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The Department of Emergency
The Department of Emergency has the role of providing emergency services that are comprehensive to all patients 24 hours in 7 days of a week throughout the year. In particular, it offers patient care services including:
Accepting every patient who comes with acute illness and provide treatment for them.
Performing emergent resuscitation and medical intervention.
Planning for the assessing, diagnosis, treatment as well as referrals for specialized medical treatment for all patients when necessary.
Providing advanced Trauma Care for patients with trauma.
Liaising with all other departments in the hospital for admission of patients and follow-up.
Providing care when a disaster occurs within the community by operating an Urgent Care Centre in a manner that is almost continuous to ensure needs of patients’ presentations that are less acute are met as well as receiving and assessing the stability of direct admissions, which includes Medivac patients on their way to critical or specialized care units within the hospital.
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Emergency and admission procedures for both new and existing patients have been laid down for any medical, psychiatric and surgical emergency, for the initiation of life-saving care procedures in a timely manner. In particular, for all emergency situations the basic procedures for both new and existing patients begins with diagnosis, initiation of treatment, discharge in case of recovery, admission for treatment continuation or monitoring, appropriate referral for specialized care in case of complications, and then follow up services.
The department of emergency medicine uses an electronic information system for the purpose of recording patients’ details when available or await for them afterwards, and transfers them to the relevant intensive care units for surgical and acute medical emergencies since they these services are only offered for a short time in the department prior to the transfer of the patients to appropriate in-patient units.
The system’s main users are the emergency department personnel, and its easy access and security is guaranteed due to its location in the King Khalid University Hospital (KKUH) Building’s ground floor, near the building’s main entrance.
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In the stages of change model, there are a series of cycles that include, precontemplation, contemplation, preparation, action and maintenance. Within each and every function, there are tasks and responsibilities (Ernecoff, Keane, & Albert, 2016).These functions are considered as interrelated and continuous. The healthcare manager therefore needs to consider individuals may change their behaviors and actions in the shorted time may be challenging. This requires an allowance for individuals to work through the various stages.
In this case, the healthcare administrators may use the Stages of Change model in the development of procedures that support the patients and subordinates in behavioral modification (Gantiva, et al., 2015). This helps in initiating motivators that gives the patient’s ability to pass through recovery stages while modifying their behaviors. Healthcare administrators may therefore effectively use this theory in developing interventions that may impact the behaviors of individuals.
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This approach aids in understanding the aspects of customary counseling that may not be effective in meeting the needs of these individuals (Koyun, & Eroğlu, 2016). Understanding the stages of behavior change, aids in the development of interventions that help employees to change their behaviors. Employers can use this approach to help employees identify and modify their actions that may negatively impact their productivity in employment.
Employers can also understand and enable the employees undergo the processes and stages of change. With this knowledge, the employers can encourage positive actions and practices that would maintain the behaviors of their employees. The Stages of Change model is a tool that can be incorporated by Human Resource managers in reinforcing positive behavior among unruly staff members within an organization.
Performance management is defined as an integrated strategic approach to delivering sustainable success to the organization by improving individual performance. Performance management is a system that helps in identifying ways to achieve the set organizational goals by constantly assessing and providing feedback that results in improved employee performance (Johansson‐Sköldberg, et al, 2013, p. 121).
The main approaches to measuring performance have identified the domains where adjustments are necessary. Performance appraisal is one of the appropriate ways of measuring individual performance. Performance appraisal involves measuring, providing feedback, positive reinforcement sharing and agreeing on set standards. Measurement is the process of determining if the set organizational goals were achieved.
After obtaining individual performance progress feedback is provided involving positive feedback to reinforce good performance. Exchanging and sharing of ideas involves reviewing the past performance and sharing experiences for learning purposes. The agreement is the final process where the set goals and objectives are discussed (Gale, et al, 2010, p 606).
Identifying individual training needs of an employee refers to reviewing the set goals and addressing the key activities to be conducted to achieve the set goals. Assessment of individual training and development needs entails monitoring performance and evaluating weak points.
Keen observation and measuring employee performance and progress is important because the outcomes will provide the training needs and the type of training and development for individual employees. Development of needs involve conducting period training as part of the learning and development process. Periodic training will improve individual skills and behavior attitudes to increase the level of performance (MacFarlane, et al, 2011, p 63).
According to Tay, Moul and Armstrong (2016, p 115), some of the strategies that can be implemented for improvement of individual in health and social care place of work can be done by offering performance feedback and incentives. Performance feedback is offered using appraisals and targets. Employees will be motivated to achieve certain targets and goals which are geared towards achieving organization goals.
If employees achieve the goals they will be rewarded by using incentive packages such as bonuses in form of increasing salary, additional training or other recognition rewards. If an employee does not achieve the goals, they should be criticized constructively to work towards achieving organization goals. This will boost individual performance because the employee will understand what is expected of him.
Performance feedback whether positive or negative can solve conflicts and update employees on their weak areas hence giving the opportunity to rectify their performance behavior that might hinder employees from achieving their career objectives.
Gale, et al. (2010, p 609) states that attractive performance –based incentives motivate employees with nonfinancial incentives having lasting impact than financial incentives. Incentives might vary from increased wages to training and development program and special rewards.
HR managers need to implement reward systems that will motivate employees. Rewarding is the process of recognizing employee’s performance and acknowledging their contribution .Rewards will encourage individuals to aim higher and work towards meeting the set objectives.
Question 1: In my opinion, Mr. Willy Watt should not bid in order to avoid conflicts of organization. The main responsibilities of board of members are to ensure financial accountability of the healthcare organization. The Board members are the trustee’s of organization assets. If he must bid, the governing board must exempt him from fiduciary duty. There is no problem with governing boards fiduciary as long as they remain trustworthy, loyal and accountable. However, there would be an issue with Mr. Watt’s fiduciary duty because there is conflict on Mr. Watt’s loyalty and interest (Gannons Solicitor, 2013).
Question 2: Dr. Wilson the gastroenterologist actions are permitted expect in situation where the healthcare providers acts are proven as gross negligence. There is problem’s with contract unless he coerces a patient to sign his contract without the knowledge of the liability exemption clause. If a patient sues him for negligence, he cannot be accused because the patient signed the contract knowingly (AHIMA, 2013).
Question 3: The areas associated with high incidences with fraudulent billing practices that are problematic are up-coding, patient identification error, cloning, phantom billing, repeated billing and service fragmentation and unbundling (AHIMA, 2013).
Question 4: There are six tips that facilitate effective compliance program. These include establishing culture of compliance, outlining procedures, policies, training, and effective communication, establishing corrective system and performing audits. These tips are all important, but the most important one is training. This is because continuous training will help the staff understand importance of providing commitment plan with technical and monetary support. Through training, the staff will understand the policies and procedures specific to their job function. Training process provides an opportunity for interaction between the various departments (National Law Review, 2016).
Improving mental health efficiency by using of community health workers to decentralize health care services
Overview of healthcare industry, markets and competition
Recent changes in the UK in National mental Healthcare Services (NHS) have introduced new complexities into the accountability arrangements of the healthcare facilities. The current mental health systems are best described as command and control system. The mental budgets as well as policy are strategically set centrally by the Department of Health (DoH) and the government is administered locally by the NHS organization but accountability lies with the DOH.
The situation is more complex than the explanation of the ‘command and control.’ The balances between the central government and the local government have led to fluctuating autonomy and misallocation of resources (Normand, 2011).
The UK mental healthcare system relies on highly centralized and costly expertise to delivery healthcare services. This type of system relies in intuitive medicine, and is best suited for healthcare issues that are complex and episodic. In addition, this type of healthcare system is associated with mismatch for chronic diseases, preventive measures and wellness care; which results into additional barriers and disparities especially among the underrepresented population.
It is time for the National Health System (NHS) to depart from a one-size-fits all model and develop channels that will enable better delivery of services that can serve the dynamic needs of the population (Clayton, 2009).
This study proposes that decentralizing mental healthcare services will aid in lowering cost of care, broaden accessibility and maintain as well as improve quality of care. For instance, the physician specialist will have the capacity to work in outpatient, the nurse practitioner will effectively provide care in retail clinics, and lay community health promoters or workers will improve health education, thereby reducing health complications associated with disease progression.
For example, the system will improve diabetic self management at patient’s residents. This measure is in line with Institute of Medicine (IOM’s) health disparity vision of confronting ethnic and racial disparities using strategies that improve care delivery and or implement preventive measures and to enhance risk reduction (Black & Gruen, 2005).
Perceived problems in current healthcare systems
The fundamental issue that is believed to affect mental healthcare activities includes quality of care, safety issues, access to healthcare, cost of care, and delivery of services. These issues arise because of the problems that affect healthcare systems which include misallocations of national health resources, allocative inefficiency, and increased inequalities. Most of the health facilities get less proportion of healthcare budgets. An example of healthcare system that suffers from misallocation of resources is the mental healthcare system, which suffers due to misallocation of resources within the sector (Goodwin, Gruen, & Iles, 2006).
In my facility, funding is done on low cost effective-interventions such as non-essential prevention strategies. For instance, People diagnosed with substance use along with mental health (commonly referred to as dual diagnosis) is associated with many health demands, yet they suffer too much to access quality healthcare services. These patients have complex needs and often experience multiple adversities in their lives including deprivation, childhood abuse, poverty and loss of support from their family members.
These persons are also associated with multiple needs such as homelessness and unemployment that makes them become prone of exploitation. This increases their risk of poor physical health, self harm, suicide and perpetrating violence. Dual diagnosis is unpopular in the UK, partly because the society is entrenched perceptions of substance abuse where most people believe that is a lifestyle choice instead of a health issue that needs urgent care and treatment (Normand, 2011).
Dual diagnosis is one of the issue facing mental health and substance abuse. In the past one and half decades has lead to development of specific initiatives but all of them have had no improvement. The same changes have been implemented since the 90s. Today, mental health services today still exclude people if the problem is not perceived as substance related disorders. The misallocation of resources is associated with inefficient delivery of care as most of the healthcare resources are wasted (Kirk and Glendinning, 1998).
For example, it is inefficient to give patient a brand name over drugs cheaper generic ones that have same efficacy. The misallocation of resources also results to underutilization of resources which also affects the productivity efficiency. In current type of healthcare system often leads to indiscretions such as specialists handling numerous uncomplicated cases at high cost, cases that primary care centers could handle with ease (Normand, 2011).
The aforementioned factors have lead to increase on cost of care without matching consumer’s health benefit. In addition, the existing weak monitoring system enables leakages of public subsidies to private sectors and medical covers which are already financially stable. This results to increased health disparities where poor and under-privileged in the society lack care affordability (World Health Organization, 2000).
These affected populations unfortunately are the majority, and often receives low quality of care. One of the best strategies is to train the staff in mental health facility in order to equip them with skills that will help make dual diagnosis by improving their knowledge and skills but have not managed to change the society’s perception and values.
Therefore, the two great challenges in this aspect of mental health a) to increase awareness on dual diagnosis in order to change attitudes people’s attitudes on mental health and b) to provide effective services to people diagnosed with dual diagnosis, especially in this unprecedented mental health crisis (Normand, 2011).
Change in mental healthcare systems
Change in the healthcare system is intended to improve the performance by adjusting the way services are delivered and relocating or roles and responsibilities for specific healthcare services and the processes of delivering care to the population including financing, implementation process, monitoring as well as regulation. There are various drivers of change in the current health care system including the expected shift in political, social and economic factors that will come with new governing system. In addition, the increase in technological advancement should be enhanced to not only improve quality of care, but also the accessibility (Normand, 2011).
The key drivers for the proposed change within the mental healthcare system in NHS includes changes in population growth, demographic characteristics due to immigration, technological advancement, health’s infrastructure conditions, and increased patient level of acuity. Change in ideologies refers to the modifications of frameworks used by the public health services to deliver care. For instance, new labor in 1997 removed department of health monopoly which created more opportunities for private sector and voluntary services that helped better healthcare system to some extent, at higher cost of care.
Similar changes have been observed with the coalition government in 2009 which removed government agents and gave more roles to local authorities and the private providers, which led to increase misallocation of resources. Therefore, decentralizing delivery of healthcare services using community workers will create freedom for providers to innovate strategic services that meet the specific demands for patient needs (Pickard and Glendinning, 2002).
In addition, the current infrastructure conditions are too old and are not adaptable to provision of modern care for dual diagnosis. The current healthcare infrastructure demerits include high cost of care, reduced staff retention and inconsistencies in delivery of care. Therefore, vertical integration of decentralized health care in this community is aimed at addressing these challenges by reconfiguring healthcare services to suit the specific community demands.
For instance, technological advancement has made it easy to access patient information and also increased portability of patient’s health information and education of appropriate optional treatment. It is time to tap on the innovative techniques to increase efficiency in delivery of mental healthcare system and manage delivery of care in a way that maximizes population health benefits (Duguid & Pawson, 1998).
Changes in population growth and the demographic factors is also another driving force for decentralization of mental healthcare services by the NHS. The increase in population has put pressure on the current healthcare system as it has led to dilapidation of healthcare facility caused by congestion due to population growth, which has led into high demands building of bigger healthcare facilities that will accommodate the patients.
In addition, the gentrification of the low socioeconomic households by the middle class has led to inconsistence in delivery of services. The increased patient level of acuity and knowledge on quality issues is pushing the healthcare providers to improve delivery of care in order to meet their expectations (Clayton, 2009).
Change refers to any alteration of healthcare services with the aim of improving its quality. Changes in healthcare system are wide and ranges from revolutionary technology to refining of health workers responsibilities. There are three types of change namely originates, borrowed and adapted. Borrowed changes are easy and cheap to implement. However, these types of changes are often not appropriate to meet the local needs as no community is similar to another, which implies that one size fits to all may not apply (Goodwin, Gruen, & Iles, 2006).
The proposed change is adapted change, which mainly implies that the strategies are borrowed from elsewhere and gets modified to fit the community needs. However, factors such as situational circumstances, management approach, wrong adaptation, and changes in political as well as economic environments determines if the change process will be effective or not.
Originated changes would be more effective as it involves more creativity than the adapted changes, but their implementation process is expensive as it requires an organizational climate that promotes innovation and creativity. The proposed change is a technical change as it modifies the ways in which normal activities are carried out by altering the organization and program structures (Clayton, 2009).
Decentralization is kind of change that involves dispersal of administrative, political and financial functions. It involves a process of shifting authority, power and responsibility from national to local government levels of the healthcare systems. The main advantages for vertical integration of decentralization in mental healthcare system includes technical benefits such as improving delivery of healthcare services, leading to better health outcomes. In addition, this method eradicates challenges associated with bureaucracy and monopoly that hinders effective delivery of healthcare services to the needy service users (Atun, 2007).
Political benefits associated with decentralization of healthcare services are that it extends democratic control of healthcare services to the needy individuals at community level. This may also increase opportunity for the citizens and services users to participate in decision making processes. This is effective strategy as it helps the government to identify the specific community needs.
Decentralization process also helps in minimizing financial burden associated with public procurement processes by transferring risks from a central point and distributing them to lower and private sector. This helps promote innovativeness and competition, which further improves the service user’s outcome (Bossert, 1998).
In this context, decentralization is the recommended as an approach of improving administrative activities that will help deliver healthcare services. This is also done for the purposes of achieving effective service delivery. In addition, decentralization helps improve local participation as well as autonomy in healthcare services. This acts as a means of redistributing power when it is effectively done, thereby reducing health disparities associated with tribal and regional tensions.
Decentralization is also invoked as a means of increasing cost efficiency in mental health care systems, which is attained by giving the local units better and greater control over the available resources as well as healthcare revenues. In turn, this approach sharpens NHS accountability in healthcare services and operations. The approach helps to covertly offload financial burden from resource poor governments to local service providers (Saltman et al., 2007).
The Mental healthcare system relies upon on highly centralized and costly. The optimal for mental healthcare system is based on intuitive medicine, and is best suited for complex and episodic mental health complication. This increases additional barriers to healthcare care disparities and the minority groups. It is important for the NHS mental health care system to depart from the one size fits all paradigms and to establish better channels that will ensure that healthcare delivery is improved to meet the growing dynamic needs for the underprivileged service users.
The potential impacts of decentralization intervention are that it creates opportunities that improve the prevention strategies. The balance between the primary and tertiary preventive measures regarding saving. The strategy will also increase access to healthcare services by ensuring that the downstream expenses are balanced. In addition, the approach will help replace the costly unnecessary services with less expensive and quality ones.
Atun, R. (2007). Privatisation as decentralization strategy, Chapter 14, 247-266. In Saltman, R. B., Bankauskaite, V., & Vrangbaek, K. Decentralization in Healthcare. European Observatory on Health Systems and Policies Series. McGraw Hill, Open University Press. Maidenhead, Berkshire, England.
Black, N., & Gruen, R. (2005). Understanding Health Services. Open University Press, Berkshire, England
Clayton, M. (2009). The Management Models Pocketbook. Management Pocketbooks
Duguid, S. & Pawson, R. (1998). Education, change and transformation: The prison experience. Evaluation Review. 22(4), 470-95
Goodwin, N., Gruen, R., & Iles, V. (2006). Managing Health Services: Understanding Public Health. Open University Press, Berkshire, England
Kirk, S and Glendinning, C. (1998). Trends in community care and patient participation: implications for the roles of informal carers and community nurses in the United Kingdom. Journal of Advanced Nursing 28:370-81
Normand, C. (2011). The healthcare system in Ireland: Controlling growth in expenditure and making best use of resources. Chapter 3 (pp 57-74). In Callan, T. (editor). Budget Perspectives 2012. Economic & Social Research Institute (ESRI) Research Series 22, Dublin.
Pickard, S and Glendinning, C. (2002). Comparing and contrasting the role of family carers and nurses in the domestic health care of frail older people. Health and Social Care in the Community 10: 144-50
Saltman, R. B., Bankauskaite, V., and Vrangbaek, K. (2007). Decentralization in Healthcare. European Observatory on Health Systems and Policies Series. McGraw Hill: Open University Press.
World Health Organization (2000). The World Health Report 2000. Health Systems: Improving Performance, WHO, Geneva.
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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.
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.
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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