. To minimize this risk, the program will offer competitive remuneration and attractive incentives to its employees, as well as involving them in decision-making to keep them satisfied.

Strategic risk – failure of organizational strategy (ASHRM, 2011)

The risk is low as a proper-needs assessment will be conducted prior to establishment to ensure that appropriate strategies are formulated. To minimize this risk, the program will market its brand through vigorous advertising. Further, regular customer surveys will be conducted to identify changing needs and expectations, and the organization will then adapt its services to align with these.

Legal risk – the risk of litigation (ASHRM, 2011)

The risk is moderate to high given the vulnerability of the served client population. For instance, one could make their own wrong nutritional choice and blame it on the program. The program will minimize this risk by putting in place a robust legal department and ensuring that all clients sign contracts guiding their interaction with the program before sessions begin

Environmental risk (ASHRM, 2011)

Barbour County is recognized as a primary natural disaster area and the risk of environmental risk is relatively high (FSA, 2019). The program will take up adequate insurance coverage for equipment and employees to mitigate the risk of loss

Financial Projections (suggested length 1–2 pages)

The program’s main source of revenue is client fees paid either out-of-pocket or through a payer. At the same time, the program operates as a low-cost diabetes education service providing health education services to low-income earners in the rural counties of Barbour and its surroundings. To subsidize its client charges, the program will seek grants and donor funding to complement revenues generated from client fees. Additional revenues will also be generated from fundraising events like local diabetes fairs organized by the local department of health, where the program will lease out booths to vendors in exchange for capital fees (QIO Program, 2016).

Clients’ out-of-pocket payments will be sourced from insurance deductibles and co-payments, fee-for-service payments, and fee-payment plans for clients using self-pay (QIO Program, 2016). Additional revenue will be generated from reimbursements from financial payers, including Medicare, Medicaid, and private insurance plans. To ensure positive cash flows, insurance claims will be proactively monitored to ensure that reimbursement claims, fees from self-paying patients, and co-payments are received within two months (QIO Program, 2016). Revenues are projected to grow by 10 percent annually. Assuming a client visitation rate of 200 in year 1; revenues are projected as shown:

Projected Revenue Growth for Year 1- 3

Operational Expense Budget

Category

Description of Each Type of Expense

Personnel Expenses

Costs incurred in the training of educators and staff - $400

Salaries and wages (3 educators & 3 support staff to start with) - $60,000

Incentives and bonuses - $30,000

Other-than-Personnel (OTP) Expenses

Client/patient costs - $10,000

Operational costs - $15,000

Technology costs - $5,000

Licensing costs - $500

Capital expenditure - $10,000

Key Performance Indicators (KPIs) (suggested length 1–2 pages)

Service Plan KPIs

Measurement and Frequency

Structure: employee trainings

The KPI will be measured by the proportion of employees who receive relevant training in their areas of work. Measurement will take place at the end of every year.

Process: knowledge achieved with training

The KPI will be measured by observing and taking records of the number of clients who can accurately self-monitor their blood sugar levels. The KPI will be measured whenever a participant completes two of the required five sessions.

Outcome: quality of life as measured by decreases in BMI, HbA1c, and systolic blood pressure

The percentage of clients in every group of 10-15 who record a decrease of at least 0.5 percent in HbA1c, BMI, and systolic blood pressure by the end of their education sessions. KPI is to be measured at the end of the five education sessions

The structure KPI will provide a plan on employee trainings, helping the program administrators make decisions on which employees are eligible for training in any given year. The KPI thus provides a crucial basis for budgeting with regard to training and development. The process and outcome KPIs provide a view of the effectiveness of the program design, helping the administrators make crucial decisions such as whether the five educational sessions are sufficient for effective learning or there is a need to increase the same. The outcome KPI further helps the program administrators assess the effectiveness of the educational strategies employed.

To improve staff performance, the program will emphasize training, with administrators keen on ensuring that all employees receive appropriate relevant training to increase their effectiveness in their area of work. To improve inter-professional collaboration, the program will encourage multidisciplinary rounds, where different members of the care team drawn from different disciplines collaboratively discuss the care of a patient and share knowledge on the most appropriate care plan (Gurses & Xiao, 2006). Studies have found these rounds to have significant benefits in fostering inter-professional collaboration among healthcare workers (Gurses & Xiao, 2006).

Service Plan Start-Up Tasks and Timelines (suggested length 1 page)