Critical Thinking Case Study

Critical Thinking Case Study

Anthony Mathew

Dean Rea

CSS/330

12 June 2004

As a not for profit organization we must insure that we provide the best possible treatment while maintaining a close watch on our expenses. We must maintain a high degree of professionalism by following all directives, guidelines and rules. By doing this we prevent mistakes from happening that could jeopardize or organization and our patients.

Currently we are experiencing a wide variety of problems that are negatively affecting our ability to effectively care for our patients while maintaining costs to the prescribed limits. It has come to my attention that some staff members are writing their own directives to either add to or take away from current directives. The directives are in place for the safety of our patients and staff. Changing a directive could result in the failure to treat a patient resulting in court action that not only affects the treating physician but also the stockholders. Not only is this a legal matter, but it also has ethical implications. Is it ethical to treat one patient and not another? No, we should strive for the ethical treatment of all our patients. Directives will only be changed or amended by senior management and only with the approval of the board and current attorneys. This will be done to insure an effective and safe environment for the staff and our patients.

Due to the changes to the directives by certain staff, not everyone is on the same sheet of paper, or following the same guidelines. This has resulted in staff not providing to the best wishes of the patient or to the patients family. For example, a DNR means just that, do not resuscitate, this is not an arguable topic. If a patient or their family has requested this it is no longer up to the staff not to follow it. This is a prime example of staff not working towards the best interests of the patient and their loved ones.

Not only are the changes to directives effecting service, some patients are not accepting the treatments and some staff are not providing certain treatments. We must do everything in our power to provide the patient the best treatment possible. If a patient does not want a certain treatment then it is up to us to explain the need for it to them in a way they will understand.

Another problem facing our hospital at this time is the rising costs of providing quality health care, while maintaining our not for profit status. At this time our costs have risen and our reimbursements have remained the same, causing the hospital to take a loss. "Look at how much our costs have increased compared to last year. A year ago, our costs were $217.00 per patient per day. On the last report that I received from accounting, that figure had risen to $240.00. Two questions came immediately to mind when I saw this number: Are we running a less efficient operation? Can we reduce costs without impacting quality?" Pat. CSS/330 Case Study.

"I asked the financial analyst for an evaluation, and he indicated that we've had a 7% decrease in patient population. Roughly 28% of our costs are fixed costs--costs that do not vary with the fluctuating patient population. This tells me that our costs do not change proportionally with the number of patients that we treat. If we can't do something to increase the patient count, then we will have to make some tough cost-reduction decisions. Assuming that we are not able to increase our patient count, we will have to reduce our fixed cost to break even." Pat. CSS/330 Case Study.

"Here is some data that you might find interesting, Chris. If we hold steady at 7,863 patients and 39,866 patient days, we will be forced to reduce our fixed costs by 15% just to break even. That assumes that our average reimbursement rate does not change. That is one heck of a big reduction!" Pat. CSS/330 Case Study.

Our goals should be simple and ones that are easily achievable by all staff members and ones the board will be happy with. One of the first things we need to understand is that no changes will be made to the hospital polices and procedures without written approval from the hospital director and the board of directors. This is to protect mainly the patient from any mistakes made due to the deviation to policy. Also this will protect the hospital, the staff and the board from lawsuits due to neglect. I f we provide equal treatment to everyone then we are achieving our objectives as care providers.

The hospital policy will be reviewed and adjusted to provide for limited deviation, this is to insure treatment to everyone that passes through our doors. This deviation will include the ability to give larger amounts of "samples" of medication to our patients and to allow for the pharmacist to set up their own collection and billing policy. Thus our patients will be treated and reimbursement will still come in.

I have defined our goals and objectives in the following bullets;

Ð'* The hospital policy will not be changed by the staff. Only the hospital director on the board of directors will review and change it. It is asked that staff notify the hospital director when a conflict arises.

Ð'* All staff members will follow the new directives to the letter. There will be no deviation, except where it is noted that there are alternatives.

Ð'* If needed we shall reduce our fixed costs to "break even" and not jeopardize our not for profit status.

The effects of the problems facing us right now are felt from through the entire ranks of our organization. Moral, Public Image and patient welfare are all at risk if we do not do something quick to improve ourselves.

A positive moral not only makes ours jobs easier, but it caries over to the services we provide to our customers. The people you come in contact with everyday will be able to pick up on your mood, and this could negatively affect people to the point of refusing treatment by you or leaving their jobs. We need to learn to leave our bad feelings and negativity at home and learn to make our day as positive as possible. The old saying "negativity breeds negativity" applies; if you are negative then others around you will be negative. If you have a positive attitude you will learn that a smile will go miles.

The public image for hospitals is taking a hit right now due to articles in the paper and on the news. In this morning headline news it stated that "medical