Case Study e regional medical center became part of an integrated delivery syste
ID: 125361 • Letter: C
Question
Case Study e regional medical center became part of an integrated delivery system ntral board of directors, the medical center's board began to struggle th its revised role. The new organizational environment included several outpatient hat had a ce WI multispecialty physician practices, and an insurance entity. Many of the current hoard members had served the organization since the medical center was built, and hoard activities always had been performed in a certain way. The administration rig- dly controlled board meetings. Board members did not ask questions and routinely financial status and future financial plans, physician credentialing, care quality moni approved committee reports. The reports covered topics such as the organization's toring, new policies, and plans for a new hospital A new board member with a healthcare background was appointed after exten screening and a personal interview with the executive committee. She was not part of the local business power structure, and the administration was concerned that her appointment might not be a wise move. During her first board meeting, two very interesting reports were given. One report detailed some reengineering projects. One of these involved redesigning nursing staffing patterns. This redesign decreased the number of registered nurses (RNs), and replaced them with licensed practical nurses (LPNs) and certified nursing assistants (CNAs). The current quality report documented a very high quality of care and positive patient satisfaction surveys. Data excerpted from this report can be seen in the "1st Quarter" column of table 15.1. Given that this was her first board meeting, the new board member remained silent and did not ask questions Within four months, the new nursing staffing pattern had been launched. Data excerpted from the quality indicators report presented to the board can be seen in the "2nd Quarter" column of table 15.1. The new board member was very con- cerned and decided to ask the nurse administrator presenting the quality report the values, which show a negative trend, were for the nursing units with the new nurs ing staffing patterns. The administrator reported that there was a direct correlation. This answer initiated discussion among other board members who were accustomedExplanation / Answer
Ans 1: The quality performance measure and patient satisfaction measures shows a decline in important parameters which is not a good sign. The quality indicators which should decrease are increasing like patient fall and nosocomial infection rate. This shows the fall in quality of care. In patients satisfaction measures also the rating of services is going down. Here the administrator needs to train and update the staff through inservice education programmes and CNEs to get good knowledge and skills and thereby improving quality of care.
Ans 2: No the CEO have not carried out his/ her responsibility for educating the board. She should have explained them about the process of redesigning and its effects.