Introduction
Ambulatory care provides an important contact between the healthcare facilities and the people benefiting from this program. This raises the importance or need for their careful planning both in terms of facilities and staff, among other issues. In the consideration of the program for the ambulatory health care center, issues such as efficiency, quality, and diversity of the services provided must be considered. Quality means that the services provided must not only march the requirements, but also be up to a certain standard or level. This is determined by the quality of staff such as the education level and the facility used. Efficiency would mean being able to serve as large number of patient as possible compared to those who seek the intervention. The program for running the facility must therefore take into consideration issues of the possible number of clients to be served. Ambulatory care centers also perform a crucial role as taking-in points for the patients who require medical attention; serve as points of contacts for the on-going, routine, and follow-up practices; serve as centers for referral operations for specialized services; and offer services such as emotional, psychological, social and psychiatric support.
The quality of the program to run the facility is therefore very essential because it might influence the quality, efficiency and the diversity of the services provided. There is need for consideration of the likely influential factors to the quality and the efficiency of the program. In the face of the increasing cost of healthcare, primary care can perform an important role by ensuring that they coordinate care for specialty services, while easing the situation for shortage of nurses and medical practitioners in the advent of increasing demand of healthcare. Ambulatory services have been used to provide outpatient services through the use of redesigned hospital ambulatory facilities, in the face of overcrowding at hospitals, wrong mix of services, problems related to equipment and personnel (Austin, Stephen, Williams & Ernest, 1997). Among the activities arising as a result of competition in the field of ambulatory services include purchase of medical practices, development of health plans and joint ventures (Warren & Annette, 2006). The paper presents a program for ambulatory primary care center. This ambulatory primary care program focuses on a community-based primary care and urgent care settings.
Components of the Program
Current demands in public health care require a diverse approach to solutions offered by clinics and medical institutions. Due to the diverse needs of the society as related to health needs of the individuals, it is important that institutions have a diversified approach towards providing health solutions in terms of biomedical services and educational programs. The primary focus of this initiative is to provide medical services to the residents. These services are of a wide scope and include provision of drugs for chronic illnesses, medical check-ups and clinical services. Provision of these services will be carried out by professionals who have been employed by the center and who have been considered competitive enough through training on the current needs, challenges and opportunities for ambulatory primary health care. In addition, the initiative will include provision of counseling services for the residents, social and emotional support. Professional counseling shall be available to groups who are interested after request, or after the individuals have been identified to require counseling following a medical examination or testing for chronic illnesses. The initiative will also involve creating awareness for the various types of chronic illnesses among the vulnerable groups and individuals through community educational health programs. Residents shall be made aware of the illnesses and diseases they are exposed to, exposure factors, ways they can prevent these illnesses, need to adhere to prescriptions, and how they can seek medical intervention for particular illnesses. The program incorporates not only biomedical health care, but also provision of medical training to residents, emphasis of medical ethics among practitioners and providers, improvement of health policy among others. Basic education shall be provided to recruited residents through ambulatory lecture curriculum on notice for the diseases identified as chronic. This is so as to equip residents with basic understanding of these illnesses. This training shall be aimed at ensuring enough practitioners are available for the community. The curriculum which shall take one year shall be designed to equip the recruits on how they can assist in providing patient care services and training needs at the community level. During this curriculum, the recruits shall be informed of the objectives of the lectures, learning outcomes and furnished with the necessary information on tests to be passed to them.
Under the Ambulatory Regulatory Program Administrator, the initiative will focus on the development of effective leaders in the ambulatory primary health care. This will be done through thorough and strict recruitment process for intake of professionals who are not only qualified in the field of ambulatory health care, but also staff in other diverse field related to the proper operation of the initiative. Effective leadership of the ambulatory primary center is very essential because it does not only ensure that there is proper management of the facilities but also that the quality of the services is not compromised. Leadership must be competitive so as to keep the center on toes with the current level of competition in the market, make sure that the services rendered are according to the current needs, and that the financial costs for the center remains as low as possible while not compromising on the quality. Leadership must be academically competitive individuals who understand ambulatory primary healthcare and the current needs and challenges for the institution. The leadership will be able to guide the institution to innovative practices such as integration with like-minded institutions which is essential to cutting down the cost. In addition, the expansion of the care facility will be largely determined by the competence of the leadership.
The modern community is no longer composed of people from one cultural, racial, traditional or religious background. In some cases, patients have preferred medical attendance on such basis, and therefore a need arises for healthcare institutions to make sure that these needs are incorporated into their programs. The current program will also focus on improving the needs for diversified community by emphasizing more on diverse cultural, traditional, religious and social-economic needs of the patients going through the initiative. With this in mind practitioners shall be drawn from the various cultural, traditional, religious and other backgrounds to make sure that there is a natural and basic understanding of these elements for the benefits of the residents to be served. In addition, because it may not be possible to schedule these practitioners based on their backgrounds, a program to train them on the various cultural, religious, traditional and other needs for their clients, shall be launched. The practitioners shall be required to serve the residents regardless of their social, economic, religious, traditional and cultural backgrounds(State of West Virginia).
Urgent care section shall aim to serve residents who visit the center with minor injuries, symptoms and illnesses before they are referred to specialized hospitals where necessary, and who require screening for various illnesses and diseases. Screening shall be carried out for cancer illnesses, simple radiology, allergy testing, diet control, pediatrics among other categories (State of West Virginia).
Opportunities for improvement
Rise in the healthcare cost in the current healthcare system present an opportunity for improvement of the ambulatory primary care as the latter tries to emerge with innovative ways that will reduce these costs. Opportunities to be explored include the alternative ways of funding. In order to make sure that there is reduced cost for the care services, the institution shall consider merging with other like-minded parties in order to share physical resources instead of building new ones unless where it is unavoidable. The institution shall therefore concentrate on linking the residents with hospitals for specialized treatments rather than major on providing specialized treatments. In addition, there shall be sourcing of medical equipments from established medical facilities such as the public health hospitals.
The initiative will aim at reducing burden for the society in the settings where members of the society cannot access medical services as a result of escalating medical costs and healthcare insurance coverage.
Potential for Growth
The result of more growth of ambulatory operations in the community may be a rise in the demand for techniques that introduce different relationship between the hospital and the physician, new financing models and new designated ambulatory leadership (Warren & Annette, 2006). Because of the benefits that could be harnessed by integration of different practicing institution in the field of ambulatory services, integration is therefore one of the potential areas of growth in this field. Integration can eliminate cultural, structural challenges in managing of primary care networks. Although integration has been a current practice in the field in order to cut cost and achieve other benefits, it is important that the institutions involved continue to focus on integration so as to achieve this and other benefits across the various communities involved. The institution will have to introduce innovative practices and systems that ensure measurement of quality and the management of chronic diseases. Because of the diversity in the healthcare which would require diverse working staff, there is a need for multidisciplinary approach to the patient-centered care (Warren & Annette, 2006). Academic Health Centers will have to carry out reforms in the current educational mission in order to end up with graduates who are ready and prepared to practice in the modern healthcare settings. The ambulatory care institution must therefore focus on making sure that the working staff is regularly updated on the current needs and settings in the healthcare as they arise. This will be carried out through retraining on intake, continuous seminars and funding individuals for higher education. In consideration that the clinical setting for the present has changed as compared to that of the past due to the technology advancement, rise in the aging population, and rise in the chronic illnesses, the staff will need training not only in the biomedical focus but also incorporated social, behavioral and cultural effects in the healthcare focus (Warren & Annette, 2006).
Expansion of the ambulatory primary health care services to the areas where there has not been wide venture is important for helping more people in the future. In addition, this presents a growth opportunity for the institution. Growth of institutions with a similar objective can be realized through integration. The institution will focus on integration with other organization to grow more and share facilities and staff to reduce on operating costs, overcome barriers such as cultural, religious and traditional, among other benefits (Esposito. et al., 2008). Strategic alliances will ensure that the institution continues to meet its objectives at a faster rate. Determination of these strategic alliances will be based on the current revenue and future revenue plans, delivery services and expansion plans among other criteria.
Projected revenue
Most of the program’s revenue will be sourced from the government as well as the non-governmental organizations. Some will be internally generated through prescription $ consultation fees charged directly to patients in their medical routine check-ups. The fees charged will be subsidized to ensure that they are affordable to all patients. The management will also establish chemist shops that will sell drugs for chronic illnesses to patients and outsiders at lower rates, also outlets for special facilities such as wheelchairs will be started. Health education programs to the community will be established aimed at generating some more revenues to the program. This will entail educating the general population on issues regarding medical health upon paying the specified amount of money as per the training session. Volunteer programs will play a vital role in supplementing the revenue earned. Here, students from every corner of the world will be encouraged to tour the region as volunteers and they will be charged a small fee.
There will be provision of counseling services to the emotionally disturbed patients at a fee. Mobile clinics will also be established in the sparsely populated regions. Cost savings from the government insurance schemes will act as a source of revenue as well.
Operationalization data
Collecting information (e.g. through questionnaires and interviews) from the target community will be a very important step in the operationalization data. This will help in establishing the community’s need in terms of medical care. Presentation and analysis of data will be helpful in the program’s establishment. Staffing needs in terms of numbers, building facilities (e.g. wards), catering facilities, patient’s clothing and medical equipments will be taken care of.
Population distribution patterns in this region will be very important in the program planning, a thing that will go hand in hand with monitoring the health care status of the region so as to identify the need (including lifestyle) of the target community (Buntin, et al., 2009).
Timeline
The program will take 14 months to be implemented fully. All these will be attained in 6 phases
- Phase 1: This will entail gathering information on the region’s healthcare status. The process will involve collection, presentation and analysis of data. This will take place in the first two months.
- Phase 2: The second phase will involve consulting with other stake holders i.e. government, non-governmental organizations and well wishers. The phase is expected to take place in the third and fourth month.
- Phase 3: Here, all the necessary facilities e.g. buildings will be set up. It is expected to last to the 8th month.
- Phase 4: The fourth phase will concentrate on staff recruitment and training. Academically qualified individuals will be recruited and later trained to ensure that they are up to the task ahead of them. This will take place in the 9th month.
- Phase 5: This will be the implementation stage where all resources will be put into use. Every player is expected to deliver for the success of the program.
- Phase 6: This will be the review period after one year of implementation. It will be a very important stage in the program’s assessment. Subsequent reviews will take place at an interval of two years thereafter.
Critical success measures
The accountability of the initiative both to the owners and the community is of paramount importance in meeting its objectives. This program therefore establishes a client and community perspective towards the assessment of the effectiveness of the initiative. Clients’ perspective is important in ensuring that the venture attracts and retains patients (Austin, Williams & Ernest, 1997). The initiative will concentrate on improving customer satisfaction and track the same. This is by making sure that the care provided is easily accessible to the residents and that it is assured. This availability is determined in terms of the hours of operation, availability of referral and consultation services and after-hours coverage. Physical surrounding of the facilities is also an important element in attracting and retaining of the clients (Esposito, et al., 2008).
Because patient scheduling is important in determining customer satisfaction, the program emphasizes efficient scheduling through scheduling and appointment system that will reduce waiting time for the patients and encourage efficient use of resources (Iezzoni, 2003). The program encourages the involvement of the government and other institution in the management of patient care through insurance coverage schemes and other financing options, in addition to requiring that the patients pay for their health care.
References
Austin R., Williams S. & Ernest J. P. (1997) Ambulatory care management. 3rd Ed. Delmar Publishers.
Buntin MB, et al (2009): Who gets disease management? Journal of General Internal Medicine 2009.
Esposito D, et al (2008). Impacts of a disease management program for dually eligible beneficiaries. Health Care Financing Review 2008; 30:27-45
Health Care Authority, State of West Virginia. Ambulatory Care Center Application. Web.
Kovner, A. R. and Neuhauser, D. (2004): Health services management: Readings, cases, and commentary (8th ed.). Chicago: Health Administration Press.
Iezzoni, L. I. (Ed.). (2003). Risk adjustment for measuring health care outcome. Chicago: Health Administration Press.
Polacsek et al., (2009). Impact of a Primary Care Intervention on Physician Practice and Patient and Family Behavior: Keep ME Healthy–The Maine Youth Overweight Collaborative. Pediatrics; 123:S258-S266.
Warren P. N. and Annette C. D. (2006). Shaping the Future of Academic Health Centers: The Potential Contributions of Departments of Family Medicine.Annals of Family Medicine 4:S2-S11.