Unit 5 and Unit 6Unit 5 and Unit 6

HS 499-01HS 499-01Adrienne Palmer, BSPH, MHA, FACHEAdrienne Palmer, BSPH, MHA, FACHE

Unit 5 projectUnit 5 projectExternship Project – Section IExternship Project – Section I

Initial Analysis of the Organization Initial Analysis of the Organization Describe the facility, patient or client base, clinical scope of practice, Describe the facility, patient or client base, clinical scope of practice,

available equipment, physical setting, and level of clinical activity of available equipment, physical setting, and level of clinical activity of the organization where your externship experience occurs. the organization where your externship experience occurs.

Describe the mission and goals of this organization and the means Describe the mission and goals of this organization and the means and strategy of the organization to support the mission and goals of and strategy of the organization to support the mission and goals of the organization. the organization.

Report the consumer and patient rights issues that the organization Report the consumer and patient rights issues that the organization follows. follows.

Prepare a SWOT analysis (Strengths, Weaknesses, Opportunities, and Prepare a SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) of the external and internal forces that are faced by this Threats) of the external and internal forces that are faced by this organization.organization.

Be sure to cite at least 4 references in this section.Be sure to cite at least 4 references in this section.

NOTE: Please see the Final Report expectations in Unit 9 for length and formatting requirements.

Unit 5Unit 5

Health Care and E-Health Care and E-CommerceCommerce

Vital to economic productivity of any Vital to economic productivity of any industrialized nationindustrialized nation

Healthcare has several supply chains: Healthcare has several supply chains: professional services, pharmaceutical professional services, pharmaceutical products, supplies, and equipmentproducts, supplies, and equipment

One challenge is finding a flexible One challenge is finding a flexible delivery enterprise with substantial delivery enterprise with substantial capital and efficient operationscapital and efficient operations

Healthcare and e-Healthcare and e-commercecommerce

Barriers to collaborationBarriers to collaboration Non-disclosure – one individual believes that Non-disclosure – one individual believes that

information is power and withholding information information is power and withholding information leads to more powerleads to more power

Disclosure - disclosing information to those who Disclosure - disclosing information to those who may not need to know in order to undermine the may not need to know in order to undermine the potential initiativepotential initiative

Contributors to effective collaborationContributors to effective collaboration Communication: first step towards collaborationCommunication: first step towards collaboration Collaboration: pursued interactionCollaboration: pursued interaction

Information technology Information technology environmentenvironment

HIPAAHIPAA Electronic healthcare: Electronic healthcare:

Value of InternetValue of Internet Electronic information management systemsElectronic information management systems

Health information and other business Health information and other business data securitydata security

E-health careE-health care

Web-enabled applications are used for claims Web-enabled applications are used for claims handling, physician practice management handling, physician practice management systems, online prescriptions, hospital systems, online prescriptions, hospital laboratories, etc.laboratories, etc.

New systems and potential advancements in New systems and potential advancements in this area include: solutions for chronically ill this area include: solutions for chronically ill patients, finance and accounting programs, patients, finance and accounting programs, medical supply purchasing, risk management, medical supply purchasing, risk management, provider credentialing, etc.provider credentialing, etc.

E. Healthcare supply E. Healthcare supply chainchain

Link between patients, insurance Link between patients, insurance companies, employers, and providerscompanies, employers, and providers

With the advancements in technology, With the advancements in technology, much of this flow is happening much of this flow is happening electronically and the data exchange rate electronically and the data exchange rate is highis high

Investing in e-commerceInvesting in e-commerce

Perform a knowledge audit of top intellectual Perform a knowledge audit of top intellectual assetsassets

Create an online directory regarding the Create an online directory regarding the expertise of individual workers and making it expertise of individual workers and making it available to allavailable to all

Established discussion groups on Internet to Established discussion groups on Internet to collaborate on problem-solvingcollaborate on problem-solving

Develop customer profilesDevelop customer profiles Reward information sharingReward information sharing

““Building on a foundation: strategies, Building on a foundation: strategies, processes and outcomes of health processes and outcomes of health promotion in primary health care promotion in primary health care settings”settings”

Treatment alone is unlikely to help market Treatment alone is unlikely to help market effects on health equities that underlie many effects on health equities that underlie many health conditionshealth conditions

To close these gaps, we need greater To close these gaps, we need greater integration of health promotion and primary integration of health promotion and primary healthcarehealthcare

Need to consider philosophical values for the Need to consider philosophical values for the foundation of health promotion, how they foundation of health promotion, how they should be incorporated into structures in a should be incorporated into structures in a supportive environment, and the processes supportive environment, and the processes that you need to make this happenthat you need to make this happen

Health promotion and Health promotion and primary careprimary care

Strategies (types of interventions) and Strategies (types of interventions) and processes (client and community centered processes (client and community centered care) are important health promotion initiativescare) are important health promotion initiatives

Strategies: Strategies: medical or preventive medicine approach directed at medical or preventive medicine approach directed at

physiological risk factorsphysiological risk factors Behavioral or lifestyle approach directed at Behavioral or lifestyle approach directed at

behavioral risk factorsbehavioral risk factors Socio-environmental approach directed at social Socio-environmental approach directed at social

and environmental factorsand environmental factors

Health promotion and Health promotion and primary careprimary care

Health promotion approach looks to focus beyond just Health promotion approach looks to focus beyond just the individual but also the communitythe individual but also the community

Individual strategies Individual strategies Focus on care interventions between an individual healthcare Focus on care interventions between an individual healthcare

provider with the individual being targeted for changeprovider with the individual being targeted for change Group strategies Group strategies

Usually fewer than 20 participants, include group counseling Usually fewer than 20 participants, include group counseling capacity building outreach and social supportcapacity building outreach and social support

Community strategies Community strategies Will affect our community and population, include community Will affect our community and population, include community

and economic development, healthy public policy, medical and economic development, healthy public policy, medical availability, etc.availability, etc.

Organizational strategiesOrganizational strategies Target the health setting itself and its practitionersTarget the health setting itself and its practitioners

Health promotion and Health promotion and primary careprimary care

ProcessProcess Proactive approach – addressing presenting Proactive approach – addressing presenting

symptoms and immediate needssymptoms and immediate needs Individualization and choice – individuals engaged in Individualization and choice – individuals engaged in

making their own decisions about their health caremaking their own decisions about their health care Mutual learning – individuals involved in planning Mutual learning – individuals involved in planning

and making decisionsand making decisions Respectful communication – good rapport between Respectful communication – good rapport between

clients and health professionalsclients and health professionals Meaningful participation – meaningful valuation of Meaningful participation – meaningful valuation of

health-related activities or serviceshealth-related activities or services

Developing an integrated Developing an integrated primary care practiceprimary care practice

Example: Kaiser PermanenteExample: Kaiser Permanente Lack of integration with the girl helped Lack of integration with the girl helped

programsprograms Usually occurs when professionals take care of Usually occurs when professionals take care of

the same given population (VA)the same given population (VA) Important to integrate to reduce unnecessary Important to integrate to reduce unnecessary

testing and ensure all providers have all testing and ensure all providers have all information about the patientinformation about the patient

Steps to developing an Steps to developing an integrated primary care integrated primary care practicepractice

Step one: analyze healthcare system, potential Step one: analyze healthcare system, potential collaborators, and alliancescollaborators, and alliances

Step two: assess current status on continuum Step two: assess current status on continuum of integrated careof integrated care

Step three: identify driving forces and barriers Step three: identify driving forces and barriers to changeto change

Step four: collaboratively implement a pilot Step four: collaboratively implement a pilot program, evaluate, redesign it, and test it againprogram, evaluate, redesign it, and test it again

Discussion questionDiscussion question

What do you think are some of the What do you think are some of the benefits of an integrated primary care benefits of an integrated primary care practice?practice?

What are some of the negatives/potential What are some of the negatives/potential risk?risk?

Time management Time management strategies in nursing strategies in nursing practicepractice Time budget studies – one of oldest Time budget studies – one of oldest

approaches for investigating timeapproaches for investigating time Usually involves task analysis, to show Usually involves task analysis, to show

range of tasks and time taken for eachrange of tasks and time taken for each Concern from nursing evolves around Concern from nursing evolves around

“invisible” dimensions, i.e. time with patient“invisible” dimensions, i.e. time with patient Most time management studies related to Most time management studies related to

nursing focus on that fact that nurses nursing focus on that fact that nurses should try to manage their timeshould try to manage their time

Time management Time management strategies in nursing strategies in nursing practicepractice This study:This study:

Identified the following time strategies:Identified the following time strategies: Routinization Routinization ConcealmentConcealment Catch upCatch up JugglingJuggling Extending temporal boundariesExtending temporal boundaries

Routinization Routinization

Helps normalize patternsHelps normalize patterns Can be taken for grantedCan be taken for granted Helps reduce “decision time”Helps reduce “decision time” Can reduce time pressureCan reduce time pressure Focuses on need to complete Focuses on need to complete

activities within certain time framesactivities within certain time frames However, can be difficult to changeHowever, can be difficult to change

Time management Time management strategies in nursing strategies in nursing practicepractice This study:This study:

Identified the following repertoire of actions:Identified the following repertoire of actions: Focusing Focusing AvoidanceAvoidance Selective attentionSelective attention Short cuttingShort cutting Saying noSaying no Making compromisesMaking compromises DelegationDelegation SynchronizingSynchronizing

PrioritizingPrioritizing

Provides structure for time-ordering of workProvides structure for time-ordering of work Must be able to deal with conflicting priorities Must be able to deal with conflicting priorities

(patients vs physicians, multiple patients, (patients vs physicians, multiple patients, timelines for other departments, etc)timelines for other departments, etc)

Methods:Methods: Patient urgency based on clinical needsPatient urgency based on clinical needs Advance timing Advance timing Nurse coverageNurse coverage DelegationDelegation Work sharingWork sharing

Take-awaysTake-aways

Need to challenge how individuals Need to challenge how individuals manage their timemanage their time

Both routines and priorities can be Both routines and priorities can be influenced by team and the organizationinfluenced by team and the organization

Individuals should be empowered to have Individuals should be empowered to have management of their time and workload management of their time and workload (within limits) to best accomplish the (within limits) to best accomplish the workloadworkload

Unit 6Unit 6

Evidence-based Evidence-based healthcare architecturehealthcare architecture

Currently, the US and the UK are both investing Currently, the US and the UK are both investing millions/billions of funds in construction of new millions/billions of funds in construction of new hospitals and other healthcare facilitieshospitals and other healthcare facilities

Current research shows hospital noise levels are too Current research shows hospital noise levels are too high, increasingly so for multi-bed roomshigh, increasingly so for multi-bed rooms

Noise has been associated with sleep loss and Noise has been associated with sleep loss and fragmentation, high blood pressure and heart rates, fragmentation, high blood pressure and heart rates, worst recovery rates, and decreased oxygen saturationworst recovery rates, and decreased oxygen saturation

Considerations: carpeting in hallways and waiting Considerations: carpeting in hallways and waiting areas to reduce noise, single bedrooms, installation of areas to reduce noise, single bedrooms, installation of noise causing surfacesnoise causing surfaces

Evidence based health Evidence based health care architecturecare architecture

Research supports design of the physical Research supports design of the physical environment is important for reducing environment is important for reducing infections as wellinfections as well

Single rooms again have advantages in Single rooms again have advantages in this areathis area

Other options include additional Other options include additional ventilation, filtration, air changes, or ventilation, filtration, air changes, or creation of negative from pressurecreation of negative from pressure

Contact transmission of Contact transmission of infectioninfection

Unwashed hands of staff is main Unwashed hands of staff is main transmission venuetransmission venue

Location of sinks and alcohol hand gel Location of sinks and alcohol hand gel dispensers are very importantdispensers are very important

Staff fatigue and patient Staff fatigue and patient workflowworkflow

Floor layouts can be designed to reduce Floor layouts can be designed to reduce staff fatigue and increase comfort carestaff fatigue and increase comfort care

Reduce transportation wasteReduce transportation waste Consider decentralizing charting stations Consider decentralizing charting stations

based on the nurse to patient ratio based on the nurse to patient ratio applicable for those unitsapplicable for those units

Discussion questionDiscussion question

Are the evidence-based upgrades worth Are the evidence-based upgrades worth the cost?the cost?

Are there any opportunities in your Are there any opportunities in your externship facilities that you believe could externship facilities that you believe could be applied to any of these principles?be applied to any of these principles?

Unit 6 assignmentUnit 6 assignment Quality Improvement Proposal You have just been hired as a consultant to the chief executive officer (CEO) of a health

care organization. Your duty is to improve the management tools and practices needed to work in teams, build cross-functional teams, and facilitate collaborative decision-making.

You need to identify elements found in an effective health care work group and identify barriers to communication that may cause conflict within a group. Also, forward communication techniques that can be used to avoid conflicts within a team where individuals hold different roles.

You need to address ways to improve communication among departments in an organization to avoid conflict. Finally, identify strategies that may be used to avoid recurring conflicts and ways a leader can prevent conflict within team in the organization.

Based upon what you have learned in this class, prepare a 1,250-1,500 word paper in which you propose a quality improvement plan to present to the CEO addressing these issues.

Cite at least four references in addition to your textbook to validate your proposal. Prepare this assignment according to the APA guidelines.

Questions?Questions?