The provision of qualified medical care to the population, regardless of the social status of patients, is an important condition for a sustainable and ethically developed healthcare system. In case the physician-patient interaction cannot be maintained at a normal level, concomitant problems arise, which adversely affect patients’ health outcomes and the reputation of the medical provider. The reviewed situation at the East Orange General Hospital Clinic shows that the clinic is facing an increasing number of follow-up appointments missed, which is directly reflected in patient health outcomes. This issue can be associated not only with the low social status of the public but also with the absence of productive provider-patient communication. The practical problem requires involving relevant stakeholders to remedy the situation and build staff motivation to provide the highest possible quality of care. As an intervention tool, a PICO question can be utilized. The question is as follows: Can the clinic staff (P) create an adequate educational base for patients (I) compared to the previous communication gaps (C) to reduce the number of follow-up appointments missed (O)?
Impacts of the Problem and the Stakeholders
The problem of the large number of follow-up appointments missed affects both patients and the clinic. According to Hickey (2021b), performance assessment can identify the quality of medical services and identify gaps in the practice of a healthcare institution. When losing patients, the clinic in question cannot count on achieving high results of work and loses its credibility among the population. To remedy the situation, targeted work with personnel is imperative. Smith (2000) highlights the relevance of involving internal stakeholders as parties that can influence change for the better from within. As internal stakeholders, one can cite the physicians and nurses of the clinic, as well as office managers. These parties are responsible for educating patients about the need to complete full courses of treatment and interacting with patients remotely to promptly remind them of the need for follow-up visits, respectively. Low-income patients who make up the target audience are external stakeholders. Due to the costs of insurance and other services, many of them refuse follow-up visits, which, in turn, affects their health outcomes negatively.
Stakeholders Analysis
The involvement of both medical and administrative staff is an adequate solution to address the issue raised. According to Hickey (2021a), the involvement of nursing employees in improvement initiatives is important because they interact with patients regularly and can communicate the necessary nuances of care in an accessible way. Physicians are also responsible for the quality of healthcare services, and their role is to create a treatment environment in which patients understand the importance of following physician prescriptions and following recommendations, including follow-up visits. Office managers are stakeholders who are responsible for communicating with the public and can alert targeted patients of specific changes in treatment regimens. The medical staff themselves are more engaged in the problem than the administrative employees since the reputation of the clinic depends on the quality of medical practice more than on organizational work.
Organizational Readiness
Organizational readiness is the willingness of personnel to participate in improvement initiatives designed to enhance the quality and productivity of work. For the East Orange General Hospital Clinic, this aspect is the willingness of the medical staff and office managers to communicate effectively with patients to reduce the number of follow-up appointments missed. As Dang et al. (2021) argue, the improvement process involves finding adequate resources to apply, relevant questions to answer, and specific objectives to address. Table 1, which is the organizational readiness form compiled as the five-point scale, provides the information on the readiness of the staff for the upcoming change. This information shows that the staff is ready to participate in the change program, although some are not convinced that the hospital can provide the necessary opportunity.
Table 1. Organizational readiness form.
References
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
Hickey, J. V. (2021a). Models for evaluation in advanced nursing practice. In J. V. Hickey & E. R. Giardino (Eds.), Evaluation of quality in health care for DNPs (3rd ed.) (pp. 65-92). Springer Publishing.
Hickey, J. V. (2021b). The nature of evidence as a basis for evaluation. In J. V. Hickey & E. R. Giardino (Eds.), Evaluation of quality in health care for DNPs (3rd ed.) (pp. 37-64). Springer Publishing.
Smith, L. W. (2000). Stakeholder analysis: A pivotal practice of successful projects. Project Management Institute.