Executive Summary
There is a current need to evaluate the provision of physical therapy in society today, taking into consideration the number of people who need therapy, and the people with actual access to the service. While therapy is mostly offered by private practitioners, our medical institution, with appropriate funding from the Government, wishes to avail these services to the general public at a lower cost. Our patients would include the elderly (suffering from Arthritis), major accident victims, and children with physical impairments.
Dreeben (2006, p. 26- 29) It’s with the growing need to address these issues that our medical institution proposes to establish a physical therapy and rehabilitative medicine department. The hospital is already equipped with some of the equipment and staff required to offer these services, and the proximity of medicinal supplies currently held in stock would ensure a quick implementation process.
The hospital is large enough to accommodate the needed space and facilities for this program; hence the capital input from the government will be minimal. From this venture, the government is sure to save on expenditure it would have incurred if insured patients had sought services from private practitioners, given their high mark-ups. The hospital’s current location is quite accessible to the general public, thus our managerial team expects an early adoption of our services from society. The government’s health plan is also expected to gain more subscribers, as the staff would be required to recommend it to access the services. (Turnock, 2008)
Introduction
Public hospitals are currently lagging in the implementation of modern technology. For the public hospitals to regain their efficiency and quality recognition they first have to match, or better, the services offered by their private counterparts. Patients in need of therapy services have been recommended to private establishments in recent years, which may be unaffordable for some members of the general public. Physical therapy, as a medical practice, has evolved tremendously in recent history.
New procedures have been developed to restore movement and functional ability once believed to be lost. The practice, mostly found in the private sector, also requires to be taken up by public hospitals to make sure that the benefits are available to all members of society. (Dreeben, 2006) p. 35- 46
Case for change
Private physical therapy establishments are expensive for most members of society, and for this reason, some patients result into buying either prescribed drugs or taking pain medication, rather than go for therapy sessions. Physical therapy is generally used to restore movement to patients suffering from permanent disabilities, major accident victims who are in a recovering state, patients ailing from arthritis, lower back pain and cerebral palsy.
Both hospitals and the government alike cannot afford to overlook the financially unstable members of the community or rely solely on the private sector to provide physical therapy programs. For that reason, there is a need to establish a plan that covers the majority of the public, a plan that will ensure therapy services are affordable. (Dreeben, 2006) p. 188-190
Analysis of the proposal
The analysis will place emphasis on benefits that will be derived from the project, if successful, as well as the costs of implementation. Risks have been considered and their effect documented. The proposal also highlights the cost of not implementing the program, while focusing on the need for this program.
Implementation of the proposal
The first phase of the implementation of the proposal would be to ascertain the initial capital requirements and procure the necessary manpower and facilities. The second phase requires input from management in terms of performance measurement and programs that will help grow and develop the physical therapy department.
Content
Executive Summary
There is a need to set up physical therapy and rehabilitative department in the hospital, to serve the community by providing affordable and efficient medical services. The key stakeholders in the proposed program include the government, the hospital and the local community. The initial capital required for the implementation of this program will be financed by the state government. The total cost of the project is estimated at $ 805,000, which includes staff expenses for the first year (Table 1).
Table 1: Initial capital outlay (prices quoted from Akrongeneral.org).
The major risks associated with the project are; the responsiveness of the public to the introduction of these services, and inadequate funding. But despite the potential risks, failure to implement the project amounts to far a greater disadvantage for the community as a whole. Without this program, many patients will be locked out of quality healthcare due to escalating costs in the private sector (Naden 2009).
The proposed department will be under the hospital’s management, which will be open to any government scrutiny and intervention. For the program to be successful, the hospital and the respective government department should work together to derive the benefits of synergy.
Introduction
The purpose of this initiative is to cater to the health needs of the general public, who include patients with disability problems as well as people suffering from arthritis. The hospital, with help from the government, will strive for affordable services while maintaining quality delivery of the same. The hospital will also engage itself in educative programs that will aim at informing the public of the benefits of physical therapy, the purpose of exercise and alternative methods of maintaining health and fitness.
Case for change
Need for physical therapy
Physical therapy is there to assist patients who have physical functionality problems (Erickson et al 2008). The therapy involves utilization of exercise treatments that aim at building on residual abilities left in a patient. In some cases, the existing health circumstance weakens a patient to such an extent that it becomes vital for them to learn how to operate within their physical restrictions. A patient could be enduring consistent pain from an injury or recent surgery, thus requiring the services of physical therapy (DeTurk & Cahalin, 2010).
Therefore, the program is meant to relieve pain in such patients, or restore movement to affected muscles or limbs. If implemented, the hospital expects the physical therapy program to be quite popular in the community due to its cheap accessibility. The government can also expect societal problems associated with physical functionality constraints to decline in the long run.
Benefits of the proposal
Financial benefits to the government will come in form of savings, whereby subsidized services offered at the hospital’s physical therapy and rehabilitative medicine department are cheaper than those offered by private practitioners. The community has a lot to benefit from this program, if the proposal is successful. Relatively cheap services and subsidized medicines would ensure that more and more community members take advantage of the proposed program so as cure their ailments.
The hospital stands to benefit from increased patients through added revenue streams, which will be reflected in the oncoming years’ budgets, as the institution looks to modernize its facilities. If the program is successful, the hospital and the government may choose to work together on future projects, whereby both organizations aim on bettering the health and welfare of the community.
Analysis of the proposal
Objectives
The main objective of the physical therapy and rehabilitative medicine department is to add value to the community’s wellbeing. The hospital seeks to offer affordable and quality services to all members of the society, educate the public on the importance of physical therapy and follow up procedures, and maintain proficiency so as to produce desired results.
Alternatives
Options considered before hand included partnerships with private practitioners and a consultancy department. A private partnership, while ambitious, does not guarantee long term commitments since the contracts entered into only cover several years. A contract with the government would ensure that the agreement is binding on both parties, whereby both institutions would achieve their desired long term goals.
A consultancy department in effect is a cheaper program to implement, but solutions offered are not enough to most members of the community. The proposed physical therapy and rehabilitative medicine department has greater overview of the needs of physically challenged patients.
Costs
Costs relating to the proposal mainly concern the procured equipments, and general staff costs. The current wage price fro a nurse in the US is projected at $ 30 an hour. With the required personnel of seven attending nurses, this figure translates to approximately $ 60,000 for each nurse per annum (Nahin et al 2007).
The hospital establishment has enough room to facilitate the implementation of the program, thus rental expenses will not be incurred. Experienced physicists call for approximately $150,000 per year, inclusive of benefits, while the expected secretary remuneration package is $ 40,000 for the same duration. Therefore, from the two physicians, seven attending nurses and one secretary, the annual expected staff expenses for this particular department amount to $ 760,000 a year. (Dreeben, 2006) p.77- 284
New equipment, specialized for physical therapy purposes, accumulates to $ 45,000 (Table 1). Other equipment, such as x-ray machines are already available at the hospital, and hence no new ones are required. The hospital is also willing to meet the cost of training personnel and equipment maintenance expenses of for present and fore coming years. Maintenance expenses are predicted to amount to grossly $ 10,000 a year.
Non-quantifiable factors
Public reception of this initiative cannot be measured, but the effects as well as the benefits are guaranteed. It is also not possible to predict correctly the number of people who will be involved in major accidents in fore coming years.
Benefits
This proposal will certainly reduce healthcare costs incurred by insured patients. The government will also be in a better position to safeguard the well being of the community (Pierson &Fairchild 2007). The government will also experience a shortage in the number of citizens claiming disability benefits, especially if the program is successful for those individuals. Physical therapy, by itself, helps prevent the reoccurrence of a treated ailment in the future.
This is a great advantage in that it also helps save money that would have been incurred to cure for the same ailment. Staff will subsequently be in a better position to serve others rather than dealing with crowded rooms (Longman, 2007).
For patients, physical therapy could help restore mobility of their limbs, and ultimately acquire the balance and coordination they need to proceed with their livelihoods. For children, the program aims to increase their motor performance, decrease joint pain, aid in development of the body as well as educate their families. Generally, the program will improve a patient’s health and fitness, reduce stress levels and ultimately give hope to patients. (Erickson et al, 2008)
Financial analysis
The hospital’s managerial team estimates that the proposed department will serve at least 1000 people a month. Various services offered, with differing price levels, makes challenging to give an actual figure for the revenue expected from the project. On average, the hospital hopes for operating revenues to reach $ 100,000 a month:
Average cost incurred by patients * estimated patients per month= estimated revenue
=$ 100 per patient * 1,000 patients per month
=$ 100,000 per month
If this were the case, then yearly turnover can be put at $ 1,200,000, which will be large enough to cover staff ($ 760,000) and maintenance expenses ($ 10,000). The surplus, $ 430,000 per year, should be enough to repay the government in two year’s time. After reimbursing tax-payers money, the additional revenue stream will be used to acquire more modern equipment so as to guarantee long term benefits for the community.
Risk assessment
Identified risks
Major risks of this project concerns the general public’s reception and perception of the hospital’s mandate to offer physical therapy services, inadequate funding, and competition from wealthy private hospitals. The risks of not implementing the program outweigh the risks mentioned, whereby some members of the society will be locked out of services. (Dreeben, 2007). p. 127
Impact of identified risks
Competition from wealthy private practitioners is also a key factor to consider, but the hospital expects that the cheaper alternatives offered at its establishment will secure long term sustainability. Cheap services offered at the proposed department might lead some members of the public to believe that the quality is sub-standard, leading to low uptake of the program. The hospital management will campaign on the high standards practiced in the institution, and ensure responsibility, accountability and proficiency in the proposed department.
Insufficient funding will undermine the integrity of the service, given that only a few elements of the service will be provided. (Dreeben, 2006). Inadequate capital may also result in cheap machinery and equipment, which may lead to malfunctions, or inappropriate treatment of patients. Consequently, if the program is not implemented, both the hospital and the state will miss out on a great opportunity to serve the community.
Service management
Governance arrangements for the project
The proposed physical therapy and rehabilitative medicine department will comprise of 10 members of staff: two physicians, seven attending nurses, and one secretary. The two physicians will be in charge of the departmental proceedings, while revenue and expenditures concerning the department will be handled by the hospitals accountants.
Technical standards to be addressed
Technical standards to be considered involve the acquisition of machinery and facilities needed for operational use within the proposed department. The hospital management intends to participate in forums and seminars concerning the practice, so as to follow up on the best of practices.
Key steps in implementing the proposal
The first step in implementing the proposal is to acquire the needed funds for the procurement of facilities, and the hospital’s role in setting up the space needed to accommodate the department. Training programs will ensure as soon as the proposal is accepted, but licensed physicians will be sought and given authority to run and operate the facility. During training, the attending nurses will be allowed to participate in the department under close supervision, whereby they will acquire the needed experience.
Risk management
The hospital’s management offers to provide basic and common physical therapy services, as opposed to offering rarely used but expensive procedures. This way, available equipment will be fully utilized as the managerial staff evaluates future services. As need develops to provide more specialized services, then management will develop initiatives to cater to such needs. (Malone & Lindsay 2006)
Change management
Change management roles and responsibilities
The hospital board of directors and management are ultimately responsible for the operations and proceedings, but operational issues will be under the discretion of the two physicians. Decisions to offer new services will be made by the physicians, after approval from the hospital’s management team. (Naden 2009).
References
DeTurk, W., E., Cahalin, L. P., (2010). Cardiovascular and Pulmonary Physical Therapy: An Evidence-Based Approach. New York, NY: McGraw-Hill Professional Publishing.
Dreeben, O., (2006). Introduction to physical therapy for physical therapist assistants Sadbury, MA: Jones & Bartlett Learning.
Dreeben, O., (2007). Physical Therapy Clinical Handbook for Pta’s. Sadbury, MA: Jones & Bartlett Learning.
Erickson, M., McKnight, R., Utzman, R., (2008). Physical Therapy Documentation: From Examination to Outcome. Thorofare, NJ: Slack Incorporated.
Longman, P., (2007). Best Care Anywhere: Why VA Health Care Is Better Than Yours. Sausalito, CA: PoliPoint Press.
Malone, D. J., Lindsay K. L. B., (2006). Physical therapy in acute care: a clinician’s guide. Thorofare, NJ: Slack Incorporated.
Naden, C. J., (2009). Health Care: A Right Or a Privilege? Tarrytown, NY: Marshall Cavendish.
Nahin RL, Barnes PM, Stussman BJ, and Bloom B. (2007). Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007. National health statistics reports; no 18. Hyattsville, MD: National Center for Health Statistics.
Pierson, F. M., Fairchild, S. L., (2007). Principles and techniques of patient care. 4th ed. Philadelphia. PA: Saunders Elsevier.
Porter, M. E., Teisberg, E. O., (2006). Redefining health care: Creating value-based competition on results. New York, NY: Harvard Business Press.
Turnock, B. J., (2008). Public health: what it is and how it works Sadbury, MA: Jones & Bartlett Learning. Web.