DNP-804-ECONOMICS & FIN. ASPECTS OF HEALTHCARE
Module 4: Discussion
Assignment Description:
Module 4: Discussion – The Case for Quality Through Innovation
Address each prompt in your response related to the financial implication of challenging changes in healthcare.
- With all the changes that are occurring in health care today, what are some of the challenges your environment is facing?
- What is your organization doing to plan for the financial consequences associated with these challenges?
- What types of innovation could be utilized to address some of the challenges?
PEER RESPONSES
The health care system, today, is facing multiple challenges in its daily operations. Hughes (2022) informs that one-third of organizations are experiencing financial strain. As this occurs, facilities are also facing staff shortages, and breaks in the supply chain (Hughes, 2022). I work at a rural facility. Currently, we are facing staff shortages, ranging from nursing, housekeeping, to dietary staff. We are also facing financial strain and have been for the last two years.
To aid in the financial strain the organization is facing, administration developed the idea to cut open positions and distribute those duties to present employees. For example, the facility employed a house supervisor from 7am to 7pm. Now, there is a rotating schedule between inpatient unit managers to act as house supervisor from 7am to 3pm. An “official” house supervisor will come in at 3pm for their shift. As this may “save” from paying an additional salary, this method does not seem beneficial to the staff nurses of the organization. Health and Safety Executive (n.d.) reports that excessive workloads placed on staff can result in slower performance and errors. With delays in receiving supplies for patient care, or a reduction in the availability in supplies, the facility has opted for purchase of less expensive medical equipment. This includes cheaper IV supplies, and the use of reusable blood pressure cuffs.
Different methods of innovation could be used to address the challenges faced by the organization. These methods include the use of analytical thinking and incorporating what you know (Waxman et al., 2023). By educating nurses on the conservation of supplies, nursing administration would be utilizing the concept of practicing what they know. For example, providing education to staff nurses on the usefulness of toiletry supplies, or linens could reduce the buying costs of the products. Also, by using analytical thinking, administration is able to identify areas where costs can be reduced or appropriate budgeting can be made (Waxman et al., 2023). This will promote cost reduction and savings for the organization.
References
Health and Safety Executive. (n.d.). Human factors: Workload. https://www.hse.gov.uk/humanfactors/topics/workload.htm#:~:text=Excess%20workload%20can%20result%20in,situation%20awareness%20and%20reduced%20alertness.
Hughes, S. (2022). Industry voices—facing unprecedented challenges, America’s hospitals and health systems need help now. Fierce Healthcare. https://www.fiercehealthcare.com/hospitals/industry-voices-facing-unprecedented-challenges-americas-hospitals-and-health-systems#:~:text=With%20one%2Dthird%20of%20hospitals,near%2Dhistoric%20levels%20of%20inflation.
Waxman, K., & Knighten, M. (2023). Financial and business management for the doctor of nursing practice ( Waxman, K., Delucas, C., & Barter, M, Eds.). Springer.
- With all the changes that are occurring in health care today, what are some of the challenges your environment is facing?
The Veterans Health Administration (VHA) faces various challenges in providing healthcare services to veterans. One of the key challenges is ensuring timely and equitable access to care for veterans, particularly in rural and underserved areas. Many veterans face long wait times for appointments and have limited access to specialized services (Barnett & Der-Martirosian, 2017). Also, meeting the demand for mental health services remains a significant challenge. Veterans often experience mental health conditions such as post-traumatic stress disorder (PTSD) and depression, requiring effective and timely interventions (Ramoni et. al., 2018). Furthermore, the VHA faces challenges in recruiting and retaining an adequate number of healthcare professionals, including physicians, nurses, and mental health providers. Staffing shortages can lead to increased workloads and decreased access to care for veterans (Weeks et. al., 2018). The VHA must also address the unique healthcare needs of an aging veteran population, which includes managing chronic diseases, long-term care, and end-of-life care. The increasing demand for geriatric care poses challenges in terms of resources and specialized services (Phibbs& Batten, 2018). Finally, Incorporating and leveraging technology to enhance healthcare delivery and improve patient outcomes is an ongoing challenge. The VHA needs to ensure efficient interoperability of electronic health records, telehealth services, and other digital tools (Trivedi et. al., 2020). Are these challenges unique to the VHA? Are there similarities in the private sector?
- What is your organization doing to plan for the financial consequences associated with these challenges?
Planning for the financial consequences associated with the challenges faced by the Veterans Health Administration (VHA) involves various strategies and initiatives. While specific references focusing solely on financial planning for VHA challenges may be limited, the following information highlights some relevant approaches taken by the VHA to address financial implications. The VHA has implemented measures to optimize resource allocation and budgeting processes to ensure the efficient and effective use of available funds. This includes strategic planning, performance-based budgeting, and realignment of resources based on identified priorities. These efforts aim to mitigate financial challenges and improve overall financial management within the VHA (Department of Veterans Affairs, 2018). Are these sustainable steps?
The organization has also explored collaborations with private healthcare providers and organizations to enhance healthcare services and address financial constraints. These partnerships can help leverage additional resources and expertise, improve access to care, and optimize the use of available funding (U.S. Government Accountability Office, 2019). The VHA has implemented performance improvement initiatives to enhance operational efficiency and reduce costs. These efforts include streamlining administrative processes, adopting evidence-based practices, and implementing lean management principles. By improving efficiency and reducing waste, the VHA aims to achieve cost savings and allocate resources effectively (Nelson et. al., 2018). Finally, the VHA has sought partnerships and collaborations with academic institutions, research organizations, and industry stakeholders. These collaborations facilitate knowledge exchange, research advancements, and innovative approaches to address healthcare challenges while considering financial implications (Department of Veterans Affairs, 2020). Does budgeting constraints have an impact on collaboration with other facilities or institutions at your facility?
- What types of innovation could be utilized to address some of the challenges?
In recent years, there have been several types of innovation proposed and implemented to address challenges within the Veteran Health Administration (VHA). Telehealth has emerged as a powerful tool to improve access to care for veterans, particularly those in rural or remote areas. It allows for remote consultations, monitoring, and treatment delivery, reducing the need for in-person visits. Virtual care also includes digital platforms and mobile applications that enable veterans to access resources, educational materials, and support services remotely. These innovations have the potential to enhance convenience, efficiency, and patient satisfaction.
The implementation of comprehensive electronic health records has the potential to improve care coordination, information sharing, and patient safety. By digitizing medical records, healthcare providers within the VHA can have access to complete and up-to-date patient information, reducing the risk of errors and improving communication across different healthcare settings. EHR systems can also facilitate data analytics, leading to better insights into population health and the identification of trends and patterns that can inform decision-making. Innovations in EHR systems and interoperability have focused on enhancing information exchange between different healthcare providers within the VHA network, as well as with external healthcare systems. This allows for better coordination of care, reduction of duplicate tests, and improved patient safety (Wickramasinghe et. al., 2018).
Collaborative care models involve integrating mental health services within primary care settings, allowing for more coordinated and holistic care delivery. By bringing together primary care providers, mental health professionals, and other specialists, these models aim to address the physical and mental health needs of veterans simultaneously. This approach enhances communication, care coordination, and patient engagement, ultimately leading to improved outcomes (Garvey et. al., 2018).
References
Barnett, P. G., & Der-Martirosian, C. (2017). Quality of care in the Veterans Health Administration: Beyond wait times. JAMA Internal Medicine, 177(5), 685-686.
Department of Veterans Affairs. (2018). FY 2019 Budget in Brief: Investing in America’s Future. Retrieved from
https://www.va.gov/budget/docs/summary/Fy2019VABudgetInBrief.pdfLinks to an external site.
Garvey, M., Tuot, D. S., Lin, J., Lyles, C. R., & Sarkar, U. (2018). Potentially preventable hospitalizations in a cohort of California prisoners with chronic disease
conditions transitioning to Medicaid. Preventing Chronic Disease, 15, E143.
Nelson, K. M., Helfrich, C. D., Sun, H., Hebert, P. L., Liu, C. F., Dolan, E., … & Taylor, L. (2018). Implementation of the Patient-Centered Medical Home in the
Veterans Health Administration: Associations with Patient Satisfaction, Quality of Care, Staff Burnout, and Hospital and Emergency Department Use. JAMA
Internal Medicine, 178(5), 686-694.
Phibbs, C. S., & Batten, A. (2018). Careful assessment of research on the Veterans Health Administration. New England Journal of Medicine, 378(10), 973-975.
Ramoni, R., McNeil, C. B., Boustani, M., &Unützer, J. (2018). Electronic consults for improving integration of mental health care in primary care. American Journal
of Psychiatry, 175(6), 456-459.
Trivedi, A. N., Grebla, R. C., Wright, S. M., Washington, D. L., & Esmail, L. (2020). Despite improved quality of care in the Veterans Affairs health system, racial
disparity persists for important clinical outcomes. Health Affairs, 39(1), 101-108.
U.S. Government Accountability Office. (2019). VA Health Care: Better Data Needed to Assess the Health Outcomes of Using Public-Private Partnerships.
Retrieved from https://www.gao.gov/assets/gao-19-20.pdfLinks to an external site.
Weeks, W. B., West, A. N., Wallace, A. E., Fisher, E. S., & O’Donnell, G. (2018). Where do veterans get their care? The Veterans Health Administration versus
private-sector care. Health Affairs, 37(6), 911-914.
Wickramasinghe, N., Schaffer, J. L., & Geisler, E. (2018). Adoption of electronic health records: A roadmap for India. Asian Journal of Information Technology, 17(3),
341-348.)
With all the changes that are occurring in health care today, what are some of the challenges your environment is facing?
The challenge affecting my clinic more than any other is the reimbursement of diagnosis-related groups (DRGs). Reimbursement for services is based on the average cost of a DRG, and comorbidities can increase the reimbursement for DRGs (Shepherd, 2022). Most patients come to my clinic for urgent care, but chronic health conditions exacerbate many urgent care needs. Adding a chronic diagnosis that complicates the urgent diagnosis can increase reimbursement, but many patients do not know their medical history or the names of their medications. The increased reimbursement for comorbidities is related to the increased cost of care (Shepherd, 2022). For instance, an older adult diabetic patient who cuts their lower leg will require more extensive monitoring and care than the average healthy young adult.
What is your organization doing to plan for the financial consequences associated with these challenges?
To stave off some of the financial hemorrhages that could result from under-charting and coding, my current organization recommends that all providers code for all chronic medical conditions for every patient. This practice helps increase reimbursements for diagnoses complicated by a chronic condition. The organization discussed this change about three months ago to hopefully make it part of every provider’s routine before it impacted the company more severely financially.
What types of innovation could be utilized to address some of the challenges?
A centralized medical record available to all providers, including diagnoses and medications, could take some guesswork from treating an urgent care patient. A system that worked like the Kentucky all schedule prescription electronic reporting (KASPER) system would be ideal. The system could report all medications prescribed and filled for the patient and the diagnosis connected to the medication. This system would capitalize on the potential for increased revenue related to increased DRG reimbursement. The system would also assist the patient in sharing their medical history with new providers, creating safer and more inclusive care.
References
Shepherd, E. (2022, February). Malnutrition coding and reimbursement in the hospital setting. Nutrition in Clinical Practice, 37(1), 35-40. doi:10.1002/ncp.10779
- With all the changes that are occurring in health care today, what are some of the challenges your environment is facing?
Some of the major challenges that my environment is facing include new nurse readiness for practice and high turnover rates. It is well known that in the current healthcare climate, especially after covid, nurse turnover and turnover intention rates are at an all-time high (Falatah, 2021). This trend is not only costly financially, due to the high costs of orientation and onboarding, but has negative implications for patient safety (Bae, 2022). Another concern is new graduate nurses unprepared for practice, which is a leading cause of rapid burnout and turnover among new graduate nurses (Kelly et al., 2019). It has been estimated that new graduate nurse transition costs approximately $49,000-$92,000 per nurse, this is a costly investment for hospitals and if the nurses do not stay in the organization the hospital does not get their return on investment (Kelly et al., 2019).
- What is your organization doing to plan for the financial consequences associated with these challenges?
To address the increase in nursing turnover my organization has implemented incentives to retain staff including offering money for continuing education and certifications, employee engagement programs monthly, and increased hourly rates. The organization has also increased its focus on preparing the new graduate nurses for practice by implementing and perfecting their transition to practice program. The program is a one-year program consisting of 2 weeks of orientation and monthly enrichment meetings including themes that previous cohorts have highlighted as important such as mock codes, quality improvement initiatives, risk management, and communication. The organization has also had to increase its budget to allow for increased turnover amongst all staff in order to accommodate this shift in culture.
- What types of innovation could be utilized to address some of the challenges?
This issue requires a bit of creativity and understanding of the bedside nurse’s needs. One way the organization can increase confidence and competency levels in new graduate nurses is to implement more simulation experiences, which have been shown to increase new graduate confidence levels (Pertiwi &Hariyati, 2019). Another innovation is using technology to streamline and reduce the costs of new employee onboarding. By decreasing the time a new employee spends in orientation the organization will save money on onboarding which will reduce their loss if that employee leaves the organization.
References
Bae, S. (2022). Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review. International Nursing Review, 69(3). https://doi.org/10.1111/inr.12769Links to an external site.
Falatah, R. (2021). The Impact of the Coronavirus Disease (COVID-19) Pandemic on Nurses’ Turnover Intention: An Integrative Review. Nursing Reports, 11(4), 787–810. https://doi.org/10.3390/nursrep11040075
Pertiwi, R. I., &Hariyati, Rr. T. S. (2019). Effective orientation programs for new graduate nurses: A systematic review. EnfermeríaClínica, 29(S2), 612–618. https://doi.org/10.1016/j.enfcli.2019.04.094Links to an external site.
Powers, K., Herron, E. K., &Pagel, J. (2019). Nurse preceptor role in new graduate nursesʼ transition to practice. Dimensions of Critical Care Nursing, 38(3), 131–136. https://doi.org/10.1097/dcc.0000000000000354Links to an external site.
