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NHS: National Health Service

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The National Health Service (NHS)

Introduction

The National Health Service (NHS) is identified as one of the best healthcare system. This is attributable to the National Health Service April 2013 health reforms; which aimed at improving care delivery with fewer resources. These reforms have made improvements in a number of areas in healthcare including funding of the system and patient satisfaction, making the NHS to be more efficient.

Patient choices have been extended to primary care, community care and in mental health services (NHS England, 2014). There has been increased transparency on patient outcomes and data. However, several studies have reported less positive information on National Health Service reforms. According to critics, the benefits and savings being reaped from the reforms is only short term, and that it is not sustainable.

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The progress of the reforms are somewhat disappointing towards establishing a sustainable integrative healthcare services which impeded the establishment of greater use of A&E alternatives, high level completion or greater capacity for outpatient care (Tian, et al., 2012).

For this reason, this article will explore how the NHS reforms introduced in April 2013 have brought changes in the healthcare services. The main reasons behind the introduction of these reforms will also be evaluated. This will facilitate the understanding of development of healthcare systems in the UK, and the State’s roles in changing of the system (Murray et al., 2014).

Additionally, the reasons for recent changes to National Health Service will be evaluated through the analysis of healthcare policies and political perspective in the contemporary health issues in the UK. This facilitates understanding of the various debates and concepts of health promotion, public health, and management of the health services. This paper is planned as follows (Trust Development Authority, 2014);

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Development of healthcare in the UK and Changing of the States roles

The healthcare system in the UK was established after World War II, and began its operations on 5^th July 1948. The National Health Service was proposed in the UK parliament in 1942 in the Beveridge report on Social Insurance (BSI) and other health services allied. The NHS is a bequest of Aneurin Bevan, a previous mineworker who turn out to be the then Minister of Health. NHS was established under the doctrines of impartiality, universality and easy access and delivery of services. The principles were facilitated by a central funding from the government (Alexander, 2013).

In England, the health policy and healthcare is the accountability of the central government. In Scotland, Northern Ireland and Wales, the health care and health policy is the concern of the decentralized governments. In every of the United Kingdom nations, the National Health Service system has its unique structure as well as organization, but has a general organization structure.

Generally, the healthcare consists of two major categories, one section deals with strategy and policy management, whereas the other deals with actual clinical care and medical interventions, which is in turn subdivided into primary care ( General physicians, pharmacists, dentists etcetera), secondary care ( consists of hospice-centred care) and tertiary maintenance (expertise hospitals) (Woringer et al., 2015).

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Recently, the distinction amid the two sections has become less clear. This is attributable to the fact that the last few years have been guided by shifting balance of authority. The other phase and Walness reports have described the gradual changes within the National Health Service that has resulted into shift towards the local or devolved rather than the centralised decision making process.

The emphasis has been on identification of barriers to effective delivery of the primary and secondary care. This was reinforced by the previous government on 2008 in the strategy dubbed “NHS Next Stage Review: High Quality Care for all” (Cornock, 2016), and “Equity and excellence: Liberating the NHS” 2010 strategy that has remained focus of the current government (Cornock, 2016).

The government has remained supportive of the initial NHS principles but possibly through different mechanisms. Recent past, the United Kingdom`s government announced plans to develop strategies that will produce most radical changes in the NHS. The white paper proposed on July 12^th, 2010 “Equity and excellence: Liberating the NHS” aimed at outlining strategies that creates a patient centred and more responsive NHS (Trust Development Authority, 2014).

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Reasons for reforming NHS

The NHS reforms introduced in April 2013 aimed at bringing positive change to the services. Learning from the past mistakes in UK and elsewhere, it was just right time to bring about the fundamental shift to reform the National Health Service. Previously, the UK politics and policy only established short-term political initiatives which were the main hindrances of long-term policy achievements and establishing a sustainable and transformational change. The previous government’s structural reforms were large-scale which acted as major distractions rather than facilitators (NHS England, 2014).

The NHS reforms ensured that such distractions are avoided in the future. Previously, the NHS reforms relied on external stimuli such as performance management, targets, quality inspection and regulation, choice and competition. These were too little to offer for improvement from within the health care. This called for a new settlement where the strategic role of a politician could be demarcated clearly. This helped minimize the frequent shift in directions which hindered transformational change (Trust Development Authority, 2014).

Unlike in the past, April 2013 National Health Service reforms did not dwell on bold strokes or politician big gestures, but rather engaged the primary care, secondary care and tertiary care providers. It focused mainly on healthcare staff improvements. The complementary approaches used by these reforms pursued national leadership in combination with devolution, competition and innovative standardization (NHS England, 2014).

The April 2013 reforms focused on transparency, devolution and performance in a systematic manner. The reforms ensured that the improvement in the NH was based on commitment instead of compliance by investing in staff improvement to empower them to achieve sustainable quality improvement. The reforms envisioned a high performing healthcare organization, which indicated continuity in leadership, organization stability and clear goals for improvement in delivery of healthcare services (Woringer et al., 2015).

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Underlying concepts of funding in healthcare

The overall organizational structure of NHS in the National Health Service fiscal support is obtained from taxation. Approximately, 60% of the funds are used for staff salary, whereas additional 20% is used for medical appliances such as drugs, buildings, training costs, and equipment. The principle founders of the NHS system were the NHS primary Care Trusts (PCTs).

They disburse funds to the commissioned healthcare providers such as the NHS trusts, General Providers and Private providers according to the agreed contract basis. In public healthcare medical cover, vast of the National Health Service services are free. This implies that UK citizens need not pay anything for doctor visits, nursing services and consumable charges such as medications and laboratory services (Iacobucci, 2015).

The Department of Health have the responsibility for direction of National Health Service, public health and social care and the delivery of care. This includes developing policies and strategic interventions and ensures that they secure healthcare resources. Previously, there are about 10 strategic Health authorities manages NHS at local level, and the PCTs control approximately eighty percent of the NHS budget to provide the commission services and governance, and to ensure resource availability within the public health.

The NHS trusts operate on basis of paying by results (NHS England, 2014). Examples of NHS trusts include the Mental Health, Acute care, Ambulance, Foundation Trust and Children’s Trust. The foundation Trusts was developed to increase financial obligations and are monitored by an independent body. These include the Care Quality Commission, National Audit Office, Audit commission, Medicines and Healthcare Products Regulatory Agency, British Medical association, and the National Institute for Health and Clinical Excellence (NICE) (Frisina Doetter & Götze, 2011).

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Evaluation of health policies as well as political thoughts in contemporary health issues

The government has embarked on widespread reform programme which aims at introducing substantial changes in the NHS structure and management, and to improve the quality of care delivery. For instance, a number of new changes in NHS was introduced by the April 1^st NHS reforms in England. One of the main changes done by these reforms includes shifting of responsibilities that originally were in the Department of Health, to the politically independent entity- the NHS commissioning Board.

The reforms will also establish a health specific economic monitor whose aim is to guard the healthcare delivery from ‘anti-competitive practices. The reforms ensure that all NHS trusts are shifted to foundation trust status (Le Grand, 2013).

The reforms are expected to fill some gaps in the UK healthcare system. According to the April 2013 reforms, the government supports the idea of GP commissioning. This implies that the key decisions of patient’s treatment should be made by GP in partnership with the service user rather than the managerial organisations.

The Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs). Under the new reform, GPs are integrated in the consortium that controls commission’s services and budgets. However, the NHS commissioning Board is expected to reduce health inequalities so as to access healthcare (Edkins, Cairns & Hultman, 2014).

The government white paper calls for a healthcare system that moves away from the centrally-driven healthcare system to one which focuses on the patient outcomes and the quality of care delivered (Mead, 2013). This devolution of healthcare system implies the five main domains used to assess the effectiveness of the program success are realized.

These includes reduction of premature death, improving the life of people living with chronic diseases, helping people recover from preventable injuries, ensure people easily access better care services equitably and ensuring a safe environment and protecting people from harm (Mead, 2013).

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The reform has been highly criticized warning that the move is creeping towards privatisation of commissioners. The opponents argue that the profit oriented firms could oust GPs from their role of making decision on effective treatments due to the creeping privatisation of primary care.

According British Medical Association (BMA), the reforms would make the relationship between physician and patients will suffer irreparable damages, and the negative impacts will damage NHS irreversibly. According to the BMA, health and social care bill is incoherent, complex and unfit for its purpose. They argue that to sustain the implemented reforms will be difficult (Sussex, n.d.).

The privatisation of commissioning will cause massive effects on public health, as it will is likely to exacerbate health inequalities and loss of accountability. Most of the areas affected by the reforms are about the issue of how money is spent and who makes the decisions. This is because new organizations are being established and others being abolished. The legal responsibility for management of NHS budget will be shifted to new organisations. Local councils are also given higher mandate in matters that influence health services. The suggested performance reforms and finance performance is somewhat daunting (Milburn & Flowerday, 2012).

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For instance, on autonomy, many people believe that the policy landscape is clear. This implies that the NHS Trusts autonomy would be progressively replaced by the independent foundation trusts. According to Cornock (2016), the rising new relationship between commissioners and providers will help bring primary and secondary care closely, which will help merge the transformation and sustainability plans to sustain effective delivery of services (Triggle, 2014).

However, this would imply deterioration of performance and finance as the central control of healthcare budget is extended to include other aspects of healthcare such as operational management and workforce (Murray et al., 2014). As the issue of finance recedes, NHS is expected to invent new approach to sustain the earned autonomy for NHS providers. This is a challenge because the foundation trust model may fail to ultimately protect the local organizations autonomy. Therefore, to reinvent autonomy, the NHS governance and structure will need to be restructured (Woringer et al., 2015).

Conclusion

Despite the fact that the reforms were established to reduce health inequalities, the reforms issues are highly debateable. The government believed that the NHS reforms were the best approach to improve the public health. Clearly, many things as highlighted by BMA have been overlooked. In this context, the NHS needs to make more honest assessment of what can be achieved and ensure that the strategic plans designed are comprehensive and realized.

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References

Alexander, J. (2013). The Tavistock and Portman NHS Trust short course Holding the Baby and Toddler Mind: An individual family and community perspective April 2013. Infant Observation, 16(2), 200-204. http://dx.doi.org/10.1080/13698036.2013.818362

Cornock, M. (2016). Removing rancour in examining mistakes would be new for the NHS. Nursing Standard, 30(30), 30-31. http://dx.doi.org/10.7748/ns.30.30.30.s38

Edkins, R., Cairns, B., & Hultman, C. (2014). A Systematic Review of Advance Practice Providers in Acute Care. Annals of Plastic Surgery, 1. http://dx.doi.org/10.1097/sap.0000000000000106

Frisina Doetter, L., & Gatze, R. (2011). Health Care Policy for Better or for Worse? Examining NHS Reforms during Times of Economic Crisis versus Relative Stability. Social Policy & Administration, 45(4), 488-505. http://dx.doi.org/10.1111/j.1467-9515.2011.00786.x

Iacobucci, G. (2015). Privatisation of cancer and end of life care services in Staffordshire could threaten NHS providers, warn critics. BMJ, 350(mar19 9), h1557-h1557. http://dx.doi.org/10.1136/bmj.h1557

Le Grand, J. (2013). Will 1 April mark the beginning of the end of England’s NHS? No. BMJ, 346(mar26 4), f1975-f1975. http://dx.doi.org/10.1136/bmj.f1975

Mead, J. (2013). Orthopaedics – Allegation of obsolete procedure dismissed: Ecclestone v Medway NHS Foundation Trust (High Court, 12 April 2013 – Judge Reddihough). Clinical Risk, 19(3), 83-84. http://dx.doi.org/10.1177/1356262213497684

Milburn, S., & Flowerday, A. (2012). Delivering scalable Telehealth: What is Scale? With case studies from NHS providers, a perspective on the challenges, constraints and issues associated with scalability. Int J Integr Care, 12(4). http://dx.doi.org/10.5334/ijic.931

Murray, R. et al., (2014). Financial failure in the NHS: What causes it and how best to manage it, The King’s Fund. Retrieved from http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/financial-failure-in-the-nhs-kingsfund-oct14.pdf

NHS England. (2014), Examining new options and opportunities for providers of NHS care: the Dalton Review. NHS England (2014), Five. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/384126/Dalton_Review.pdf.

Sussex, J. (n.d.). How Fair? Competition between Independent and NHS Providers to Supply Non-Emergency Hospital Care to NHS Patients in England. SSRN Electronic Journal. http://dx.doi.org/10.2139/ssrn.2640148

Tian, Y. et al. (2012). “Data briefing: Emergency hospitals admissions for ambulatoryCare-sensitive conditions”, The King’s Fund. Retrieved from http://www.kingsfund.org.uk/publications/data-briefing-emergency-hospital-admissions-ambulatory-care-sensitive-conditions

Trust Development Authority. (2014). Annual report and accounts for the period 1 April 2013-31 March 2014. Retrieved from http://www.ntda.nhs.uk/wp-content/uploads/2014/07/NHS-TDA-Annual-Reports-and-Accounts-201314.pdf.

Triggle, N. (2014). Five-year plan to transform NHS focuses on teamwork. Nursing Management, 21(8), 10-11. http://dx.doi.org/10.7748/nm.21.8.10.s12

Woringer, M., Cecil, E., Watt, H., Chang, K., Hamid, F., & Khunti, K. (2015). Community Providers of the NHS Health Check CVD Prevention Programme Target Younger and More Deprived People. Int J Integr Care, 15(5). http://dx.doi.org/10.5334/ijic.2185

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Banner Health Care Organization

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Case Study: Banner Health care

Banner Health organization is among the biggest non-profit organization in the USA. Its headquarters is at Phoenix, Arizona. It oversees about twenty nine healthcare facilities including home care programs, family health clinics, and long-term healthcare facilities. Banner Health care delivers its services to nine States in the Western and Mid-Western States (Banner Health, 2015).

This organization was established in 1999 through the merging of Samaritan Health Systems and Lutheran Health systems. Currently, the organization has employed about 47,000 people who deliver services to about 300,000 service users (Berlyl Institute, n.d.). This healthcare organization caters for patient’s basic medical costs and emergency healthcare costs.

Additionally, the organization covers for specialized healthcare services such as heart transplants, bone marrow transplants, and psychosocial rehabilitative services. This non-profit organization also covers for life threatening healthcare complications such as spinal injuries and Alzheimer disease. It is approximated that the total worth of the organization as 3.1 billion dollars, with an annual return of 2.6 billion dollar (Kuhn and Chuck, 2015).

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Banner healthcare has focused its resources into delivery of safety and quality of care. This entails establishing stringent measures that detect mistakes such as patient identification errors, which impede delivery of quality services. The coordinated service improves the organization performance and maintains organization’s integrity as well as improving patient satisfaction (Banner Health, 2015).

This has enabled the organization to identify functional areas, which require improvement in order to sustain its performance. This has led to the creation of cross-facility employees, whose role is to deliberate on ideas that ensure new knowledge on organization is gathered and integrated within the organization standards (Armbrister, 2012).

For example, for a very long time Banner health institution overlooked the relationship between organization cultures and its leadership, and ways they influenced the organization performances. The Banner Health organizations works together with other multiple healthcare facilities across the Nation, which makes it challenging to identify a standard policy that would ensure effective delivery of services in each of the healthcare facilities across the miles (Armbrister, 2012).

This is attributable to the fact that each of the healthcare facility are in different geographical location, thus, the sociocultural factors differs from one healthcare facility to another. Thus, applying a common method would lead into more challenges. For this reason, the organization has adopted the integration of culture driven policies that would help sustain the organizations success. The organization culture plays an integral role in shaping the organizations performances (Berlyl Institute, n.d.). This includes identification of management themes that put the interests of the service users as the priority.

The above diagram illustrates the model used at this organization to run its day –to- day practices. The model comprises of four main themes;

a) effective communication of the organization vision,

b) measurable accountability,

c) developing effective leadership and

d) sustaining the success.

The first theme addresses the role of effective communication, which is one of the main hindrances of success in most of the institution. This model ensures that there is effective communication between the employees and their leaders; thus, the employees work to achieve the organization vision, mission and goals (Kuhn and Chuck, 2015).

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The second theme discusses the issue of employee’s responsibility and accountability. The leader’s roles are to ensure that the employee’s accountability is aligned within the organization’s framework. This implies that the leaders acts as role models, and are expected to exemplify the true measure of accountability within their organizations (Armbrister, 2012).

Banner Health has established solid metrics (patient’s satisfaction and experiences) systems, which evaluates the accountability and success each healthcare facility. The applications of score cards ensure that each employee is held accountable of their services. The leaders are expected to guide and provide all the resources needed, and to motivate the employees. This is to ensure that Bander’s health mission and vision are articulated effectively (Berlyl Institute, n.d.).

The third theme involves recruitment process and staffing ratios. The banner health has adopted the habit of recruiting leaders who are proactive and are likely to steer success. This is because active leaders ensure that their employee’s skills are improved through refresher courses and internal programs.

This ensures that employees’ specific skills and talents are improved, and new skills are developed through continuous learning. The organization promotes teamwork. It is through the teamwork that cultural competencies are developed which ensures that the employees respect each other’s values and beliefs which reduces the incidences of office bickering (Kuhn and Chuck, 2015).

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The last strategies used by the organization are by establishing measures that ensures that there are sustainable developments. This ischallenging as the healthcare industry is dynamic. Therefore, the organization has recruited research employees whose work is to identify the changes in market demands so that the organization can change its strategies to align with the market demands.

This increases their competitive advantages as the organization manages to make changes according to the market demands. This ensures that the organization explores new areas and discovers other opportunities that have not been realized by their competitors. These processes sustain its development effectively (Berlyl Institute, n.d.).

From this discussion, it is evident that these strategic measures are only effective if articulated simultaneously. For example, integrating effective communication within the organization ensures that each employee understands the organization’s visions and missions. This also ensures that the employees understand their responsibilities within the organization (Armbrister, 2012).

Working with competent leaders ensures that the team members are committed to achieving the organizations goals. The motivation is transmitted from the top management to employees. The clarity of the organizations directives establishes a foundation that ensures that the employees are held accountable of their actions (Banner Health, 2015).

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In summation, Banner Health has sustained their successes by improving the delivery of services. The Banner Health performances have exceeded the internal targets and are reported in the past years to have achieved stretch targets. The organizations financial capacity has been improved such that it can survive any healthcare dynamic trend. Thus, Banner Health is an established and efficient network concerned with improving the community wellbeing (Armbrister, 2012).

References

Armbrister, M. (2012). Just what is Banner Health planning? Northern Colorado Business Report 18(4) p2B-8B

Banner Health (2015). Banner Health Medtrack company profile. Database Business complete. Retrieved from https://www.medtrack.com

Berlyl Institute (n.d.). Banner Health: Best practices in leadership an exceptional patient experience. Retrieved from http://www.theberylinstitute.org/?page=CASE122010

Kuhn, B., and Chuck, L. (2015). Value-based reimbursement: The Banner Health Network Experience. Winter, Vol 32, 2, p17-31

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The National Health Service (NHS)

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The National Health Service (NHS)

Introduction

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Development of healthcare in the UK and Changing of the States roles

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Recently, the distinction amid the two sections has become less clear. This is attributable to the fact that the last few years have been guided by shifting balance of authority. The other phase and Walness reports have described the gradual changes within the NHS that has resulted into shift towards the local or devolved rather than the centralised decision making process.

The government has remained supportive of the initial National Health Service principles but possibly through different mechanisms. Recent past, the United Kingdom`s government announced plans to develop strategies that will produce most radical changes in the NHS. The white paper proposed on July 12^th, 2010 “Equity and excellence: Liberating the NHS” aimed at outlining strategies that creates a patient centred and more responsive NHS (Trust Development Authority, 2014).

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Reasons for reforming NHS

The NHS reforms ensured that such distractions are avoided in the future. Previously, the National Health Service reforms relied on external stimuli such as performance management, targets, quality inspection and regulation, choice and competition. These were too little to offer for improvement from within the health care. This called for a new settlement where the strategic role of a politician could be demarcated clearly. This helped minimize the frequent shift in directions which hindered transformational change (Trust Development Authority, 2014).

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Underlying concepts of funding in healthcare

They disburse funds to the commissioned healthcare providers such as the National Health Service trusts, General Providers and Private providers according to the agreed contract basis. In public healthcare medical cover, vast of the National Health Service services are free. This implies that UK citizens need not pay anything for doctor visits, nursing services and consumable charges such as medications and laboratory services (Iacobucci, 2015).

The NHS trusts operate on basis of paying by results (NHS England, 2014). Examples of National Health Service trusts include the Mental Health, Acute care, Ambulance, Foundation Trust and Children’s Trust. The foundation Trusts was developed to increase financial obligations and are monitored by an independent body. These include the Care Quality Commission, National Audit Office, Audit commission, Medicines and Healthcare Products Regulatory Agency, British Medical association, and the National Institute for Health and Clinical Excellence (NICE) (Frisina Doetter & Götze, 2011).

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Evaluation of health policies as well as political thoughts in contemporary health issues

The government has embarked on widespread reform programme which aims at introducing substantial changes in the National Health Service structure and management, and to improve the quality of care delivery. For instance, a number of new changes in NHS was introduced by the April 1^st NHS reforms in England. One of the main changes done by these reforms includes shifting of responsibilities that originally were in the Department of Health, to the politically independent entity- the National Health Service commissioning Board.

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Conclusion

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References

Cornock, M. (2016). Removing rancour in examining mistakes would be new for the NHS. Nursing Standard, 30(30), 30-31. http://dx.doi.org/10.7748/ns.30.30.30.s38

Edkins, R., Cairns, B., & Hultman, C. (2014). A Systematic Review of Advance Practice Providers in Acute Care. Annals of Plastic Surgery, 1. http://dx.doi.org/10.1097/sap.0000000000000106

Le Grand, J. (2013). Will 1 April mark the beginning of the end of England’s NHS? No. BMJ, 346(mar26 4), f1975-f1975. http://dx.doi.org/10.1136/bmj.f1975

Triggle, N. (2014). Five-year plan to transform NHS focuses on teamwork. Nursing Management, 21(8), 10-11. http://dx.doi.org/10.7748/nm.21.8.10.s12

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Mayo Clinic’s Utilization Management Program

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An Overview of Mayo Clinic’s Facility Utilization Management Program

Mayo clinic is a sophisticated health care organization, which runs a variety of health care facilities, medical schools, and health science schools in the United States (Kashyap et al, 2016). This organization has developed an elaborate healthcare facility management program, which is aimed at enhancing the functionality of its facilities and personnel by integrating the most qualified health specialists and staff with a well-designed and equipped environment. Mayo clinic provides health care services to millions of patients from within the country and outside at a reduced cost (Miller et al., 2014).

The health care provider has facilities that are located in some of the following areas; Rochester, Jacksonville, Minnesota, Phoenix, Arizona, Scottsdale and Florida. In fact, its clinical campuses in Rochester are regarded as the world’s most integrated clinical facilities (Kashyap et al, 2016). In Mayo clinic, facility utilization and management program is based on empirical and evidence based strategies, which are aimed at providing the clinicians and other health care service providers with a conducive work environment, and the clients with high quality services, depending on urgency, and in the most appropriate and efficient manner (Kashyap et al, 2016).

Facility utilization management is also regarded as a venture that assists the management to reduce the overall costs of running the facility. It is therefore implemented in a prospective, concurrent, and retrospective approach (Kashyap et al, 2016). The health care provider has also developed the ‘at-risk care delivery program’, which is meant to increase the effectiveness of health care provision to its clients, as well as an enabling environment for the physicians and other staff members.

For instance, the at-risk care delivery program is designed to provide clients with; a well-planned discharge schedule for inpatients; provision of services with minimum variation for all clients; and a continuum of high quality care services to both inpatients and outpatients in the clinic, and all these being designed to result in minimization of any unnecessary care that could be provided to patients, and as such, an overall reduction of costs incurred in service delivery to patients is achieved (Kashyap et al, 2016).

Critique of the Facility’s Utilization Program In Light Of the Standard Utilization Management Programs

Facility Utilization Management (FUM) in this organization is evident in the systems and procedures that it has adopted as an effort to achieve health care savings. In particular, FUM is achieved through effective management of patients’ care as well as minimizing unnecessary care that is given to the patients (Kashyap et al, 2016). Physicians and other medical staff in Mayo clinic have been sensitized to the need to adhere to FUM guidelines as health service providers, as an effort to increase the accountability of medical service provision to patients who are regarded as payers in the system.

As such, they are required to provide health care services in accordance with the patient’s needs and the medical necessity that arises from the need, which in this case should be provided to the patient in the most efficient and appropriate manner at all times (Massimino et al., 2015). To achieve this, Mayo clinic has adopted the necessary technology to oversee efficient and economical service provision to patients including hospital admission programs, length of stay management, and precertification programs (Julianna et al., 2013).

All these programs are designed to provide patients with services in the most economical manner, where costs are aligned with the type of service provided. These programs have been adopted in all areas within Mayo clinic’s health facilities including medical, substance abuse, laboratory, and surgical sectors.

FUM within Mayo clinic is performed retrospectively and concurrently as deemed necessary. The specific objectives include maintaining the average number of patients who receive services, but at a reduced cost; establishing a DRG-guided inpatient health care facility; and to effect free for service outpatient services as a containment strategy to cut down on costs (Kashyap et al, 2016).

In its prospective review programs, Mayo clinic evaluates patients’ perceived medical or care need before admission, and assesses its appropriateness in terms of the proposed service requirement against any available medical information about the patient’s condition. This is followed by conducting an extensive consultation to determine the necessity for the required services or procedure (Julianna et al., 2013). If positive outcomes are obtained, then the patient is admitted for services or provided with outpatient services, if negative, alternative treatment options are discussed with the patient (Kashyap et al, 2016).

The prospective review program may be seen as a cost effective measure since it prevents the patient from being given unnecessary treatment services, and the health facility from incurring costs from the services provided, medicine and consultancy fees for physicians. The likely disadvantage in the program is that prospective reviews are bound to take lots of time if they are to be effective and meaningful (Massimino et al., 2015). In addition, the type of review may not be effective in cases where patients require emergency services, and this is because unnecessary costs would still be incurred during the diagnosis.

In its retrospective review programs, Mayo clinic conducts a detailed analysis of the duration of stay among other metrics in all its institutions and health facilities, including an analysis of the length of stay at the physician(s) level. Retrospective review is aimed at identifying any gaps in care provision, and whether there exist anomalous utilization patterns in the system (Kashyap et al, 2016). The information provided is used to make updates on clinical guidelines and registries according to care outcomes, after which necessary adjustments are made.

The retrospective review may be seen as an important venture because it helps management to optimize the health service outcomes, and at the same time achieve a reduction in the overall costs of operating the clinics. In addition, gaps in the utilization of medical staff and facilities may also be identified through the review, which would allow the appropriate adjustments to be effected. If effectively done, this would be reflected as reduced operation costs.

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In its concurrent review programs, Mayo clinic emphasizes that its physicians and the medical staff screen patient’s conditions or health service requirements before admission, which is a means of determining the medical necessity of the patient’s need requirements (Kashyap et al, 2016). Information from the screening procedure is also used to determine the appropriateness of the patients’ perceived requirement. As an effective care management program, the screening procedure helps determine the appropriate duration required in giving the patient the required service care, and this information is used to schedule the period of stay from admission to when the patient is discharged.

The concurrent review program may be seen as an effective venture in as far as cost reduction in care provision is concerned. This is so because; information obtained from the screening procedure may be used by physicians to prescribe the correct treatment. Specifically, it allows the nurses and medical staff to provide health care services in an efficient manner while focusing on the anticipated outcomes (Kashyap et al, 2016). In this case, wastage of time and medication is minimized; the clinic is also able to anticipate the appropriate bed days for scheduling.

On the other hand, the clinic is able to cut down on costs incurred through bed stays and admission services, which is because the applicability of the provision of home support services may be evaluated during the screening procedures. In addition, the patients are also able to receive high quality services and the needed attention, since the nurses and physicians would need to monitor the patient’s progress in an effort to adhere to the schedule and discharge plans.

References

Kashyap, R., Farmer, J. C., O’Horo, J. C., & Farmer, C. (Eds.). (2016). Mayo Clinic Critical Care Case Review. Oxford University Press.http://books.google.com/books?hl=en&lr=&id=XxQ9DAAAQBAJ&oi=fnd&pg=PP1&d q=mayo+clinic++&ots=PwF_auNEbd&sig=Bj5vKP_jdmz1YhiYaEc4U9IBTBI

Massimino, P. M., Joseph, M. L., & Kopelman, R. E. (2015). Hospital Performance and Customer-, Employee-and Enterprise-Directed Practices: Is the Mayo Clinic Reputation Deserved?. Journal of Management Cases, 28.

Merten, Julianna A., et al. “Utilization of collaborative practice agreements between physicians and pharmacists as a mechanism to increase capacity to care for hematopoietic stem cell transplant recipients.” Biology of Blood and Marrow Transplantation 19.4 (2013): 509-518.

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Risk Management Program Analysis

Risk management is an intrinsic component of any healthcare organization’s regular business practice. Risk management encompasses of recognizing risks, evaluating risks and coming up with implementations that could help reduce or completely eliminate risk (Cagliano, Grimaldi & Rafele, 2011). This risk management plan is developed for to guide new employees to ensure risk is effectively managed within the healthcare center to reduce or completely eliminate risk while dealing with patients. The rationale why I chose to develop a risk management plan for new employees is that new employees need to be taught about risk management practices within the organization to ensure smooth transition and minimization of risks in future.

Administrative steps and processes

Be as it may risk management program is often administered through the risk manager who is expected to report to the healthcare administrator. It is the duty of the risk manager to work in tandem with the administration, healthcare workers, staff as well as other professionals to ensure that risks are minimized. It is imperative to note that the risk manager has the power to cross operation lines to ensure that the risk management goals are met. It is also the duty of the risk manager to chair all activities concerning patient safety and risk management committee.

The five typical steps of risk management in healthcare include

Establish the context: It is paramount to establish the context of risks in the risk management process. High priority areas for risk management include ICU (Intensive Care Unit), E. R (Emergency Room), O.R (Operation room), CCU (Coronary Care Unit) and blood transfusion services (Cagliano, Grimaldi, & Rafele, 2011). Likewise, it is important for new employees to identify the context based on their assigned duty.

Risk Identification: This process enables healthcare professionals and employees to become aware of the risks prevalent in health care services and the environment. All risks identified must be documented in the Risk Management Tool (RMT). This is a typical process and thus new employees should be able to identify risks win the health care services and the environment.

Analyze risks: This step enables new employees to understand the risk identified. Typically, this process encompasses of understanding the risk score, underlying causes, and existing control measures.

Evaluate risks: The goal of risk evaluation is to prioritize risks depending on risk analysis score. Similarly, it enables the risk management team to make a decision on risks that need treatment and how it can be treated.

Risk treatment/ risk mitigation: The decision concerning risk mitigation should be in tandem with the internal, external and risk management context put in place.

Key Agencies and Organizations that Regulate the Administration of Safe Healthcare

American Society for Healthcare Risk Management (ASHRM)

This body provides guidelines that help healthcare professionals to comply with risk management. ASHRM is made up of members from AHA that represent risk management, issues to deal with patient safety, low, insurance, finance among others.

The Agency for Healthcare Research and Quality (AHRQ)

This organization help in risk management. AHRQ is under HHS (department of Health and Human Services). Their main role is to conduct research with the aim of bettering the quality of healthcare, reduce costs, and address medical errors and the issue of patient safety.

The Joint Commission on Accreditation of Health Care Organization (JCAHO)

This organization is a non-profit organization that operates to make certain that health care organizations offer quality care. This is achieved by examining health care organization and ranking them using scores of 1-100.

Centers for Disease Control and Prevention

The CDC is a public health regulation program that examines public health and warns of possible health threats arising from infectious diseases. The agency achieves this by monitoring disabilities, birth defects, conditions, diseases, environmental health, genetics, workplace safety and health.

Other agencies include Food and Drug Administration (FDA) for controlling the safety as well as the effectiveness of drug supply used for the treatment of humans and animals, Environmental Protection Agency (EPA) for protecting the environment as well as human health.

Analysis of New Employee Risk Management Plan

Be as it may, the American Society for Health Care Risk Management encompass of approximately 6,00 members that represent risk management, issues to deal with patient safety, low, insurance, finance among others. Their mission is to “advance patient safety, reduce uncertainty and maximize value through management of risk across the healthcare enterprise” (The American Society for Healthcare Risk Management, 2017). The new employee risk management plan has been tailored to comply with ASHRM standards.

Privacy of new employees in the risk management program is maintained. New employees record risk issues identified in the risk management tool without including their private information such as name and contacts. All documents and records that are part of the risk management program are privileged and confidential as stipulated by the federal law. The confidentiality covers on attorney work product, attorney-client privilege among other peer review protections.

The risk management program has also put in place measures to ensure the safety of the healthcare worker. The program provides the guidelines and safety measures that health care worker should adhere to while in the workplace to ensure their safety. New employees are also trained in risk management and given effective strategies to ensure that they cushion themselves against risk while attending to patients. The environment in which healthcare workers carry out their duties is also inspected to ascertain if it meets Occupation & Health Safety (OHS) standards.

The new employee risk management program is also tailored towards patient safety. Patient safety is enhanced by adequately training health care workers and staff, encouraging good communication among the patient and staff members. The program also provides counseling services to employees that work with patients. On the same note, competency assessment is conducted regularly.

Recommendations

One area of concern in risk management is avoiding potential financial concerns. Therefore, plans designated for risk management should cover patient-specific risks. On the same note, these plans should be well documented and made accessible to all health care workers working with patients. New employees should be trained and provided all the requisite information concerning risks and safety in the workplace. New employees working with patients should also be provided counseling services. Adequate training of staff help reduce the prevalence of risks in healthcare organizations.

The plan should also encourage strong communication among staff members and patients. Good communication between different stakeholders enable the risk manager to identify potential risk as the health care workers are able to communicate freely and note some of the risks they encounter while in the workplace.

References

Cagliano, A. C., Grimaldi, S., & Rafele, C. (2011). A systemic methodology for risk management in healthcare sector. Safety Science, 49(5), 695-708.

The American Society for Healthcare Risk Management. (2017). About ASHRM – The American Society for Healthcare Risk Management. Ashrm.org. Retrieved 25 February 2017, from http://www.ashrm.org/about/index.dhtml

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