Abstract
Effective operations of healthcare organizations depend on the ability to manage personnel, finances, and materials. With valid and reliable employee assessment information, personnel managers can make effective decisions in terms of fitting employees in the right jobs such that they can excel to improve the facilities’ services, enhance their retention, and/or develop effective and highly productive work teams. The current paper discusses issues of personnel and material management at SMARTcare health facility. SMARTcare Company is a hypothetical healthcare organization that operates in the state of California. It aims at delivering quality healthcare to the general population via its specialized and general care units.
To achieve this objective, the paper recommends the necessity for adopting the best practices regarding Quality Safety Education in Nursing (QSEN). To facilitate the reimbursement of revenues, the organization uses managed care plans, specifically HMO and the Affordable Care Act of 2010. To guarantee optimal performance, SMARTcare values the need to reduce the cost of operations as reflected in its budget. The paper identifies the use of cost reduction strategies and philosophies as important cost containment strategies.
Introduction
Healthcare organizations bring together different workers to one environment. Such people have diverse differences that are manifested through their skills and knowledge bases. In the effort to build long-term success around people, it is important for healthcare organizations such as SMARTcare to adopt strategies for effective personnel management. Without effective management of financial resources, the organization may fail to achieve its strategic vision and mission. The facility is based in California. SMARTcare’s mission is to provide quality care to all people to guarantee a disease-free society. The organization endeavors to recruit the best staff members in the medical industry. It also warrants effective management of financial resources. The company’s vision is to manage its personnel and financial resources effectively and to continue diversifying its healthcare services so that it can expand into other regions within the United States of America.
In the process of executing its purpose of providing healthcare services to the Californian population and beyond, SMARTcare provides a safe working environment for its employees to increase their work motivation. It guarantees a continuous review of employee wages and salaries together with providing avenues for upward mobility. Work shifts are designed to warrant adequate employee flexibility. This paper primarily addresses SMARTcare’s resource management with a focus on financial materials and personnel management. Recommendations are made based on legal, ethical, scope, and standards of practice for the Nurse Administrator guidelines concerning the Christian Worldview.
Quality Safety Education in Nursing (QSEN)
Quality Safety Education in Nursing (QSEN) project proposes six main competencies that can help in increasing safety and quality of service delivery in healthcare facilities. Sherwood and Zomorodi (2014) identify them as “patient-centered care, teamwork, and collaboration, evidence-based practice, quality improvement, safety and informatics” (p.17). At SMARTcare, patient-based therapy addresses issues such as communication, responses to the offered services, and respect for all persons who are involved in the care delivery. It also involves engaging families of the patients on decisions that are made during service delivery.
In terms of treating families as part of the healthcare team, SMARTcare believes that it can promote safety in the service delivery process by minimizing errors during the process of diagnosis. Families are also encouraged to notify clinicians when they note inconsistencies in the care delivery or when they discover that different medications have been given. This way, although the clinicians may have altered the medicine to suit the needs of patients, it becomes possible to identify and track errors.
SMARTcare builds its philosophy on the principles of collaboration and teamwork. By collaborating on a variety of issues, SMARTcare can reduce errors in care delivery. In fact, from 1995 to 2005, Sherwood and Zomorodi (2014) assert that a breakdown of work teams and ineffective communication that hindered collaboration accounted for 66% of the total healthcare errors in the US. In many healthcare facilities, adverse drug errors mainly occur during transition points from one caregiver to another (Pollard et al., 2014). Therefore, SMARTcare endeavors to ensure that this issue does not occur by encouraging teamwork and collaboration. Indeed, recognizing the responsibilities of different team members helps in detecting errors at the earliest stage before adversely influencing the patients negatively. Therefore, all work team members are anticipated to collaborate in an effective manner to attain the best outcomes for different patients.
SMARTcare believes that the best patients care is the one that is delivered based on evidence-based practices. Such practices measure up to the best industry standards. Different units of SMARTcare caregivers understand the best standards of care since they have a guide to their practice. They also possess knowledge on when to deviate from the prescribed standards and values within the paradigm of the evidence-based care system. This appreciation helps in developing new evidence to guide future practices and/or ensure continuous improvement in service delivery.
Quality improvement is critical in ensuring the reliability of services that are delivered at the SMARTcare facility. The quality improvement process that is deployed by SMARTcare entails measuring any deviation from the ideal and actual situation of care delivery. The organization deploys quality improvement tools for measuring outcomes and/or benchmarking on the existing industry’s best practices.
Safety entails all efforts that are aimed at minimizing risks and harms on patients together with care providers. It can amplify the performance of individual caregivers by increasing their effectiveness in service delivery (Sherwood & Zomorodi, 2014). At SMARTcare, all nurses have the responsibility of ensuring the safety of their fellow nurses. Employees are charged with ensuring the safety of other employees. This observation implies that safety is a collective responsibility for all people at SMARTcare. The safety culture helps in preventing close misses while at the same time ensuring that errors do not occur, especially those that can be prevented.
At SMARTcare, informatics provides safety alerts with the goal of ensuring rapid response to emerging problems. Through the system, medical practitioners from different units, including nurses, participate in the development of applications and the making of decisions on procurement and training and development. Quality Safety Education in Nursing (QSEN) influences SMARTcare’s budget in terms of the allocation of implementable financial resources and revenue compliance to the six established areas of focus. For example, informatics requires the allocation of resources in providing security to the information system, which may be prone to cyber-attacks.
Financial/Material Management
Several approaches may be deployed to ensure the flow of financial resources in SMARTcare. Some of the most important mechanisms include DRGs, PPSs, capitation, HMO structure, Medicare, Medicaid, or other current legislative measures such as the Affordable Healthcare Act of 2010. At SMARTcare, compliance with the legislative directions is incredibly important to ensure harmony between the organization’s operations and the legal environment (Surendra, Omar & Amit, 2010). The organization values the importance of accepting different financial flow mechanisms. Nevertheless, SMARTcare values the contribution of managed care through the HMO and the Affordable Care Act of 2010 to the reimbursement healthcare of funds.
Through the Affordable Care Act of 2010, the central driving force for the healthcare plans is the need to avail affordable healthcare to all Americans while at the same time minimizing the number of uninsured Americans (Antos, Wilensky, & Kuttner, 2008). To realize this endeavor, the healthcare reform plan provides mechanisms such as offering financial assistance, tax credits, and mandates to individuals and/or employers. The goal is to boost the health insurance uptake rate. The plan has some other additional reforms that are aimed at improving the outcomes of healthcare together with streamlining the healthcare delivery. The Act places an obligation to insurance companies to ensure that all applicants are subtly covered at equal rates with the gender and pre-existing conditions of the applicants. SMARTcare ensures a smooth flow of revenues since all American people now have health insurance cover.
The HMO is the most renowned kind of managed care in the US. It uses the group model and the Individual Practitioner Association (IPA) model. Under the two models, all patients are included in a prepaid fee that is termed the capitation charge. The HMOs focus on the preventive care with the final goal being to ensure that all covered people remain healthy and hospitalized. The goal corresponds to SMARTcare’s mission.
Although SMARTcare may also accept other sources of care coverage, financial flow within the facility follows a common cyclic pattern. It begins with patient admission into the facility, followed by the delivery of service. The patient or the third party who accompanies the patient is billed for the delivered care. The payment is then collected before all contractual allowances are deducted. Payment is then made for the facility expenses such as wages and salaries of the employees, medications, and supplies among others. Through the funds that are collected through HMOs and the Affordable Care Act, SMARTcare can increase the quality and safety of the delivered care. For example, the realized profits help in the growth and expansion of the facility’s services. It also ensures that the facility gains the capacity for treating more patients. The funds are channeled to different units to increase their capacity to access new evidence on the emerging effective treatment options.
Cost Containment Opportunities and Strategies
Through technology, SMARTcare can reduce the cost that is related to delays in terms of retrieval of patients’ information. The organization’s information system has databases for patients’ health records, including medication, effects of the drugs on the patients, and any potential allergies. This historical information is recorded in an easily accessible format to enhance information retrieval. To facilitate information sharing, the SMARTcare patient information system has networked databases. It has systems in other medical facilities where patients who seek services from the medical facility may also seek either an alternative or additional healthcare services (Rhay, Wen & Li-Yu (2010). Interconnection of the SMARTcare personal medical history databases ensures that medical practitioners can have access to patients’ medical history, irrespective of the location of the alternative facility.
Cutting the cost involves ensuring that SMARTcare does not incur repetitive expenses such as expenditure on recruitment of new employees. For example, putting in place mechanisms for nurse retention is a critical measure of the success of any health institution since nursing management scholars consider nursing one of the stressful professions. For instance, Stacie, Hsiu, Dale, and Sondra (2015) assert that nurses often encounter situations that make them burn out. In fact, issues such as handling injured and sick patients and managing almost dying people subject nurses to emotional turmoil. Hence, they have to be managed such that their cognition and physical efforts are not affected by the constant exposure to these strenuous situations (Stacie et al., 2015). This observation means that nurses’ managers must deploy appropriate strategies to ensure that they always remain motivated and committed to their work. It is important to note that nurses work in organizations, which are similar to any other organization where the concepts and theories of organizational management are important in addressing issues that relate to recruitment and retention.
Cost-saving opportunities exist to prevent health facilities from running short of the required services. In 2008, CMS stated that Medicaid would stop paying for preventable acquired ailments within healthcare facilities (Rhay et al., 2010). This issue emerged due to the increasing concerns among payers in terms of patient safety, the quality of healthcare delivery, and the performance of healthcare facilities (Sherwood & Zomorodi, 2014). Preventing health facility-acquired infections implies that SMARTcare will not incur the expenses of employing more healthcare staff members to meet the increasing workload that arises from contagious infections within the hospital. Cost/benefits analysis is also important in ensuring that the benefits of the delivered services equate to or exceed the costs of care. Cost reduction is also possible by increasing the efficiency of service delivery through the increased productivity that emanates from the high staff motivation. This case may involve looking for strategies for increasing employee motivation and/or incorporating technology in executing various processes and operations in SMARTcare.
Deploying the Affordable Care Act as a means for reimbursing revenues at SMARTcare creates opportunities for improved quality and safety, which can further reduce the cost of the organization. Under the Affordable Care Act, hospitals that fall under the top quartile in terms of health facility-acquired infections together with those that possess high readmission rates have their Medicare reimbursement reduced by 1% and 3%. Under the Act, all healthcare facilities face the risk of a reduction of 2% in Medicare reimbursements (Rice, Unruh & Rosenau, 2014). The saved funds are deployed in rewarding healthcare facilities that have improved quality and safety measures. In search of this reward, SMARTcare emphasizes quality and safety.
Recommendations for Operations, Budget, and Staffing
Medical practitioners have the obligation to ensure confidentiality of all information that is included in the patients’ medical files as issued by a doctor, an individual, or organization that takes charge of patients’ healthcare (Wilson, 2008). They must also protect insurance and billing information that relates to a patient. Conversations that are held between patients and doctors also require protection in the effort to ensure optimal confidentiality. However, inclined on the Christian Worldview on moral values, with regard to confidentiality of patients’ information, SMARTcare is obliged to provide information to the extent that it facilitates the treatment process of a patient while at the same time ensuring his or her wellbeing.
To increase effectiveness, SMARTcare needs to adopt the best practices in operations management. Some recommended practices include the just-in-time (JIT) service delivery and kaizen. Consistent with SMARTcare’s approaches to waste reduction, the focus of JIT philosophy is waste elimination together with a reduction in inventory levels. The goal of adopting the JIT concept at SMARTcare should correspond to the need to provide quick and quality healthcare services to patients.
Kaizen focuses principally on the continuous improvement of various operations of an organization. The performance improvement approach also dwells on the reduction of production wastes in the effort to ensure that the final services have optimal value addition. In healthcare settings, kaizen can ensure value addition and continuous improvement of every operation. Continuous perfection involves improving the day-to-day operations of an organization to minimize hard work and complex decision-making processes, which may delay service delivery at SMARTcare. Indeed, the speed of delivery of care is an important aspect of quality care.
Through Kaizen, it is possible to ensure that all employees are encouraged to engage in practices that foster collective organizational improvement. The budget analysis aims at allocating financial resources optimally. This process requires the elimination of unnecessary costs. In the effort to save on costs that are associated with the implementation of new designs to ensure the safety of patients, employees, and family members of the patients while at SMARTcare’s premises, kaizen should be deployed as a measure of performance improvement since it focuses on small-scale testing of designs before they are implemented on a large scale. This process has the effect of saving the organization millions of dollars due to the failure of large-scale or full-size new models and operations routes. From the context of employee operations and performance, Kaizen focuses on increasing worker morale while at the same time encouraging collaboration and teamwork. It also pays incredible attention to organizational improvement at all levels. Therefore, the principles of kaizen are critical in improving healthcare operations and the elimination of unnecessary components of SMARTcare budgets.
Staffing involves employee recruitment and retention. It is recommended that SMARTcare evaluates and adopts the necessary changes to ensure not only acceptance of jobs that are offered to employees, but also employee retention. Different employees have different issues that they consider before they can accept job offers within an organization. For example, scholarly research on the recruitment of nurses identifies several factors that may influence nurses to accept nursing jobs within different health care facilities. It also reveals factors that influence nurses’ decisions to stay on the job. Jones (2009) claims that factors such as salary, the reputation of the health facility, the nature and the status of unions, and more importantly the autonomy of work influence recruitment and subsequent retention of the nurses. At SMARTcare, the retention of nurses may be influenced by factors such as recognition and inclusion of an individual nurse in the decision-making process, nature of workload, and the interrelation of a nurse with fellow workers within the departments and even the entire organization.
Material Management at SMARTcare
In the process of providing quality healthcare, SMARTcare needs to reduce the cost of supplies while at the same time guaranteeing effective flow and tracking of materials as they flow from the suppliers through its different units. However, this process should be done without negatively impairing the quality standards of care that are delivered to the patients (Callender & Grasman, 2010). However, SMARTcare reduces the participation of human decision-makers in material management systems. It deploys integrated information systems to increase the efficiency of material flow.
SMARTcare uses an Enterprise Resource Planning (ERP) system in the management of its material flows. The ERP system has the capability of evaluating the remaining material stocks in different units. It also forecasts materials that are required in the next two weeks, depending on the utilization rate within a given unit. Where deficiencies are noted, the system automatically requests the procurement modules to secure more supplies. The modules then link to the suppliers by sending information on the necessary materials to be supplied. Therefore, the system is important in determining the reorder levels and quantities to ensure that SMARTcare will never have shortages in material supplies.
The system has modules for management of service delivery functions, modules for management of customer relationships, inventory controls, service scheduling and planning, and forecasting and procurement. It also has modules that foster the flow of information across the boundaries of different units while at the same time connecting with external stakeholders. While making decisions on the implementation of the ERP system, Christian Worldview plays a vital role.
Personnel Management
Personnel management involves recruitment, training and development, and retention of employees within an organization (Jones, 2009). To tap this crucial resource, SMARTcare needs to develop and implement training and development programs in the most effective manner. This goal can be achieved through the strategy of studying employee-training needs and matching the emerging new evidence on healthcare.
Possessing valid and reliable data on training and development requirements for different employees makes it possible for personnel managers to empowering, mentor, manage, and motivate employees to mitigate labor turnover, which increases the cost of recruitment and subsequent training and development. This observation underlines the need to increase employee motivation to work. Motivation refers to the driving force, which determines the desired human behavior. SMARTcare can deploy Maslow’s hierarchy of needs and Herzberg’s two-factor theory to increase employee motivation.
Herzberg’s two-factor theory holds that people in an organization have two main groups of needs. The first group comprises the hygiene need such as competitive salaries and good working conditions. The second group comprises the motivators such as the creation of career progression opportunities, recognition, achievement, and the feeling of responsibility. In the nursing setting, Stacie et al. (2015) suggest a major advantage of this theory by finding a direct correlation between motivators and job satisfaction among high-ranking employees. Satisfaction with salaries and wages influences employee performance and commitment to their work.
People report to work due to some compelling factors. Abraham Maslow’s theory suggests that this drive emanates from the need to satisfy various needs, which keep on evolving as an employee progresses from one hierarchy level of need to another. He groups these needs into five categories, namely bodily needs, protection needs, collective needs, admiration needs, and self-actualization. Monetary reward in the form of wages and salaries is important for the satisfaction of the first three groups of human needs and work motivators. This claim implies that HRM can motivate people who belong to these first three groups by increasing monetary rewards. Most importantly, it is necessary to create an organizational culture that encourages all employees to embrace other employees’ diversity in a bid to minimize organizational conflicts, which are detrimental to the quality of care delivery. Therefore, in recruitment, the strategy for recruiting people from valid cultural, age, ethnic, and gender among other demographical differences is important.
Conclusion: Strategies for a Safe Working Environment
Safety at SMARTcare is enhanced through compliance with the established standards of design of healthcare facilities to foster fresh air circulation. This strategy can reduce the incidence of acquired infections such as tuberculosis within the health facility. Safety can also be ensured through the provision of appropriate material-handling equipment and protective devices while handling patients or materials that are handled by patients such as gloves. Fire safety gadgets such as infrared sensors for detecting smoke are also important. Employees have the right to remain free from dangers. Through a job description where employees are only allocated tasks that best suit their capability, consistent with the Christian Worldview, they are treated with dignity and respect, despite their differences.
Annotated Bibliography
Antos, J., Wilensky, G., & Kuttner, H. (2008). “The Obama Plan: More Regulation, Unsustainable Spending. Health Affairs, 27(6), 462-470.
The article discusses the Affordable Care Act and its pitfalls. It claims that the Act may lead to unsustainable spending in the health care sector in the long term. However, it also reveals how the Act has the impact of increasing access to quality healthcare.
Callender, C., & Grasman, S. (2010). Barriers and best practices for material management in the healthcare sector. Engineering Management Journal, 22(4), 11-19.
Callender and Grasman (2010) discuss the application of the concept of supply chain management in healthcare settings. They note that the healthcare sector has been experiencing increasing supplies costs together with high competition among care providers. Therefore, it cites that without effective material management approaches, healthcare facilities risk losing the capacity to provide long-term quality care.
Jones, B. (2009). The Costs of Nurse Turnover. Journal of Nursing Administration,35(1), 41-49.
The article discusses turnover and turnover intentions among nurses. It notes that nurses work under stressful conditions, which reduce their job satisfaction levels. This situation makes them experience burnout. The author attributes this situation to the case of the new nursing recruits.
Pollard, M., Stapleton, M., Kennelly, L., Bagdan, L., Cannistraci, P., Millenbach, L., & Odondi, M. (2014). Assessment of Quality and Safety Education in Nursing: A New York State Perspective. Nursing Education Perspectives, 36(4), 224-229.
The researchers surveyed 98 nursing programs to determine the integration of QSEN competencies in them. Using focus groups, the authors found the application of QSEN in curricula beneficial for nurses in New York.
Rhay, W., Wen, T., & Li-Yu, J. (2010). Exploring the Impact of Mentoring Functions on Job Satisfaction and Organizational Commitment of New Staff Nurses. BMC Health Services Research, 10(240), 1-9.
The authors identify mentoring as one of the major components that influence nurses’ job satisfaction. It claims that mentoring can promote organizational commitment, which is important in reducing turnover.
Rice, T., Unruh, L., & Rosenau, P. (2014). Challenges Facing the United States of America in Implementing Universal Coverage. Bulletin of the World Health Organization, 3(1), 894-092.
The article analyzes different challenges in implementing the Affordable Care Act of 2010. It cites statutory requirements for organizations to comply with the policy directives as possible impediments to the implementation of the Act due to the increasing cost of covering employees.
Sherwood, G., & Zomorodi, M. (2014). A New Mindset for Quality and Safety: The QSEN Competencies Redefine Nurses’ Roles in Practice. Neurology Nursing Journal, 14(1), 15-22.
The article discusses various approaches to quality and safety education in nursing. It identifies six core competencies for delivering quality and safe care. These elements include, “delivering patient-centered care through, teamwork and collaboration, evidence-based care from continuous quality improvement, with a mindset for safety, and employing informatics” (Sherwood, & Zomorodi, p.224).
Stacie, H., Hsiu, C., Dale, M., & Sondra, H. (2015). Factors That Influence the Development of Compassion Fatigue, Burnout, and Compassion Satisfaction in Emergency Department Nurses. Journal of Nursing Scholarship, 47(2), 186-194.
The article studied empathy, satisfaction, burnout, and compassion fatigue among nurses within the nursing emergency care departments. It finds minimal to standard cases of sympathy weariness together with exhaustion. However, compassion satisfaction is on average and at high levels among the studied nurses.
Surendra, S., Omar, E., & Amit, D. (2010). Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems Literature Review and Research Issues for Information Systems. Communication of the Association for Information Systems, 26(3), 565-597.
The researcher discusses the application of information systems in healthcare. They conclude that the systems are important in ensuring efficiency and effectiveness of services delivery.
Wilson, J. (2008). Health Insurance Portability and Accountability Act Privacy rule causes ongoing concerns among clinicians and researchers. Ann Intern Med, 145(4), 313–316.
The article discusses issues of accountability in healthcare systems. Its main concern is the privacy and confidentiality of electronic health records integration systems.
Reference List
Antos, J., Wilensky, G., & Kuttner, H. (2008). “The Obama Plan: More Regulation, Unsustainable Spending. Health Affairs, 27(6), 462-470.
Callender, C., & Grasman, S. (2010).Barriers and best practices for material management in the healthcare sector. Engineering Management Journal, 22(4), 11-19.
Jones, B. (2009). The Costs of Nurse Turnover. Journal of Nursing Administration,35(1), 41-49.
Pollard, M., Stapleton, M., Kennelly, L., Bagdan, L., Cannistraci, P., Millenbach, L., & Odondi, M. (2014). Assessment of Quality and Safety Education in Nursing: A New York State Perspective. Nursing Education Perspectives, 36(4), 224-229.
Rhay, W., Wen, T., & Li-Yu, J. (2010). Exploring the Impact of Mentoring Functions on Job Satisfaction and Organizational Commitment of New Staff Nurses. BMC Health Services Research, 10(240), 1-9.
Rice, T., Unruh, L., & Rosenau, P. (2014). Challenges Facing the United States of America in Implementing Universal Coverage. Bulletin of the World Health Organization, 3(1), 894-092.
Sherwood, G., & Zomorodi, M. (2014). A New Mindset for Quality and Safety: The QSEN Competencies Redefine Nurses’ Roles in Practice. Neurology Nursing Journal, 14(1), 15-22.
Stacie, H., Hsiu, C., Dale, M., & Sondra, H. (2015). Factors That Influence the Development of Compassion Fatigue, Burnout, and Compassion Satisfaction in Emergency Department Nurses. Journal of Nursing Scholarship, 47(2), 186-194.
Surendra, S., Omar, E., & Amit, D. (2010). Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems Literature Review and Research Issues for Information Systems. Communication of the Association for Information Systems, 26(3), 565-597.
Wilson, J. (2008). Health Insurance Portability and Accountability Act Privacy rule causes ongoing concerns among clinicians and researchers. Ann Intern Med, 145(4), 313–316.