Applying Economic Decision Making to Health- Activity

TRANSCRIPT

Strayer University

Applying Economic Decision Making to Healthcare

Introduction Part of any health administrator's job is to make decisions about allocation of resources specifically in terms of Supply and demand to meet patients’

healthcare needs. Such changes cannot be made lightly and whatever decision is made will have pros and cons .

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and whatever decision is made will have pros and cons . Leaders must be able to put together an implementation plan in which they identify and document the key steps involved in such a project.

In this activity, you will practice acquiring and analyzing key information, assessing the business needs, identifying necessary resources, and determining a timeline for an implementation plan for addressing staffing shortages.

Objectives: Apply economic principles and tools for decision-making to address staffing shortages. Gather preliminary information that will allow you to develop a process and timeline to address staffing shortages. Identify key considerations and potential risks that will affect allocation of resources to address staffing shortages.

Your Office Vila Health is a medium-sized system of health operating facilities in the Minnesota and Wisconsin area. They have recently acquired two smaller systems: Delaware County Regional Health System, which consists of Independence Medical Center and Delaware County Hospital, and Red River Rural Health System, which consists of Valley City Hospital and several small clinics.

The leadership teams from all three organizations are now focused on providing a smooth transition for both staff and patients. As part of the

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providing a smooth transition for both staff and patients. As part of the

transition, they need an implementation plan for allocation of resources to effectively address ongoing staffing shortages.

The transition team has tasked you with researching staffing shortages, using economic principles and tools to create an implementation plan to balance supply, demand, and cost for healthcare services.

Email #1 Implementation Plan to Address Nursing Shortages

From: Evelyn Unger, Chief Operations Officer

I hope all is going well! I am touching base with you about the project to address the nursing shortages inside our organization. There are some people at Independence Medical Center who I think can really help you pull that together.

I put some documents in your folder that I hope will help you get a sense of the scope and give you some background on what the plan will need to take into account. I've also scheduled face time on your calendar with the people at the hospital. They work in different departments so that we can learn more about departmental needs in order to allocate our resources effectively to address the nursing shortage. If you have additional thoughts prior to meeting with the team, please let me know and we can block off some time prior to the team meetings!

Kind Regards,

Evelyn

Hospital Administration

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Hospital Administration About Us Independence Medical Center is a rural referral hospital in Waterloo, Iowa, and we provide a broad range of emergency, medical, surgical, outpatient, and psychiatric services to the citizens of Black Hawk County and beyond. We have a rich history of caring for our community, starting in 1927, and nearly 80 years later we're still going strong.

Services & Team Our services include inpatient and outpatient surgical care, intensive care, primary and specialty medical care, pediatrics, and imaging services. We specialize in many types of services, including neurology, physical therapy, oncology, hematology, cardiac and pulmonary rehabilitation, ophthalmology, and more.

Our Women's Health practice is second to none, with care for breast health, gynecological services, infertility, menopause prevention, and many other offerings.

Our fully-staffed Emergency Room is open 24 hours a day, seven days a week, and we strive to keep patient wait times as short as possible.

Our Team Our dedicated team of health care providers and support staff includes active medical staff and registered nurses, and we offer the best care from highly trained specialists.

Administration Like our nurses and doctors, the leaders of Independence Medical Center

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Like our nurses and doctors, the leaders of Independence Medical Center work day and night to deliver the best possible care while making sure that the hospital runs as efficiently and effectively as possible. Whether it's developing better ways to deliver quality care, installing better systems for more advanced diagnostic testing, or upgrading billing systems for simpler, easier-to-read medical bills, the hospital's leaders are always trying to find ways to better serve the patient and the community.

Independence Medical Center's leadership:

Chief Executive Officer: Norman Reynolds Chief Financial Officer: Jarvis Norwood Chief Medical Officer: Patricia Deering, MD Chief Nursing Officer: Diane St. John Chief Operating Officer: Gwendolyn Zimmer Chief of Therapeutic Services: Anne Chief of Diagnostic Services: Shawn Hayden

Business Services Admission Services Independence Medical Center maintains a qualified staff of admissions counselors who help patients with both elective and emergency admissions. For elective admissions – planned stays at the hospital for procedures or surgery – counselors gather necessary insurance and other information, answer patient questions, and provide information regarding the hospital stay. They also confirm admitting privileges for visiting physicians, get signatures for legal consents or releases, and assign patients to beds while notifying nursing units that the patient has arrived.

These same counselors help patients with discharge and connect them with necessary resources. For example, for patients who need physical therapy at home or skilled nursing after discharge, admissions counselors connect them

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home or skilled nursing after discharge, admissions counselors connect them with hospital caseworkers. They also help patients who know they will have

trouble paying their bills to apply for financial assistance from the hospital.

Human Resources Independence Medical Center hires only the most talented people to take care of our patients, and our competitive salaries and benefits attract a large number of candidates. Our staff of human resources generalists works hard to recruit, screen, and recommend for hire the best possible candidates for each role.

The Human Resources department educates our more than 225 employees about their benefits and continuing education opportunities, and also provides training and resources for bringing new employees on board and getting them up to speed on hospital procedures, policies, and practices.

Medical Records Every patient's medical records include a wide variety of information about their health: contact information, allergies, insurance information, medicines, test results, and other data. Because these data can be very sensitive, HIPAA regulations dictate what hospitals are allowed to do with medical records. Our medical records staff protects patent medical records and helps them to safely and confidentially share that information with physicians, clinics, or others they designate.

To release medical records, patients need to fill out the Authorization to Disclose Protected Health Information/Medical Records. When the hospital has the signed authorization, it will send the records to the designated recipient. If a medical record contains information about the following, patients will need to initial the appropriate section:

Alcohol/Drug Treatment Mental Health Treatment (except psychotherapy notes) HIV/AIDS Related Information

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HIV/AIDS Related Information

Diagnostic Services Audiology For pediatric to geriatric patients suffering hearing loss or difficulties with balance, Independence Medical Center's Audiology department offers sophisticated diagnostic equipment and techniques to diagnose many hearing- or balance-related conditions.

Our board-certified audiologists can perform many diagnostic tests and treatments for hearing and balance-related problems, including tests of electrophysiology, auditory brainstem response, electrocochleography, and more. They are trained in working with patients whose special needs might make diagnostic tests difficult, such as patients with head injuries or dementia. One of our audiologists is also certified by the American Institute of Balance.

To prevent a conflict of interest, Independence Medical Center does not sell hearing aids, so patients can trust that the diagnosis they get is the right one.

Among the services our audiology department provides are:

Adult hearing evaluations Pediatric hearing evaluations Otoacoustic emissions testing Balance assessments Auditory processing assessments Videonystagmography (dizziness evaluation) Tinnitus evaluation

Clinical Labs Laboratory testing plays a crucial role in the detection, diagnosis, and

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Laboratory testing plays a crucial role in the detection, diagnosis, and

treatment of disease, and more than 65 percent of all decisions regarding a patient's diagnosis and treatment are based on it. That's why the lab at Independence Medical Center is staffed with highly trained and dedicated technologists, technicians, and phlebotomists who put the patient first. Our lab performs more than 100,000 lab tests each year, and we perform over 175 different procedures. Results from procedures that we cannot perform in- house are usually available within 24 hours from Medlabs in Cedar Lakes, Iowa.

Just a few of the tests we perform on site include:

Hemoglobin A1C Glucose tolerance Renal function panel Protime Influenza A and B antigen Urea nitrogen, 24-hour urine ABO & Rh type Basic metabolic panel

These and all other tests done at Independence Medical Center can be completed at a doctor's order and results reported the same day.

Imaging and Radiology Precise, high-quality medical images can make the difference between a wrong diagnosis and a right one. At Independence Medical Center, we offer state-of-the-art diagnostic imaging, including MRIs, bone density tests, CT/PET scans, mammograms, and more. Our highly skilled medical imaging technicians keep patients' comfort and concerns in mind while taking accurate images for diagnosis.

Our board-certified radiologist is highly qualified in medical imaging

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technologies, and is on staff three days a week to consult with physicians to

determine the meaning of the image and the best available course of treatment. When our on-site radiologist is not available, we send images digitally to Cedar Valley Radiology for consultation.

Some of our imaging services include:

DXA/bone density testing CT/PET scans Colonoscopy Digital mammography Electro/echocardiograms Fluoroscopy Mobile nuclear medicine Ultrasound X-rays

Neurology Patients with diseases of the brain, spinal cord, or central nervous system can expect expert care from the neurologists at Independence Medical Center. Carefully trained and board-certified in both general neurology and such specialties as vascular neurology, our neurologists can diagnose and treat a broad array of neurological disorders.

For patients suffering from stroke, neuromuscular diseases such as multiple sclerosis, ALS, dystonias, and peripheral neuropathies, movement disorders such as Parkinson's disease, seizure disorder or epilepsy, migraines, or dementia, Independence Medical Center is the place to get the most modern treatments from physicians whose dedication to continuing education is critical to their dedication to delivering the best patient care. Among the diagnostic tests and treatments available at Independence Medical Center's Neurology department are:

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Botox injections for movement disorder

Baclofen administration via pump therapy Electromyagram Nerve conduction testing Deep-brain stimulation Vagal nerve stimulation Tissue plasminogen activator (tPA)

Pharmacy The medications doctors order for patients are provided by the hospital pharmacy, and Independence Medical Center's pharmacists are important members of the health care team. Our pharmacists and technicians work closely with doctors and other caregivers to meet each patient's specific health care needs and to explain medications and interactions to patients.

Pharmacists will explain what each medication does, what side effects may be expected, and what to avoid while on each medication. They will also evaluate patient prescriptions in terms of other over-the-counter or herbal medications the patient might be taking, and suggest ways to reduce possible side effects and ensure that medications are working at their best. Our pharmacists are highly educated in detailed drug information, and they can help nursing staff to educate patients about the safe and effective use of their medications.

Medication Formulary Like most hospitals and health plans, Independence Medical Center a list of drugs that are routinely available for dispensing to patients (the formulary). Most of the medications a doctor orders will be on our formulary.

Financial Services Billing and Coding

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Billing and Coding Questions about bills go to our staff of billing specialists, who help patients understand the services they received and the cost of those services.

Patients must present all insurance cards at the time of service to make sure that claims will be submitted promptly. This includes private insurance, Medicare, Medicaid, Medical Assistance, commercial insurance, and worker's compensation.

Online bill pay: Patients can pay their bills online with MasterCard, Visa, or Discover. Refunds: Independence Medical Center will verify any reported errors, and if an overpayment is discovered, will issue a refund within 30 days. Financial assistance: For patients with low incomes or significant bills, the hospital offers financial assistance. Address changes: Address changes can be made online or in person.

Budget Administration The Budget Administration department reports to the Director of Financial Services. Budget analysts gather information from C-level executives at the hospital to develop and maintain annual operating and capital budgets for Independence Medical Center. They project and allocate both revenues and expenditures, and analyze utilization, patient volume, and other trends to make short-term and long-term projections.

Based on input from executives, analysts also do budget reallocations throughout the year to address surpluses, shortfalls, and overruns. They review expenses and conduct cost-flow analyses to monitor spending.

Budget analysts report to the Director on all of these matters, so that the Director can report to the hospital's CFO and participate in the strategic planning process for the hospital.

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Information Technology and Data Services Independence Medical Center is at the cutting edge of today's technology, and our IT Department helps us to stay that way. All of our software and hardware is installed and maintained by a staff of highly qualified IT professionals with certifications in networking, databases, and many other types of technology.

These professionals build install, maintain, and troubleshoot all in-house hospital systems. They run regular maintenance and perform upgrades on these systems. They also work with vendors to install and maintain third- party applications. User training and support are also part of their responsibilities.

Among the systems our IT professionals maintain:

Electronic medical record Formulary database Building/environmental system Patient flow software E-mail Medical billing

Medical Services Independence Medical Center is proud to provide caring and comprehensive health services designed to meet the needs of all our patients. With an emphasis on quality care, our staff of highly trained professionals will treat you with the compassion, care, and understanding patients expect. We are

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you with the compassion, care, and understanding patients expect. We are

pleased to offer a variety of services including primary and specialty medical care, pediatrics, inpatient and outpatient surgical care, imaging services and a fully staffed Emergency Department able to provide the community with 24/7 emergency medical care.

At Independence Medical Center we strive for excellence on every measure and our nursing services are a direct reflection of that focus. Our nurses are compassionate, highly skilled, and culturally competent professionals. They are the key to delivering outstanding patient care and at Independence Medical Center, that is always our number one goal.

Ambulatory Care Our ambulatory care registered nurses interact with patients who need care or treatment but do not need to stay overnight in the hospital. They conduct initial assessments of patients' condition, perform procedures, educate patients about their health and next steps, advocate for patients' needs, coordinate care with the hospital and with outpatient clinics in the area, and follow up to make sure patients' needs are being met. The focus is on the patient's well-being and on how outpatient clinics can be the next step in the healing process.

Behavioral Health Independence Medical Center offers both inpatient and outpatient assessment and treatment for behavioral health issues. Our on-staff psychiatrists are available 24/7 for emergency admissions for psychiatric disturbances, such as suicidal depression or psychotic episodes, and help stabilize patients in our inpatient mental health center. They provide individual and group therapy, as well as family assessments and recommendations for after-care action.

Psychiatrists also provide short-term counseling and treatment, as well as consultations regarding psychoactive medications for patients whose

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consultations regarding psychoactive medications for patients whose

diagnoses are less acute. When appropriate, they refer patients to social workers, counselors, and off-site psychologists or psychiatrists for long-term treatment.

Conditions treated by our Behavioral Health clinic include:

Substance abuse and chemical dependency Eating disorders Mental health disorders such as schizophrenia, OCD, depression, anxiety, and bipolar disorder Detoxification (through the Emergency Room)

Cancer Center In the event of a cancer diagnosis, Independence Medical Center is the place to go.

Prevention The Cancer Center at Independence Medical Center provides cancer screenings on a regular basis throughout the year for breast, cervical, colon, rectal, and other cancers. The Women's Health Center also provides breast exams and annual Pap smears.

Detection The Cancer Center is equipped with state-of-the-art MRI, PET and CT scanning technologies and on-staff radiologists interpret images in consultation with our board-certified oncologists.

At the Cancer Center, we offer:

Positron Emission Tomography (PET) Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound

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Ultrasound Mammography

Nuclear medicine Stereotactic breast biopsy

Diagnosis Independence Medical Center's board-certified pathologists work with Cancer Center oncologists to determine whether a patient's biopsy suggests a cancerous mass. They also help to determine how advanced a detected cancer is, and consult with oncologists and surgeons on treatment plans.

Treatment Oncologists at the Cancer Center will explain every aspect of the patient's treatment plan, whether it includes surgery, radiation, chemotherapy, or a combination of methods. Radiation and chemotherapy can be administered on site at our infusion area, and oncologists monitor patient progress throughout treatment while continually educating patients about their options and symptoms.

Emergency Department If you or a family member is experiencing a life-threatening injury or illness, call 911. Independence Medical Center is the place to go in time of crisis. Our 24/7 emergency room can handle everything from critical injuries to life- threatening illnesses to mental health crises. Emergency Medical Team Our team includes highly qualified nurses, nurse practitioners, emergency medical technicians, and doctors who are skilled in high-pressure situations. We also have specialists on call for emergency consultation, diagnosis, and surgery if needed.

Situations We Handle Here are just a few of the conditions that are considered medical emergencies:

Broken bones or dislocated joints

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Broken bones or dislocated joints Severe pain, particularly in the abdomen

Persistent or severe chest pain Difficulty speaking, altered mental state or confusion Head or eye injuries Loss of vision High fever or fever with rash Persistent shortness of breath or wheezing Weakness or paralysis Deep cuts that require stitches Rape Suicidal Behavior Chemical dependency or mental health crises

ICU Independence Medical Center's Intensive Care Unit is staffed with a 35- member Critical Care team with specialized skills in caring for critically ill or injured patients. For renal or pulmonary complications, trauma, overdoses, and other life-threatening conditions, the ICU has the personnel and technology to safeguard the lives of its patients.

Some of the equipment in the ICU:

ventilators for invasive and/or non-invasive ventilation hand ventilating assemblies airway access equipment vascular access equipment monitoring equipment, both non-invasive and invasive defibrillation and pacing facilities equipment to control patient temperature chest drainage equipment infusion and specialized pumps portable transport equipment

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portable transport equipment

Each patient in ICU will have a physician in charge of the case, who will work with consultants from other specialties, such as cardiologists or respiratory specialists, when necessary to determine the best course of action. For continuity of care, a nurse will be assigned to each patient to deliver daily care, and other specialists, such as respiratory therapists, will be on hand to help patients who require ventilation, medication, or other treatment.

The ICU is located strategically in the hospital for easy access to the emergency room and operating rooms.

Medical/Surgical Care St. Anthony Medical Center's 30-room medical/surgical unit takes over when patients of all ages come out of the post-operative ward but still need care before they go home. The unit also cares for patients with acute and chronic illnesses or conditions who don't need to be in the ER but need treatment before they go home.

The unit's 31 registered nurses, licensed practical nurses, and nursing assistants provide heart monitoring, post-surgical observation, rehabilitation, and other services. They work with each patient's physician to determine an appropriate care plan, and educate patients and their families about their options and how to care for themselves after they go home.

Neonatal ICU Independence Medical Center provides care throughout patients' life cycle, and that starts with premature or sick infants. Independence Medical Center's Neonatal Intensive Care Unit can care for infants up to 17 weeks premature, and our neonatologists care for endangered infants with a wide variety of presenting conditions.

The NICU is equipped for specialized, around-the clock care with cutting- edge diagnostic and treatment equipment, including oxygen hoods, a CPAP

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edge diagnostic and treatment equipment, including oxygen hoods, a CPAP system, neonatal ventilators, incubators, pulse oximeters, and an ECG

monitor with defibrillator.

With pharmacists, respiratory therapists, lactation consultants, and other support staff on the NICU's interdisciplinary team, families with sick infants can stay in one place to get all the treatment their baby needs. After the infant is discharged, specialists help families with post-hospital care to make sure the newborn grows and develops appropriately.

Operative Services Independence Medical Center offers a wide range of surgical care.

Our surgical specialties include:

Bariatric surgery General surgery Trauma surgery Neurosurgery Gastroenterology Cardiology Ear, nose and throat Gynecology/obstetrics Ophthalmology Oral and maxillofacial Cancer Orthopedic Surgery Pulmonology Transplants Urology

We provide elective and emergency surgeries for adults and children in our operating suite, which offers four operating theaters and the latest medical technology. Each patient will receive expert pre-op and post-op care. Pre-op

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technology. Each patient will receive expert pre-op and post-op care. Pre-op

nurses help coordinate the patient's needed medications, lab tests, and arrival, while post-op nurses assist with medication management and discharge either to the medical/surgical unit or from the hospital. They also help get services, support, and necessary equipment or supplies for post- surgery care.

Pediatric ICU Independence Medical Center's Pediatric Intensive Care Unit offers the specially trained pediatric intensivists and highly specialized nurses to provide comprehensive, multidisciplinary care for critically ill or injured children ages 0 to 18. We provide acute surgical-medical care, monitoring, diagnostic procedures, and a wide variety of therapies. Our PICU has the most advanced equipment, including ventilators, specialized beds and cribs, specialized syringe pumps, and intra-cranial monitoring equipment. Our child-friendly rooms help children and their families to stay together during treatment and recovery.

Among the many conditions the PICU can treat or monitor are:

Respiratory diseases Endocrine or metabolic diseases and abnormalities Neurological diseases or seizures Hematological conditions Cancer-related or cancer conditions Renal, cardiac, and multi-system diseases Trauma Burn care

Sports Medicine Athletes who need a clean bill of health, preventive care, or treatment for an injury can come to Independence Medical Center's Sports Medicine clinic for

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injury can come to Independence Medical Center's Sports Medicine clinic for the best orthopedic and sports medicine in the county. Our Sports Medicine clinic is staffed with an orthopedic surgeon, other sports medicine physicians, physical therapists and a certified athletic trainer.

The clinic's physicians work with each patient's primary care doctor and provide treatment for common sports injuries, such as ankle sprains, torn tendons, and ligament injuries. They consult with Independence Medical Center's specialty physicians, such as neurologists, on more complicated injuries involving the head or spine, or for exercise-related conditions such as exercise-induced asthma. For each injury or condition, physicians and physical therapists work together to decide on the best course of treatment and rehabilitation to return the patient to full strength and flexibility. The clinic has a pool for aquatic therapy.

Conditions we treat include:

Sprains and strains Stress fractures Anterior cruciate ligament (ACL) or other ligament injuries Meniscus tears Knee chondrosis Adhesive capsulitis Exercise-induced asthma Impingement syndrome and rotator cuff tears Overuse injuries, such as tennis elbow Shin splints Shoulder instability and superior labral (SLAP) tears Chronic exertional compartment syndrome Tendonitis Patellofemoral disorders

Our services include:

Sports physicals

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Sports physicals

Preventive care Physical therapy and rehabilitation Joint replacement rehabilitation Home exercise programs Aquatic therapy

Women's Health At Independence Medical Center, we want to meet all of our patients' health needs. The Women's Health Center at IMC is a place where patients with health issues specific to women will get personalized, knowledgeable attention.

A dedicated gynecologist, nurse practitioner, and midwife staff the Women's Health Center, and they work with other specialty physicians at the hospital to provide additional care or consultation as needed. They provide routine health screenings and exams as well as treatment for many conditions or transitions, such as menopause, osteoporosis, and chronic pelvic pain. Among the services we offer are:

Annual exams Cervical cancer screening Patient education Routine prenatal and obstetrical care Postpartum depression treatment Minor surgical procedures Perimenopause and menopause Newborn and well child care Osteoporosis screening and treatment Pelvic floor disorder and chronic pelvic pain treatment Physicals Preventative health care

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Preventative health care

Social service referrals

Nursing Support Nurse Credentialing and Development Independence Medical Center couldn't function without the hard work and specialized knowledge of its nurses. So it's mission-critical to keep Independence Medical Center nurses fully credentialed, and to give them opportunities to expand their nursing skills. Our Nurse Accreditation Manager and staff of nursing support specialists track the continuing education and licensing requirements for each of Independence Medical Center's registered and licensed practical nurses, and helps nurses with periodic license renewal.

They also work with nurses who wish to pursue further certification. They help nurses pursuing bridge programs, such as the transition from licensed practical nurse (LPN) to a master of science in nursing (MSN). And they work with nurses who seek specialty options like intravenous therapy, gerontology, foot care, and others, helping them to find the correct training and track subsequent certification renewal requirements.

Nursing Informatics To keep nurses doing what they do best – caring for patients – while still documenting the care they provide, our professional staff of informatics specialists works to develop or improve systems of documentation for Independence Medical Center's nurses.

Doctors and nurses use a combination of handheld devices, tablets, and laptop computers to update patients' medical charts at Independence Medical Center. Our informatics specialists regularly survey all health care providers to find out what's working and what isn't, and analyzes monthly chart data to determine under what circumstances providers are not charting

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chart data to determine under what circumstances providers are not charting

as effectively as they could. Based on this information, they roll out regular improvements to the hospital's charting system.

The department reports on its progress to Independence Medical Center's chief nursing officer, chief medical officer, and chief operating officer. They also work with the hospital's Nursing Informatics Council, which includes nurses from across the hospital's medical specialties, to register complaints, learn about bugs, and test new systems before implementation.

Staff Interviews Albert Lynton Operations Manager, Operations What are the issues that most concern you about the current staffing shortages for nurses across the organization and allocation of resources to address the challenges that we are facing?

Albert: "The entire healthcare organization is impacted by staffing shortages and particularly the nursing shortage crisis. Because we offer a number of services across our facilities and departments, operations play a key role as part of the project to explore where the resources are needed the most and in the areas of high demand for patient services."

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What departments do you think are most impacted by the nursing shortages and where can we best allocate the resources to meet the needs of the organization?

Albert: "The biggest worry is that we must ask departmental managers to provide the data on staff shortages and we may not have the budget to fill the needed positions in all departments, so we must prioritize the most needed areas like the emergency care department as we explore solutions.

We currently have 25% less registered nurses than needed to meet patient demand and many of our emergency department nurses are working double shifts. This has led to some resignations due to nurse burnout and we continue to see more nurses resigning which is not impacting our capability to provide patient care but increases the risk for affecting patient safety.

Our Pediatric services are another major concern because we have a limited number of pediatric specialists and nurses, and although we have tried different recruiting strategies, human resources is not receiving very many inquiries about these positions."

Paul Hartwell Chief Nursing Officer What are the issues that most concern you about our organizational expansion and the nursing shortage that we are facing?

Paul: "The main concern that I see is future projections for nursing shortages and the fact that we are not only facing budget shortfalls, but even with sign on bonuses and other perks, we still cannot recruit and retain the nurses needed to meet patient demands. This is leading to burnout and work overload for

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our nurses and can potentially impact patient safety."

What are your thoughts about hiring immigrant nurses and providing relocation expenses for them versus hiring travel nurses that is more

expensive due to higher compensation?

Paul: "Other healthcare organizations are using this approach for supply and demand and is has been reported to reduce the cost curve for providing healthcare services. This is an area that we need to explore, and our nursing leaders should be part of the process to explore this option.

If this approach is used to address the nursing shortage, training the nurses will require a training plan that outlines specific goals and then, we must also address state licensure requirements for the nurses." "

Alex Moody Human Resources Manager, Human Resources As you know, we are exploring ways to address the nursing shortage that we are facing and considering hiring immigrant nurses. What concerns your department most about this consideration and how can your team support us?

Alex: "My greatest concern is that the biggest problems and greatest needs need to be prioritized. From my perspective that points to two things – getting all Vila Health partners on board including the board of directors to approve the plan to address the nursing shortage and to ensure that our current nurses and other staff are trained to train the new immigrant nurses.

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The other thing that needs to be addressed is making sure that we effectively train the new nurses and that we have a support system in place for them. State licensure requirements must also be met. Just to mention, some

hospitals are partnering with nursing school programs and providing clinical rotations and supervising nursing students to perform some functions to assist RN's, so this is another opportunity to explore as well."

What do you anticipate the current staff being most concerned about as we recruit a large number of immigrant nurses to work in the departments with the highest demand for medical care?

Alex: "Oh, that's easy… The number one concern will be effective training and how the training will roll out and who will oversee the training. Another major concern will be ensuring that all the new hires meet the nursing licensure requirements in our state. That can be accomplished by our human resource department though." "

Email Follow-Up Evelyn has sent you a follow-up email.

Email #2 Interview Update?

From: Evelyn Unger

I am following back up on the outcome of the interviews. Can we block off some time to discuss what you learned from the departmental managers

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some time to discuss what you learned from the departmental managers about the needs in their departments and about HR's role and thoughts about how to address the nursing shortages? We would like to move the project forward as quickly as possible to present to the BOD for approval. Thanks!

Conclusion Having met with leaders at Independence Medical Center, you should now have a solid understanding of

what it will take to address the nursing shortage, including collecting data on the resources available in the organization including departmental needs and budgets, along with the departments that have the greatest patient demand.

You should be able to analyze the areas with the highest patient demand and the available resources that we have to address the nursing shortages. What departments have the greatest need for nurses and how do these shortages impact how we deliver healthcare? Identify the factors that are leading to nursing shortages and propose strategies to address the problem so that we may recruit and retain the nurses that we hire to fill these roles.

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