Healthcare Delivery System: Needs Assessment

Executive summary

Healthcare organizations are entities whose main goals are to provide quality and affordable health services to the people who seek such services. Such organizations require a well-organized system to facilitate the delivery of services. A well-organized system is the one that ensures that all components of an organization work in a manner that is cohesive. Such components are for instance, human resources, operations and the facilities in a hospital. All these components have to function efficiently for a healthcare organization to be regarded as an organized system. The purpose of this paper is to analyze the needs assessment in a healthcare organization. St. Luke’s Cornwall Hospital in New York will be considered as the specific case for this assessment.

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The assessment will majorly focus on the human resource, facilities and the operations perspective. An assessment of these factors will help to determine where there are gaps in health care service delivery. This will in turn help to identify the kind of interventions that can be employed to fill the gap/ gaps which hinder the effective delivery of health services. For interventions to be suggested in an organization; all the stakeholders need to be aware so that their contribution can be considered, therefore this paper will also suggest a communication process to facilitate dialogue. A principal factor in proposing interventions to a problem is to develop a mechanism to measure the success of the interventions so as to determine whether the interventions are effective or not. Therefore, the paper will develop ways in which the proposed interventions can be tested for the levels of success.

Introduction

St. Luke’s Cornwall Hospital is located in Newburgh along Dubois Street, New York. The hospital is specialized to handle patients with pediatric need and those who require intensive care. The Hospital has two campuses, Cornwall and Newburgh. Of the total 232 bed that are found in the Cornwall campus, 194 beds are meant for adults with pediatric care while 28 are meant for patients in need of intensive care. The hospital has gained recognition for its specialized treatments in pulmonary diseases, cardiac diseases, vascular diseases, and also critical services. As a result of this recognition, the hospital has won several awards for the scoring high ratings at the national average. This fame has therefore prompted the high rates of the patients who visit the hospital to seek treatment. However, this hospital is small and is only able to handle minor diseases and therefore any disease which seems to be complicated or may later lead to complication is usually transferred to other tertiary hospitals (Wood et al, 2005). These hospitals are far as one hundred miles away, this could be very serious to the health of a patient since a patient can even die in the course of the transfer process. According to DeMarco (2007), “sending patients this far can have a deleterious effect not only on their health, but their wallet too” (56). This problem among others forms the gap that has prompted the need for gap assessment in order to make the healthcare system work effectively.

History

St. Luke’s Hospital was opened in 1875. The first location was in a house called Mr. Baldwin’s cottage; this house had a capacity of only three beds. During the first year of operation, the hospital reported a census of thirty-three patients; this figure later grew to 200 in 1894. Most of the cases reported that year were related to surgery, this was attributed to the construction of a well equipped room meant for that specific purpose (Shojania & Grimshaw, 2005, p. 65). From the first location, the hospital underwent several relocations before 1909 when it purchased Singler School properties located along Dubois Street. Since that school was old and it had an ample expansion space, it was renovated and its size doubled. A notable landmark during that renovation and expansion process was the construction of theaters and patient rooms. This process lead to the increase of the number of beds to eighty four and the total number of patients treated in the hospital that year was reported to be nine hundred.

Between the years 1920 and 1925, the number of patients who frequented the hospital had increased considerably therefore demanding the expansion of the hospital. Funds were raised for the purpose of the expansion program and in 1930, Senff building was opened. The expansion process would continue later with major buildings completed at every time. For instance, an eight storey building meant for patient rooms and Emergency Department was constructed in 1960. Another notable expansion was the construction of a ten storey building meant for patient room in the 1970s. Poen & Harry (2009) noted that “these additions formed the shape of the multi-story structure that is St. Luke’s today” (p. 67). Elaine Kaplan Intensive Care Unit was later opened in the hospital in 1997 as one of the strategies to improve the excellence of the hospital. Renovations in the hospital continued to take place and even new projects also introduced. For instance, the mother/baby project was also introduced in the year 2000 to cater for the pregnant women. As noted by Poen & Harry (2009) “the hospital’s current certified 242-bed capacity includes 182 medical/surgical beds, 18 critical care beds, 23 obstetric beds, and 19 pediatric beds” (p. 78). In 2004 Newburgh Campus was opened after the Emergency Department was renovated and expanded.

Hospital description

Human resource

The hospital has two campuses as indicated. The total number of employees is 1500. Of this, there are close to three hundred physicians who are specialized in various professions and the rest include clinical officers and other support staff. The hospital receives 270,000 patients per year who come to seek treatment. Staff members undergo training and undertake various researches related to health care in the campuses. Also undergraduate students who study in the campus get the opportunity to exercise what they are taught by taking part in minor surgeries and any other tasks as they may be directed by their instructors. For instance, Cornwall Campus has several departments like: biological department which is the Center for Ecology and Conservation, this department provides a good opportunity for undergraduate students to research in their respective fields of specializations.

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Operations

The Newburgh Campus has 242 patient beds and is considered to be the regional center for neonatology. Neonatal Intensive Cares are offered in this campus. Also, in partnership with the New York Presbyterian Hospital, pediatric subspecialties are offered in this facility. Campion (2007) added that “the Newburgh campus also provides cardiac rehabilitation, pain management/palliative care, and a speech and swallowing center” (p. 45). On the other hand, Cornwall Campus has 125 patient beds. Services rendered here include advanced intensive care. Other services rendered here which were identified by Ornstein & Bearden (2006) include “a full array of ancillary services, such as radiology, physical therapy, respiratory therapy, EKG/EEG, and pain management” (p. 56).

Facilities

The hospital has continually grown to the status of acquiring various awards due the quality of services provided in the hospital. The hospital has several buildings and offices which provide spaces for the various departments in the hospital. The total number of patient beds in the hospital is 242. In 2004, the hospital established Newburgh Campus and the Cornwall Campus after renovating the Emergency Department. The establishment of this facility was crucial since it provided an adequate facility for students to perform minor medical and also surgical services in the course of learning. Other facilities in the hospital as noted by Mahar (2006) include “six neighboring facilities, which include state-of-the-art dialysis, radiology and rehabilitation centers” (p. 56). This success could be attributed to the use of modern state of at art and technology used in the designing of the hospital. The hospital serves more than 270,000 people who reside in the Hudson Valley of New York. The Joint Commission on Accreditation of Health Organizations is the commission that was established with the core role of determining the standards to measure the quality of health provided by healthcare organizations in United States. JCAHO accredited St Luke’s Cornwall hospital for its success in the establishment of health facilities. These facilities as identified by Fishbein (2007) includes “the two hospital campuses, as well as our outpatient satellite services (Dialysis Center, Rehabilitation Center at New Windsor, Unity Center for Recovery, and Outpatient Care Center)” (P. 13).

The hospital has two emergency departments. The Kaplan Family Center for Medicine which is located at the Newburgh campus and the second one which is located at Cornwall campus is referred to Littman Center for Emergency medicine. These two departments have played a critical role in solving emergency cases related to acute surgery. As a result of this role, an upgrading program for the department was started in 2007 costing 11 million United States dollars. According to Fishbein (2007) “the upgrades equipped the departments with the latest technology and additional trauma and specialty treatment bays, and reflect SLCH’s commitment to patient privacy, comfort, and convenience” (20).

Needs Assessment/Gap Analysis

Healthcare systems work based on certain standards and objectives. All these standards and objectives are targeted on ensuring that patients acquire high quality of health care on affordable fees (Roland 2004, p. 112). On the other hand, since the healthcare systems are supposed to work as well coordinated systems, all the staff members in health care organizations should receive high levels of satisfaction for the services offered. Often, services offered in health care organizations fail to reflect on the best practices and sometimes patients receive care that is not appropriate (Numbers 2008, p. 124). As a result of this, patients fail to acquire their expected outcomes and the amount they spend for the care is not therefore justified. The patients who visit healthcare organizations expect to receive the best quality health, medication and any other health procedures at the lowest cost. While as health care providers wish to provide the best quality of care to patients using the resources and facilities available at their disposal. However, this is not always possible since problems or gaps exist in healthcare system thus impacting negatively on health care delivery (Kahn 2006, p. 45). This section will establish the kinds of gaps that exist in St Luke’s Cornwall Hospital which for one reason or another affect the delivery of quality health care to the people served in the hospital.

High costs of health care

The cost of treatment in many health care organizations in the United States is high. Many people depend on insurance covers that are provided by their employers or the employers of their spouses. This has been noted by Burrow (2005) who argued that “around 84.7% of citizens have some form of health insurance; either through their employer or the employer of their spouse or parent (59.3%), purchased individually (8.9%), or provided by government programs” (p. 102). However, those people who are enrolled to receive care through insurance firms are supposed to cover some of the costs incurred during treatment while the insurance firms cater for the rest. Those medical insurance covers that are either provided by private firms or the government limit the kind of care a person can get and they therefore only specify types of care as agreed upon.

According to Burrow (2005) “visits to facilities outside the insurance program’s “network” are usually either not covered or the patient must bear more of the cost” (p. 78). Normally, reimbursement rates are agreed upon between the health care providers and the insurance companies. These rates often fail to cover the costs of care agreed between the hospitals and the insurance firms. The outcomes of these disagreements result to the doctors failing to accept the type of insurance that a patient provides no matter if the insurance is Medicare or Medicaid. Mahar (2006), supporting this argued that “low reimbursement rates have generated complaints from providers, and some patients with government insurance have difficulty finding nearby providers for certain types of medical services” (p. 34). This has been a common problem in St Luke’s Cornwall Hospital where patients fail to receive care as a result of the high rates charged in the hospitals.

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Any visit at St Luke’s Cornwall Hospital requires a patient to fill a form about the kind of insurance the patient is enrolled or the expected source of income for the treatment. The Hospital provides an allowance of 45 days from the day billing starts to take place. If under some circumstance the insurance is not able to settle the bills within these 45 days, the hospital looks for the patient to cover the bills. Poen & Harry (2009) supported this saying “any patient having inadequate insurance coverage, or no insurance coverage, will be requested to make appropriate deposits at the time of admission” (p. 23). This problem affects majority of the patients because insurance firms are not predictable in terms of the time required to process the medical bills of the patients. The hospital rules regarding the information about insurance coverage are very strict and they even result to penalties on the patients. As noted by Poen & Harry (2009) “failure to provide accurate and current insurance information and required referrals when you are admitted could result in penalties or a reduction of benefits by your insurance company” (p. 30).

Space

Since St Luke’s Cornwall hospital; is located in a populated area, there are high number of patients who visit the hospital daily. The census of the year 2009 indicated that there are 270,000 patients who visit the hospital per. Considering that people require health care daily irrespective of the day, it can be noted that there are 739 people who visit the hospital daily. This high rate could be attributed to the fact that the hospital has always improved the level of services offered year after year. However, the total number of beds in both the Campuses is 367; this is almost half the number of the patients admitted daily. Additionally, the historical background of the hospital showed that the rate at which people visit the hospital increased at a high rate. It is therefore evident that the number of people who will be visiting the hospital in future will always increase. The limited space in the hospital has a direct influence on the amount of waiting time that is spent by patients (Goldfield et al, 2005 p. 113). It is evident that the high numbers of people who visit the hospital create congestion in the hospital. The outcome of this congestion is that people spend more time waiting for services.

Proposed interventions

Adoption of health care policies

There were many laws that were enforced in America to help the people of America save the amount of money the spent in health care. These laws were enforced by the government and they were meant to be applied in all the health care organizations. If these laws are fully enforced, patients who visit St Luke’s Cornwall hospital would not complain about spending a lot of money in health care.

The 2009 Health reform legislation was passed with the aim of Medicare saving for the patients in America. In 2009 the House H.R. 3962 approved the Affordable Health Care for America. This bill contains several provisions that are expected to affect Medicare program expenditures for the people of America. There are many laws that have so far been passed in the last fifty years; they are expected to reduce expenditure in the medical care for the people of America. An example of such law is Medicare Prescription Drug, Improvement and Modernization Act 2003. This law is a federal law of the United States that was passed by the congress and signed by President George Bush in 2003. The law is considered to have made a great contribution in the reduction of the Medicare expenditure for the last thirty eight years. The law made great contributions in terms of cost shifting, cost savings, quality Medicare and also accessibility.

The Medical Modernization Act resulted to reduction in the cost of prescription through the introduction subsidies and tax breaks. The years before the introduction of this Act, citizens from whom Medicare was designed to help could not afford prescriptions. MMA was able to avoid this problem through:

  • Large employers were provided with subsidy so as to discourage them from making private prescription eliminations on workers who were already retired. Such companies were therefore entitled to a subsidy equivalent to $400 million for a period of six years since 2006.
  • The law prevents the federal government from discount negotiations with companies that manufacture drugs.

The law prohibited the government from establishment of a formulary, although private providers were not prevented from doing the same.

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Hospital expansion

As it has be found out, the number of people who visit St Luke’s hospital per day is approximately equal to 739 persons. Considering the fact that the hospital is located in Newburgh, there daily number of people who visit the hospital will increase in the near future. The census statistics of the year 2009 showed that there were 270, 000 people who visited St Luke’s hospital yearly. Further statistics showed that the hospital has two campuses, Cornwall and Newburgh. There are 242 and 125 patient beds in Cornwall and Newburgh campuses respectively. In addition, there are 1500 total number of employees in the hospital ranging from physicians to other support staff. With 739 patients visiting the hospital daily, these statistics proves that there are likely chances for the congestion in the hospital. This in turn would result to patients taking longer times before they are served; this could be very serious especially in emergency cases. People wish to receive care at minimum time and without any complications and therefore congestion can have negative implications on the people’s aspirations (Goldfield, et al, 2005 p. 34). The hospital should therefore seek a funding mechanism and develop a long term plan to expand the hospital since it is anticipated that there expected number of people visiting the hospital would increase.

Partnership with other health care organizations

In order to avoid congestion and to share the costs of health care delivery, the hospital should seek ways of collaboration with other organizations. One way to achieve such an objective is through partnerships. The hospital administration should arrange ways in which patients can be transferred to other hospitals when it is necessary. Such scenarios include when the number of patients increase, and also when serious health care complications are reported. This is a good opportunity in that, the hospital may lack facilities to treat certain diseases and therefore by partnering with other organization helps the hospital overcome such a problem. Through such a program, the hospital can also help solve the problem of congestion thereby improving its efficiency in service delivery.

Justification

Health education in the United States of America has passed through major transformation in regard to its approaches in the improvement of health in various learning institutions and organizations. Health education in the United States of America is influenced by health care delivery system in various degrees.

Availability of health education services

Impact on the availability of health education services in the United States has made several contributions to the health care systems. For instance; the impact of the characteristics of health care delivery system on dissemination of health education services to its entire citizen. A lot of the people are of the opinion that the health information technology need be upgraded to compliment the terms of health education services. Thus, concurrency should be established between the health information technology and health education services, is the major factor, to be considered to deliver the health care system to all people. It is conceived that the use of electronic health records giving health education produce huge awareness in the youth. Every case of diseases needs to be recorded separately to allow future access of the related information (Martone, Emori & Gynes, 2006). Therefore, the cause of the disease to the patient can be established. Health education service providers are entitled to funding by the health care delivery system to help them in collecting and maintaining correct information. In absence of grants and loans it will be impossible for the health education service providers to carry out this important task.

A general view of the health education also concerns the health care administration. There is need for the simplification of the billing and codes in the various health care organizations. Another important aspect in health education is how to treat a disease. This requires effective research studies to establish the right practices for the consumers. Another responsibility of the health education service providers is to identify the disease for which you need to be admitted in the hospital and that which needs readmission.

According to the change theory, the complexity of the healthcare delivery system can be minimized by integration of the systems. The health care systems should have organizational leadership and a way to supervise risks in order to minimize practices and performances that are unsafe. The health care systems that are complex should be organized in a way that they demonstrate a self organization approach so as to ensure that the various actors of the health care system develop a spontaneous interaction. An error in medication for a patient can have varying effects to a patient; the error can either have fewer effects or can lead to permanent effects on the patient health or even death. The nurse therefore has a key role in determining the health of a patient; this is because the nurse delivers the medication to the patient and as well ensures that the patient gets the medication at an appropriate time. The RNs can either perform malpractices or have professional deficiencies that can lead to the death of a patient (Martone, Emori & Gynes, 2006).

Impact on health behaviors of the population

Some positive transformation in the health habits of the American citizen realized, thanks to the health education service providers. In fact, after the introduction of modem health delivery system, there was an increased expectation in the improvement of the public health by the general population. This is not the case, however; some positive as well as negative changes in the habits of the American population have been observed in the past three decades (Martone, Emori & Gynes, 2006).

Positively, there has been small reduction in the cigarette smoking and alcohol drinking cases. As a matter of fact, smoking percentage has reduced from 40% to 25%, whereas, alcohol drinking has reduced from 7% to 4%. On the other hand, health care delivery system has impacted negatively on the health of the Americans whereby; cases of obesity have increased from 49% to 68%. Nevertheless, the mortality rate for diabetes between 24 to 74 years old has fallen from 9.8% to8.4%. It is anticipated that obesity will increase mortality rate (Martone, Emori & Gynes, 2006).

For the past twenty years, American population have experienced reduction in acute care facilities, thus severity of the illness of the hospitalized patients has increased, besides being more immune compromised. As a result, risk for hospital acquired diseases has increased (Starr, 2006 p. 69).

Delivery of health care in homes is becoming the most rapidly growing sector of the health care delivery system (Starr, 2006 p. 67). In fact, the number of patients receiving health care services at home is equal to those receiving the services at hospitals. To compliment the expansion of the American health care delivery system, infection control personnel require doubling of their efforts. Improved administrative support schemes to prevent infections and medical mistakes to achieve reduced risk of infections. Finally, infection control branch will need to increase their surveillance of infections and occurrence of problems as well as their avoidance strategies to all situations which call for delivery of health care services.

Implementation plan

Proposed intervention actors Time frame Expected outcomes
Adoption of health care policies
  • Government agencies
  • Health care organizations
  • Hospital administration
Medium plan Low costs of health care delivery
Hospital expansion
  • Donors
  • Government
  • Hospital administration
Long term plan
  • Reduced congestion
  • Reduced waiting time
Partnerships
  • Health care organizations
  • Hospital administration
Short term plan
  • Efficiency in service delivery
  • Reduced congestion

Marketing communication plan

In order to develop the implementation plan effectively, there is need for the establishment of a good communication strategy. The communication strategy is meant to convey the proposed interventions to all the stakeholders (Campion, 2007, p. 45). The hospital can use the various marketing campaigns to inform the actors about the intended plans. Online marketing is the best marketing method for this case. This is because the method is economical and the particular message can be relayed to many people at one time. Therefore, there hospital can post the intended plans on its website and welcome comments from the willing stakeholders. In this case, the hospital can decide the best option by evaluating the comments sent be the stakeholders. The most viable plans are the ones that are preferred by most of the stakeholders. Such plans should therefore be discussed in a consultation meeting with all the stakeholders in order to decide the plans to adopt.

Effectiveness measurement plan

The effectiveness of the proposed plan should be evaluated for efficiency. A good way to determine the effectiveness of a plan is to carry out a patient satisfaction survey. This survey can be carried out by designing questionnaires which seek to know what complaints are raised by the patients. Such a survey can be carried out by an independent body instead off the hospital staff (Burn & Caldwell, 2009 p. 23). This help to avoid any fear that may develop in a patient when being interviewed by a member of the hospital staff; in addition, the patients can feel free to raise all concerns to a neutral person. The questionnaires should be structured to address the gaps that were identified in the needs assessment stage. The outcomes of the survey can help to determine what improvements should be done on the proposed interventions or what other interventions should be employed in order to improve the efficiency of health care delivery at St Luke’s Cornwall Hospital. The findings are also useful in that they can be employed by other health care organizations because they all experience similar problems.

Reference List

Burn, J. & Caldwell, L. (2009). Management of Information System Technology. Hong Kong: Alfred Waller Ltd.

Burrow, J. (2005). AMA: Voice of American Medicine. Baltimore: Johns Hopkins Press.

Campion, F. (2007). The AMA and U.S. Health Policy since 1940. Chicago: Chicago Review Press.

Carroll, J. & Edmondson, A. (2002). Leading organizational learning in health care. Quality and Safety in Health Care, 11: (3), 51-56.

Conner, M. & Norman, P. (2006). Predicting Health Behavior: Research and practice with social cognition models. Philadelphia: Open University Press.

DeMarco, T. (2007). Structured Analysis and System Specification. Eaglewood Cliffs, NJ: Prentice Hall.

Fishbein, M. (2007). History of the American Medical Association, 1847-1947. Philadelphia: W.B. Saunders.

Goldfield, N. et al. (2005). Pay for performance: An excellent idea that simply needs implementation. Quality Management in Health Care, 14: (1), 31-44.

Kahn, C. (2006). Intolerable Risk, Irreparable Harm: The Legacy of Physician-Owned Specialty Hospitals. Journal of Health Affairs, 25: (1), 130-133.

Mahar, M. (2006). Money-Driven Medicine: The Real Reason Health Care Costs So Much. New York: Harper/Collins.

Numbers, R. (2008). Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912-1920. Baltimore: Johns Hopkins University Press.

Poen, M. & Harry S. (2009). Truman versus the Medical Lobby: The Genesis of Medicare. Columbia, MO: The University of Missouri Press.

Roland, M. (2004). Linking physicians pay to the quality of care-A major experiment in the United Kingdom. The New England Journal of Medicine, 351: (14), 1448- 1454.

Shojania, K., & Grimshaw, J. (2005). Evidence-based quality improvement: The state of the science. Health Affairs, 24: (1), 138-150.

Starr, P. (2005). The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. New York: Basic Books.

Starr, P. (2006). The Social Transformation of American Medicine. New York: Basic Books.

Wood, H., et al. (2005). Information Systems Definitions: The Multiview Approach. Oxford: Blackwell Publication.

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