Organizational Dynamics in Healthcare

Citations and formating need to follow AMA 11th edition. 

You are the CEO of a 200-bed community hospital that serves an increasing number of older patients. Your top priority is the quality and safety of care. Given the recent economic down- turn and decreased Medicare reimbursement to your facility, you are increasingly concerned about the hospitals ability to stay open and continue serving all of the community. 

You have heard that Medicare hospital payments will continue to be trimmed for patients who experience harms considered to be largely preventable: for example, blood clots, surgical infections, ventilator-associated pneumonias, health careacquired infections (HAIs), and others. You want to ensure your hospital takes every precaution to prevent all possible avoidable harms to patients. 

With the help of your assistant, you summarize the challenges before you as follows: 

  •  Medicare-denied payments focus exclusively on the additional care required to treat injury or condition arising from a preventable harm (such as when a second procedure is required to retrieve a surgical instrument). 
  •  To date, the denied payments have pertained only to hospital care. However, you also know that some analysts are recommending that the same policy be applied to physician payments. 
  •   One measure your hospital already has taken is to require that all workers who interact with patients wash their hands in order to prevent HAIs. Although this would seem a simple and obvious initiative, its success has been limited. 
  •  You also learn that your hospitals patient safety department isnt tracking the kinds of events for which the hospital may be financially penalized. 
  • Finally, you are aware that the ACA affects hospital payment in another way: by trimming reimbursements for potentially avoidable hospital readmissions. As noted earlier, your hospital serves a high proportion of older patients. Many of them currently have multiple admissions for acute exacerbations of chronic illnesses, such as congestive heart failure and diabetes. In the future, these multiple admissions could become very costly. 

Consider how you would address these leadership challenges. Be sure to address the follow- ing questions: 

  1. Who on your senior team should lead this effort? 
  2. Who else should be involved? 
  3. What precisely are you charging the team to do? 
  4. Who will help to communicate this effort to all front-line staff? 
  5. What kinds of systems need to be created to track progress? 
  6. What external resources could be utilized? 
  7. What are three items youd like to measure? 
  8. How do you set up a system in such a way as to increase the likelihood of sustainability? 


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