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1 1a) The External Environment (Threats)- (1) the demand for HNS nursing services is declining, (2) the government changes its rules about paying for HNS’ kind of nursing services, either cutting back what it will pay for or reducing the amount it will pay for specific services, or (3) new competitors enter the market. 2 Also,decreases in insurance reimbursements are a continuing threat to most nursing home facilities. It is not expected that there will be increases in payouts for at least four years. As such, an entrepreneur needs to take this into account when developing a care facility.
1a) The External Environment (Opportunities)- Some hospitals are expanding into home health care who are willing to provide nursing services that are similar to HNS. 3 Nursing homes can really only expand by developing additional facilities once the initial location has reached 100% occupancy. Although not common, some licensed facilities develop home healthcare services so that round the clock nursing can be provided to patients that want to remain in their homes. 2 In a sense, this is like starting a completely new type of business. However, there is a trend among existing nursing homes to establish these types of operations. The market for existing facilities that can be purchased is moderate. Financial companies almost always provide financing to established facilities given their highly profitable and economically secure nature.
1b) The Internal Environment (Strengths)- For both men and women, as the life expectancy has been increased over the years, the demand for nursing homes such as Home Nursing Services Inc has grown too. 3 Nursing homes are an important part of most countries. Elderly people generally require round the clock care once they become a certain age. One of the most important strengths of a nursing home is that they are able to remain profitable at all times. Once a nursing home reaches 100% occupancy, the profits of the business will continue even in times of economic recession. Many nursing homes receive their fees from patient co-pays, Medicare, Medicaid, publicly funded health systems, and private insurance. As such, the costs to families is reduced through these reimbursements. The barriers to entry for a new nursing home a relatively high depending on whether or not the entrepreneur purchases or leases the facility. The license requirements are substantial. A new nursing home generally has startup costs of $500,000 to $2,000,000 depending on the size of the real estate to be acquired.
1b) The Internal Environment (Weaknesses)- The expenses related with providing professional nursing care are too high. 4 But fortunately, a registered nurse is not required for care and comfort services. O the other hand, such a person is required who is honest and is willing to work with all kinds of people and take over various responsibilities. 2 Competitive issues are not a major issue with nursing homes as the demand currently far outweighs the number of spaces available in most markets. The primary weakness for a nursing home is that they have substantial regulatory issues. Additionally, the operating costs of a nursing home are extremely high. Facility, payroll, and insurance costs are very expensive for this type of business. 3 In most states, it is required that a physician be kept on retainer in case of a medical emergency.
1c) The Current Market Strategy- Carol is thinking whether to ask Board of Directors to let her offer a completer line of home health care services which is moving into care and comfort services. 5 Home care services are extensive and varied, depending on the need. Services can include meal preparation, medication reminders, companionship or assisting with errands. Home care services can also include respite care, wound care, serious injury care, or palliative care. Home care is about meeting the most basic, but essential, needs such as a friendly face dropping by for a chat or something as intimate and poignant as end-of-life care. Being able to stay at home and maintain independence to the extent possible is important for most seniors. Living at home allows them freedom to maintain their independence longer and not have to follow a mealtime or activity schedule. The home setting is the “least restrictive environment”, allowing older adults to stay engaged with their normal daily activities, including regular interaction and companionship with family and community. It allows for more choices and encourages active participation in their own lives. Aging at home extends and improves overall quality of life by postponing institutionalization and preventing premature decline. By encouraging independence and self-care, aging parents stay in charge of their own lives for as long as possible. They report high rates of personal satisfaction and unlike other forms of health care, in-home care helps extend life by eliminating stressors associated with aging in a senior care facility. Choosing in-home aging can enrich the quality of our loved one’s later years.
2a) Primary Problem Statement- If a new full service home health care organization come into market, then Carol might end up losing her patients over the organization. 4 This could cause issues for HNS as overhead costs are more or less fixed. A loss in revenue might force Carol to lay off some of her staff, giving up part of the office and so on.
2c) Symptoms- The truth, however is that Carol has a big decision to make between in- home senior and nursing home care. While senior care facilities are extremely convenient, the downsides of nursing homes can encourage people to explore other options. Some of the downsides include:
High instances of nursing home depression
Inconvenience for families visiting their relative
The rising cost of nursing facilities
Nursing homes being understaffed — and possibly unsafe or negligent as a result
Lack of personal relationship with organization and staff
6 Poor quality of life / monotony 3a) Alternative 1- Carol is thinking of offering a better service to present customers and make more effective use of the computer systems and organization structure that she has developed over the last two years. 7 Carol estimates that the administrative and office capabilities could handle twice as many clients without straining the system. 1 Additional clients or more work for some clients could increase revenue and ensure the survival of HNS.
8 3a) i) Cost and Benefits- Long-term care administrators have a strong influence on the quality of healthcare services available to those in need of long term care, providing quality leadership in nursing homes, assisted living facilities, and similar environments where skilled nursing is required. These senior-level managers establish healthcare standards, make strategic policy decisions, and implement personnel management procedures so as to support their overall vision for quality long-term care. According to the Centers for Disease Control and Prevention (CDC), more than 8 million people received care through long-term care facilities in the United States in 2012. Long-term care services comprise a significant component of personal healthcare spending in the United States. According to the SCAN Foundation, total spending for long-term care in the United States in 2010 was nearly $208 billion, or 8 percent of all personal healthcare spending.
3a) ii) Analysis- Long-term care administrators manage the operations and staff of long-term care facilities. The main job responsibility of long-term care administrators is to provide residents with a high quality of life—including superb medical and personal care—while ensuring the efficient operation of a single facility or multi-facility system. Because long-term care facilities are businesses, long-term care administration professionals oversees both the business management side and the healthcare side of the facilities they manage. Long-term care administration professionals must be proficient in a wide array of areas, including:
Facilities operations
Financial planning
Personnel management
8 Long-term care administrators serve as the head of operations, or the chief executive officer, of a facility. Long-term care facilities are quite diverse, with some housing older adults who require minimum assistance with their daily lives and others housing very ill patients who require specialized, complex nursing care services.
3 b) Alternative 2- Carol is planning to offer honorary work by providing services to those who are not now able to pay. 6 By expanding to provide more services, she might be able to keep serving more of these nonpaying clients. This possibility excites Carol because her nurse’s training has instilled a deep desire to serve people in need, whether they can pay or not.
3b) i) Costs and Benefits- Governments spend lot of time, money and resources in providing health care services and it is only after carefully examining the benefits that these services are provided. The advantages that will be considered include benefits to all classes of people, the continual improvement of healthcare services and the reduction and control of disease outbreaks.
3b) ii) Analysis- Free health services benefit all classes of people especially the poor and needy who cannot afford expensive treatments offered at private hospitals and those citizens who do not have health insurance. Consequently, poor families benefit greatly from this service as they get the most out of it. In addition, another advantage to consider is that the government continually improves its services. Finally, free health services help to reduce and control disease outbreaks. Those individuals who are carriers of infectious diseases are treated and cared for. For example- Ministry of Health has sections dealing with HIV and AIDS,adolescent and reproductive health, oral health and non communicable diseases to name a few. These services are very beneficial to the citizens and the nation as a whole as it stops the risk of spreading the illness to the entire population. Free health services are indeed beneficial to the entire nation.
4 a) Desired Alternative- I think it will be more beneficial if Carol decides to implement the idea of making effective use of the computer systems and organization structure that she has developed over the last two years (Alternative 1). 8 The job duties of long-term care administrators depend on the type of facility, the size of the facility, or the number of facilities within one campus or under one umbrella organization. However, their general focus includes:
Setting and enforcing policies
Staff hiring, training, and retention
Patient/resident care
Day-to-day operations
The promotion of the institution to the public
Budgeting
Disease control/prevention and pharmaceutical control
Federal/state/local regulations and legislation
Employee/patient/family grievances
8 Health administrators of long-term care facilities supervise a staff that may include food service, nursing, cleaning, maintenance, finances, admissions, and social services departments, among others. On any given day, long-term care administration professionals juggles everyday activities, emergencies, and situations requiring their immediate attention. The daily responsibilities of these healthcare professionals involve:
Communicating with diverse populations
Establishing and maintaining relationships with staff, patients, and patient family members
Assessing the needs of the patient and staff populations
Employing outstanding counselling and crisis intervention techniques
Analyzing financial needs and predicting future financial needs
Protecting patient rights
Analyzing, creating, and updating policies and procedures as needed
The alternative 2 is not a feasible option because it cannot be used for a long term basis as Carol might end up getting into a loss. Another disadvantage of free healthcare is the shortage of doctors and nurses. Thirdly, free health care services lead to overcrowding in nursing homes. With availability of free medical services, citizens have the opportunity to make the most use of the services provided to them and this in turn leads to overcrowding. It is an all to common site to see long queues and frustrated patients at the outpatient section of major nursing homes. Many people wait for hours before they are seen as the nursing homes are not just large enough to cater for them all.
4 b) Other Recommendations- Apparently, Carol can think about investing into Assisted Living. Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Assisted living facilities range in size from as few as 25 residents to 120 or more. Typically, a few “levels of care” are offered, with residents paying more for higher levels of care. This way Carol will be able to expand her services economically as she does not require trained professional nurses to treat them but simple personnel who can take good care of them.
5) Implementation Plan- Alternative 1 can be implemented in the following ways: As with any industry, leaders in healthcare administration only succeed to the extent they form workable plans and then execute them, inspiring confidence, trust and maximum effort from their employees. When deciding to step into a leadership role in healthcare administration, different theories can govern the approach and actions taken to reach goals such as better operational efficiency, employee retention and growth. There are a number of ways to approach developing a strategy for addressing a healthcare facility’s issues. 9 These approaches are formed on the basis of a leader observing the culture of a given facility and developing a theory around what kind of approach and initiatives can combine to best drive change within the organization. Theories that drive strategic leadership in healthcare have changed over time. An approach that works well in one organization will not in another and changes must be made over time as medical operations evolve. After identifying organizational issues, those in a position of leadership have to determine their approach. Some of the various leadership approaches include:
9 Transformational – Focuses on bringing people together behind a mission to transform the organization, the idea being that people work better when they collaborate on a shared goal. This requires leaders to clearly communicate their vision for an organization – and it needs to be a vision that excites and motivates employees.
9 Collaborative – In this approach, leaders facilitate communication between various groups within an organization who then use information they exchange to establish and attain goals. This encourages communication between different departments within the healthcare organization and requires people at all levels to participate in leadership, finding solutions to operational challenges and reducing complexity within the organization.
Conflict Management – Conflicts arise in every organization, especially in complex, large healthcare operations and are often a source of inefficiency. Most of the time these happen because of poor communication and a lack of shared goals, although it also can involve long-standing conflicts between individuals and teams that must be addressed. By placing priority on addressing these issues, healthcare leaders can eliminate bottlenecks and longstanding problem areas while creating positive outcomes for all parties involved.
Shared Leadership – A top-down, authoritarian approach does not always work well in a healthcare setting, which is staffed by highly skilled professionals who are experts in their fields. With shared leadership, decisions are made on a team level, with each area responsible for maintaining efficient operations, retaining qualified employees and continually improving quality of care.
Strategic Initiatives
Whatever approach is applied to healthcare leadership, there are some basic strategic initiatives that can help improve your chances of success. The following areas are expected to keep in mind when developing a leadership plan.
9 Improved Communication Lack of good communication underlies the problems in almost every organization. Leaders must take on the challenge of communicating the company vision and goals and creating an atmosphere in which employees know how they can take action to achieve those goals. This is vital when it comes to developing employees, offering a clear path for the most skilled and ambitious people to move up in an organization.
Focus on Improved Care Every team and individual in healthcare should focus on the quality of care, but this can get lost in a large operation. Making the improvement of patient care the top priority – and properly communicating this – can bring employees together. This includes integrating the efforts of everyone on a healthcare team involved in providing patient care, as well as the collaboration between patients and medical professionals on treatment plans.
Acquiring New Executive Skills True organizational change must come from the executive level. Today’s healthcare leaders wear a variety of hats. Beyond providing an inspiring vision and communicating that vision consistently, they also must be aware of the latest advances in technology that are transforming healthcare delivery, as well as the shifting government regulations that medical operations must follow. All of this is against the backdrop of sometimes tight financial situations in which leaders must maximize the resources of their employers.
9 Establish Metrics Milestones It’s impossible to get where you want to go without having important milestones along the way. Having a vision, communicating it well and getting everyone on board are important steps – but establishing metrics to determine whether you are moving in the right direction is just as important. Everyone must know what success looks like.