Implementation of Strategic Management, To fulfill the needs of patients, the fast-expanding healthcare system requires transformational leadership. Strategic leadership entails establishing and pursuing essential objectives such as lowering healthcare costs, maintaining development, and enhancing the quality of health services (Kumar et al., 2015). While leaders concentrate on enhancing healthcare service delivery, a variety of methods are used to assess every area of treatment in order to guide quality improvement.
Implementation of Strategic Management
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is one of the most widely acknowledged instruments in the United States for guiding quality care delivery and process improvement. The HCAHPS ratings displayed on Hospital Compare, which is part of the government’s Medicare website, enable consumers to make fair and objective comparisons between hospitals and state and national averages on key variables relating to the patient’s unique viewpoint on the treatment received. This debate examines how strategic leadership may be used to increase HCAHPS scores by using evidence-based strategies and involving stakeholders.
Banner Boswell Hospital’s HCAHPS Ratings
Survey Questions
BANNER BOSWELL MEDICAL CENTER
Patients whose nurses “always” communicated effectively
74. Patients whose physicians “Always” communicated effectively with them
72. Patients who said they “Always” got immediate assistance when they requested it
69. Patients who claimed that personnel “always” discussed medications prior to administering them.
60. Patients who indicated that their room and bathroom were “Always” clean had cleaner rooms and bathrooms.
60. Patients who stated that the environment around their room was “Always” silent at night were evaluated further.
47. Patients who said that they had been provided with instructions for their recuperation at home
88. Patients who “Strongly Agree” that they comprehended their treatment before leaving the hospital.
50. Patients who rated their hospital 9 or 10 on a scale ranging from 0 (lowest) to 10 (highest) (highest)
65. Patients who said that they would refer the hospital to others
68. Statewide and National Means
Implementation of Strategic Management
Medicare and Medicaid programs have assigned Banner Boswell Medical Center a two-star rating, and HCAHPS survey findings suggest potential for improvement in a number of areas. The facility compares well to Arizona and national averages, according to the results of the most recent study. The first factor is the percentage of patients who felt that their nurses “Always” communicated effectively, which is 74% compared to 77% and 81% for the state and national averages, respectively (U.S. Centers for Medicare and Medicaid Services (a), n.d.). The physicians’ communication score is 72%, which is somewhat below the state and national averages of 76% and 82%, respectively. The healthcare institution seems to perform well based on the proportion of patients who said they “Always” got assistance when they requested it. The average hospital score is 69%, which is two points higher than the state average and one point below than the national average. Patients who claimed that personnel “always” explained medications to them before administering them had a score of 60%, compared to the state and national averages of 65% and 66%, respectively.
Banner Boswell Medical Center seems to be much below the state and national standards for cleanliness and nighttime stillness of the rooms. The facility’s cleanliness rating is 60%, compared to the state and national levels of 72% and 76%, respectively. The score for quietness is 47%, compared to 57% and 62% for the state and national averages, respectively. The hospital relies heavily on patients who indicated that they were provided with instructions for their recuperation at home. The findings reveal a score of 88%, compared to scores of 86% for the state and 87% for the country (U.S. Centers for Medicare and Medicaid Services (a), n.d.). The percentage of patients who “Strongly Agree” they comprehended their treatment before leaving the hospital is 50%, compared to the state average of 51% and the national average of 54%. Patients who gave their hospital a rating of 9 or 10 on a scale of 0 (lowest) to 10 (highest) indicate a score of 65% compared to the state and national averages of 69% and 73% respectively. Lastly, 68% of patients would suggest the hospital, compared to 69% in the state and 72% nationally.
Comparative Study of Other Hospitals
I have chosen to compare Banner Boswell Medical Center to two Arizona hospitals, namely Arrowhead Hospital and Banner Baywood Medical Center. All three hospitals are acute care institutions with a Medicare and Medicaid rating of two stars. All three hospitals fall below the state and national averages for the proportion of patients who indicated that their nurses “Always” communicated properly. Boswell medical facility has a score of 74%, whereas Arrowhead and Banner Baywood have respective scores of 73% and 70% (U.S. Centers for Medicare and Medicaid Services (b), n.d.). On the topic of doctor communication, the ratings for the three hospitals are 72%, 72%, and 70%, respectively. These results are lower than the state average of 76% and the national average of 82%. Sixty-nine percent of Boswell Medical Center’s patients, 64 percent of Arrowhead’s, and 55 percent of Banner Baywood Medical Center’s patients get prompt assistance.
Patients at Banner Boswell Medical Center said that personnel “Always” explained medications to them before administering them 60% of the time, which is two and four points lower than their peers. The same holds true for room cleanliness, when Banner Boswell got 60% compared to Arrowhead and Baywood hospitals’ respective scores of 68% and 65%. Nighttime stillness is found to be lacking in every facility. (U.S. Centers for Medicare and Medicaid Services (b), n.d.) These ratings are much lower than the state and national norms, showing opportunity for growth. Banner Boswell has fared better in terms of the percentage of patients who reported receiving instructions for their recuperation at home. The facility gets an 88% rating, compared to the other two institutions’ scores of 85%.
Understanding the care provided during a hospital stay is crucial for judging the level of service provided. Banner Boswell performed better in this category, scoring 50% compared to 49% and 45% for the other two universities. In addition, patients who awarded their hospital a score of 9 or 10 on a scale ranging from 0 (worst) to 10 (best) indicate a satisfactory performance from the three hospitals. Banner Boswell scored 65% compared to Arrowhead’s 67% and Banner Baywood Medical Center’s 64% (U.S. Centers for Medicare and Medicaid Services (b), n.d.). The last component of comparison is the percentage of patients who said they would definitely recommend the hospital. Boswell and Arrowhead tied at 68%, while Banner Baywood Medical Center scored 65%.
Implementation of Strategic Management Rates of Survey Participation
The survey response rates of the three institutions vary depending on the number of surveys completed. The hospital with the most performed surveys, 1827, and the lowest survey response rate, 17%, is Arrowhead Hospital (U.S. Centers for Medicare and Medicaid Services (c), n.d.). With 596 completed surveys and a 30% survey response rate, Banner Boswell Medical Center is ranked second. As indicated in the table below, Banner Baywood Medical Center has the lowest number of completed questionnaires, 511, and a survey response percentage of 26%.
Implementation of Strategic Management Population Profile and Services Offered
Banner Boswell Medical Center, located on West Thunderbird Boulevard in Sun City, Arizona, provides a range of healthcare services to the area it serves. The hospital is committed to enhancing patient care by consistently concentrating on patient outcomes and service, training an engaged team, and using cutting-edge technology. Banner Health is the biggest non-profit employer in Arizona and one of the largest in Northern Colorado, with over 50,000 workers. The majority of the hospital’s patients are from Sun City, which has a population of 39,348. The population consists of individuals from many ethnic and racial origins. Whites account for 94.93% of the population, while blacks or African Americans account for 2.92%. (United States Census Bureau, 2019). Other races make up 0.51 percent of the population, while Asians account for 0.99 percent. The area has a typical household income of $50,139, and 9.09% of its people lives below the poverty level.
Banner Boswell Medical Center has been the cornerstone of community healthcare specialized on geriatric disorders. This indicates that the bulk of the population served consists of those aged 65 and older. Cancer care, emergency services, endoscopy, geriatric care, imaging, integrative therapy, neurology, orthopedics, wound care, endocrinology, renal care, cardiology services, intensive care, palliative care, surgery, nutrition, and women’s health are provided by the healthcare center (Banner Health, 2020). The Heart Center at Banner Boswell has received national recognition for its cardiovascular preventative care, diagnostic services, medical and surgical treatment, and rehabilitation programs. Truven Health Analytics, a renowned national health care research and quality evaluation firm, named the facility among the top 100 hospitals in the country.
Implementation of Strategic Management Cultural Dynamics
HCAHPS ratings rely on good connections between hospitalized healthcare workers and patients. With almost fifty percent of HCAHPS survey questions concentrating on communication, culture is vital to optimal patient outcomes. First, the institution must establish a culture of safety and belonging by ensuring the diversity of its healthcare personnel. Diverse members of the healthcare team, particularly those who share the patient’s racial or cultural heritage, are better able to comprehend the patient via diversity. The venue may also foster cultural awareness by including interpretation services. These approaches may facilitate improved patient-provider connection and communication. Diversity in the institution may increase HCAHPS ratings for discharge information, nurse communication, and medication communication.
Implementation of Strategic Management Educational Change
The provision of healthcare is a two-way process requiring ongoing contact between the patient and the healthcare professional. When a patient has a poor level of knowledge, it might be difficult for medical professionals to offer treatment. Education has a significant impact on the acceptance of therapy and the comprehension of care throughout the healing process. In addition, successful communication depends on the language used and comprehension of fundamental medical concepts. If the patient is poorly informed, HCAHPS ratings on elements such as knowledge of care following discharge and communication by nurses and physicians might be compromised. Ineffective communication and comprehension might potentially delay medical measures, resulting in patient discontent. Educated patients, on the other hand, are able to communicate their concerns and get the appropriate care, resulting to greater patient satisfaction.
Implementation of Strategic Management Socioeconomic Change
Access to healthcare services and how treatment is viewed are influenced by the socioeconomic position of people, as measured by their income and poverty levels. Individuals from affluent socioeconomic origins seek medical treatment with high hopes of recovery due to their financial resources. This view profoundly affects their interactions with healthcare professionals and their understanding of their treatment. The end outcome is a greater comprehension of care, stronger contact with clinicians, and higher HCAHPS ratings. This includes strong connections with care providers, communication throughout care delivery, and the quality of received services. These patients cannot afford specific hospital treatments, and their dissatisfaction stems from their inability to get the care they sought. The resulting low HCAHPS ratings demonstrate the failure of patient-provider interactions.
Financial Impact
Current survey results indicate a correlation between improved physician care, patient satisfaction, and reimbursement. There is evidence that quality care delivery, as measured by higher HCAHPS ratings, influences Medicare and Medicaid Services payments (Akinleye et al., 2019). On the near term, healthcare organizations with high HCAHPS scores get more cash that may be utilized to enhance organizational procedures. These facilities may grow and attract more patients, hence increasing their income. Medicare and Medicaid Services retain a portion of payments for hospitals with low HCAHPS ratings. This implies that the organization must struggle to generate income in order to maintain basic services. Long-term, increased HCAHPS scores create more capital, which leads to organizational development and expansion (Akinleye et al., 2019). The facility may adopt additional patient-attractive procedures. Poor scores result in a financial shortfall for the organization owing to a decline in Medicare funding and customer revenue.
Implementation of Strategic Management Influence on Quality
Healthcare organizations employ HCAHPS surveys to identify areas for development in order to get better outcomes. The hospital assesses regions that did badly and adopts measures to enhance quality after collecting the findings. The HCAHPS scores assist the organization in establishing objectives and using various methods to enhance the quality of services provided (Akinleye et al., 2019). Poor communication between nurses and physicians, for instance, is indicative of poor organizational performance. The firm might then opt to focus on enhancing communication to get better outcomes. Ineffective communication between healthcare teams may result in substandard results, such as an increase in medication mistakes, a delay in patient care response, and an increase in death rates. In addition, poor HCAHPS ratings destroy the morale of healthcare employees, who may lose faith in their management, resulting in a breakdown in communication and coordination of services.
Reasons for Scores
The first category with low HCAHPS ratings is the percentage of patients who said their room and bathroom were “Always” clean, with a score of 60%. Comparing the state average of 72% to the national average of 76%, there is potential for improvement. According to the hospital’s statistics, inadequate cleanliness is a result of an insufficient number of supported personnel and poor coordination of services among the existing employees. In addition, the hospital mostly accepts older people with a variety of diseases that make self-care difficult. These patients are likely to make it challenging to keep the patient rooms and restrooms clean. The second area with a low HCAHPS score is patients’ perceptions that the area around their room is “Always” peaceful at night. The survey findings reveal a score of 47% compared to the state and national averages of 57% and 62%, respectively. The proximity of the nursing station to patients’ rooms and the absence of clear norms for hospital quiet hours are the primary sources of nighttime noise in the institution.
Organizational Alteration
Organizational change is the process of modifying the organization’s structure, strategy, operational procedures, technology, and organizational culture in order to attain predetermined objectives. The issues requiring improvement at Banner Boswell Medical Center include cleanliness and nighttime tranquility. These two areas of patient care may be enhanced by the implementation of a variety of techniques, including the employment of more support workers and the implementation of a regular schedule for maintaining hygiene. These modifications may guarantee that patient rooms are constantly maintained clean, which can have a beneficial effect on a hospital’s HCAHPS score. Second, the institution should establish clear norms for quiet hours between 10 p.m. and 4 a.m. so that patients may sleep adequately. Except for admissions, all services at the nursing desk should be performed before or after the quiet hours. These modifications may enhance the patient experience, resulting in higher HCAHPS ratings in the indicated areas.
Structure, Procedure, and Results
Implemented quality improvement methods will attempt to increase the cleanliness of rooms and restrooms and reduce nighttime noise. In order to promote cleanliness, the healthcare organization will devise a cleaning schedule for patient rooms. In addition, management will evaluate the quantity of subordinates available to do cleaning duties, particularly at night, to ensure that all shifts are filled. Nighttime noise reduction will mostly include keeping a consistent schedule of calm hours between 10 p.m. and 4 a.m. During night shifts, the nursing department will coordinate with other healthcare experts to ensure that the protocol is strictly adhered to.
The process of adopting these strategies will include the selection of a quality improvement team that will collaborate with management to establish objectives and timeframes for each activity. The healthcare practitioners will be informed of the new developments and the significance of QI procedures to the enhancement of HCAHPS ratings. The anticipated result is increased hygiene of patient rooms and restrooms day and night. In addition, the quiet hours policy should be adhered to and the nurse managers should report on the strategy’s efficacy. Patients who indicated that their room and bathroom were “Always” clean and patients who claimed that the environment surrounding their room was “Always” quiet should have higher HCAHPS ratings if the two practices are implemented.
Enhancing Organizational Excellence
Evidence-based practice is a method that enhances healthcare quality, patient safety, and patient outcomes by using best practices. The evidence-based technique of quiet time intervention has been demonstrated to enhance patients’ sleep quality and have beneficial physiological impacts on patients (Lim, 2018). In addition, the approach fosters a healthy work atmosphere and improves patient satisfaction. This evidence-based approach will be used to enhance organizational quality and increase HCAHPS ratings. Shared governance is an approach that relies on cooperation and responsibility to tackle challenges affecting clinical practice and patient care. Diverse healthcare teams, comprising nurses, physicians, subordinate staff, and hospital management, will implement the two ways. These teams will be permitted to provide suggestions for the new practice shift and identify methods that, in their opinion, will aid in the enhancement of the new program.
Shared Responsibility
The development of healthcare quality is not a solitary endeavor, but rather the combined duty of patients, healthcare professionals, and other stakeholders. During the facility’s quality improvement process, the patients will actively evaluate the new programs by giving feedback. In order to involve medical professionals in shared responsibility, the Chief Medical Officer shall be engaged about committee membership for medical providers. They will be able to analyze organizational performance and give comments if they serve on committees. Working with the finance department will enable timely analysis of the HCHAPS scores and comments in order to demonstrate payer responsibility. In addition, the department will supply clinical and claims data to strengthen the views of healthcare organizations on the health state of patients. To encourage employee engagement in shared responsibility, management will be urged to encourage participation in committees and frequent input on organizational procedures and performance.
Implementation of Strategic Management Technological Developments
Today’s healthcare service delivery is distinguished by the use of technology to enhance the quality of treatment offered to patients. The new plan will utilize technology, particularly electronic health record systems for patient documentation. The use of computer systems will guarantee that healthcare personnel arrange duties in advance, hence reducing nighttime paperwork. The findings will be communicated through the hospital’s website and patient portals, showcasing the usage of technology. In addition, the facility may replace the overhead pager system, which is a major source of nighttime noise and annoyance, with individualized telephone communication.
Enhancing Health Care Delivery System
Banner Boswell Medical Center may enhance the quality of its services by using evidence-based practices. Implementing techniques such as the usage of quiet periods and the creation of regular cleaning schedules can guarantee that patients get excellent care, resulting in increased patient satisfaction. Methods such as the usage of communication whiteboards will guarantee that patients are promptly informed about their treatment and given the chance to ask questions or express concerns. Implementing communication techniques will result in patient satisfaction, which will increase HCAHPS ratings in relation to the price of healthcare delivery. Better HCAHPS ratings will increase payments. Implementing and improving hourly nursing rounds will boost patient access to timely care. In order to boost service accessibility, the organization may also endeavor to improve interpretation services across all hospital departments. By fostering communication between patients and healthcare practitioners utilizing communication whiteboards, patient-centered care will be enhanced. In addition, patients and families will be able to provide feedback on the enhancement of care delivery after the new techniques are implemented.
Implementation of Strategic Management Enhancing Economic Stability
The approach to strengthen Banner Boswell Medical Center’s financial viability will center on increasing HCAHPS ratings. Today, healthcare organizations are compensated based on the HCAHPS survey’s evaluation of the quality of care provided. Making patient-centered care a hospital priority will be the most effective strategy for achieving financial stability. Enhancing patient-centered care through enhancing communication between doctors, including patients in their treatment, and utilizing whiteboards. These techniques will enhance quality, reduce readmission rates, and increase reimbursements to stabilize the organization’s financial standing.
Participant Functions and Responsibilities
The new tactics will be implemented by hospital management, nurses, and subordinate employees. All members of the healthcare staff will be involved in the administration’s coordination of the stages of implementation. Second, the administration will be actively engaged in allocating the necessary resources for the new change’s implementation. This includes allocating funds, coordinating with permanent stakeholders, and monitoring the implementation’s success.
The nursing staff will be responsible for creating quiet hours during night shifts to provide a peaceful atmosphere for patients. During implementation, nurses will serve as patient educators and advocates, react swiftly to patient needs, perform hourly rounds, and offer feedback to nurse managers. In addition, the team will analyze the plan’s progress and propose further actions to meet the established objectives. The responsibility of the subordinate employees will be to maintain a safe and clean environment by keeping the patient rooms and restrooms clean. The staff will examine the cleanliness of patient rooms and restrooms on an hourly basis and offer input to the QI team about the success of the new strategy.
Implementation of Strategic Management Responsible Accountability
To ensure stakeholder engagement, the nurses, administration, and subordinate staff will be actively engaged via frequent communication. Each week, the quality improvement team will hold briefing meetings at which departmental representatives will deliver their progress reports. The administration department will maintain accountability by monitoring the execution plan, confirming deadline adherence, and taking disciplinary action against those who fail to reach the established requirements.
Implementation of Strategic Management Training
Prior to adopting a new policy, method, or organizational strategy, it is essential to teach workers effectively in order to achieve success. Any new technology, policy, or process, as well as HCAHPS survey questions, must be covered in training. The nurses will need training on how to enforce the new policy mandating quiet hours between 10 p.m. and 4 a.m. Regarding the development of a cleaning plan, subordinate personnel will be instructed on how to conduct periodic inspections of patient rooms and restrooms. In addition, new equipment will be acquired to expedite the cleaning process, and training will be needed to operate and maintain the equipment.
Implementation of Strategic Management Plan Implementation
The transformation will begin with the formation of a task group to advise employees and other interested parties through the implementation process. The duration of the implementation phase is six months, with frequent evaluations occurring every two months. The first month will be devoted to the allocation of resources, the selection of the QI team, and the dissemination of the strategy to the stakeholders. In addition, the time will be utilized to acquire cleaning equipment and design a new policy on quiet hours and hourly room inspections by subordinate employees. The execution of a strategy to guide hygiene, as well as quiet hours for nurses, will commence in the second month. Beginning between the second and third month, nurses and junior personnel will be trained. The nurses, patients, and other staff will be informed of the practice guidelines, implementation timeframe, and assessment procedures throughout this time period.
After establishing a firm foundation for implementation, the third to fifth month will be utilized to assess training comprehension, complete execution of nighttime quiet hours, and compliance with hourly cleaning rounds by subordinate employees. At this stage, intermittent assessment via feedback collecting will be performed. Each week, the QI team will meet to review progress and report its findings to the administration. At the conclusion of each month, audits of nurses and junior staff will be conducted to guarantee compliance with the established requirements. The sixth month will entail rounding and getting data on the effectiveness of the intervention programs via assessment reports. Patient interviews and HCAHPS assessments will be utilized to describe the success of the treatments.
Success Evaluation of the Strategic Plan
The effectiveness of the strategy plan will be measured by the HCAHPS ratings for room cleanliness and nighttime quietness. Although the first review will be conducted after six months, the plan’s effectiveness will be assessed after a year. The technique of analysis will consist of comparing the new HCAHPS scores to the old scores on the previously selected survey components.
Implementation of Strategic Management Involvement of Stakeholders
Administration, nurses, and subordinate cleaning personnel will be the primary stakeholders in the assessment procedure. The healthcare administration will assess the plan’s performance based on the responsibility and collaboration of the process improvement team. In addition, the team will analyze the HCAHPS scores and communicate the findings to other team members. The nurses and subordinate cleaning personnel will be included in the team that provides input on the whole process and any areas that may need future development.
Transmission of Results
The hospital newspaper, direct contact to the stakeholders, emails, and internal memoranda addressed to the division heads would be used for internal communication of the outcomes. During daily rounds and staff meetings, direct contact with patients and other personnel will occur. External communication will include the utilization of the hospital’s website, local newspapers, and social media platforms such as the Instagram and Facebook pages of the institution. In addition, patient portals will be deployed to facilitate direct connection with patients outside of the healthcare institution.
References
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https://www.bannerhealth.com/locations/sun-city/banner-boswell-medical-center
Kumar, S., Kumar, N., Adhish, V. S., & Reddy, R. S. (2015). Strategic management and leadership for health professionals – the use of resources to accomplish health objectives. Official journal of the Indian Association of Preventive & Social Medicine, Indian Journal of Community Medicine, 40(3), 158–162.
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https://www.medicare.gov/hospitalcompare/compare.html#cmprTab=1&cmprID=030061%2C030094%2C030088&cmprDist=0.0%2C0.0%2C0.0&stsltd=AZ&dist=25&state=AZ&lat=0&lng=0
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