MHA-FPX5042 Assessment 4.edited (1)
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Team Development Analysis
Beth Doeden
Capella University
MHA-FPX5042 Team Dev Pers Leadership Health Care
May 4, 2021
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Introduction
To improve finances within my healthcare organization, each department has a margin
enhancement project to increase revenue or improve finances.
For my department in Urgent
Care, we were tasked with increasing our hours of operation.
The need for same-day non-Emergent Care extends past the current Urgent Care hours of
9 am to 9 pm, and these patients must either wait for Urgent Care to open or go to the ETC.
The
cost/benefit of extending Urgent Care hours to meet the needs of additional patients needs must
be discovered, and a group has been charged with evaluating the opportunity.
Urgent Care is staffed daily for operating hours of 9 am to 9 pm every day of the year.
Urgent Care staffing includes a core staff of Providers, RNs, LPNs/CMAs, PCEs, and Urgent
Care, who are scheduled to work the 12-hour shift.
The staff has a rotating Holiday and weekend
schedule.
Urgent Care relies on the collaborative work of many other departments to care for
patients, including Lab, Imaging, and Pharmacy, which must also staff appropriate hours for
Urgent Care operations.
These departments also have earlier weekday operating hours to serve
other Plaza clinics.
Urgent Care sees approximately 150 patients daily, although this average varies
significantly with seasonal demand.
Patient volume is generally highest in the AM, with lines
frequently forming before 9 am for patients who want to be seen as early as possible.
Arrivals
slow down after 7 pm, resulting in fewer patients arriving from 8 pm to 9 pm.
Urgent Care currently employs two practices, Diversion and Pause, which serve as
patient limitations when the Charge RN or Manager implements them.
Diversion limits patients
to non-complex symptoms.
This aims to increase patient turnover to see a large volume of
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patients during high-demand times and prevent many low-acuity patients from seeking services
elsewhere.
Diversion is communicated to stakeholders with a standard list of symptoms this
determination affects.
Pause ceases all check-ins of new patients.
This is often implemented in
the late afternoon or evening on days of exceptionally high demand when the wait time to room a
patient exceeds the time remaining before closing.
For example, if there are 50 patients currently
in the lobby at 7 pm with an estimated 2.5hr wait, the Charge RN may call a Pause.
Additionally,
patients who arrive later in the evening may be asked to seek care elsewhere or return in the
morning if their symptoms and triage indicate that the workup necessary for this patient will
significantly exceed the time remaining before closing.
The ETC sees an increase in low acuity patients from 7 pm to 9 pm, coinciding with the
decrease at Urgent Care.
The group assesses that this results from patient uncertainty about
whether they will or will not be able to be seen in Urgent Care during this time.
The impression
that patients have those late evening arrivals in Urgent Care are "risky" is likely driving both the
lower volumes in Urgent Care and the higher non-urgent volumes in the ED during these evening
hours.
The group determined that clarity in the message to the community would be vital to
bringing these patients back to Urgent Care.
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To combat the perception of the community that is causing the lower evening URGENT
CARE volumes, the group determined that efforts should be undertaken to restore confidence.
The first would be redefining operating hours when publicized to the community.
The group
assessed that the best way to define this would be "Check-ins Reliably Accepted" during this
time.
Under the current staffing, this time was determined to be 8 pm.
This would allow long
workups and wait times to be completed before the staff's scheduled shift ends.
The expectation
is that this will also decrease the frequency of using Pause and Divert.
It was determined to use
this definition in planning for extended operating hours and in a communication push to
advertise any changed hours and increase confidence in Urgent Care.
The group determined that expanding into the earlier morning hours during weekdays
would be the easiest to achieve without additional full-time employees and recruiting to fill
positions because of the existing staffing in imaging, lab, and pharmacy to support the other
clinics.
Only the core Urgent Care staffing model would need to change in this scenario.
With
the recent change to a mode of team-based staffing in Urgent Care, additional hours could be
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achieved by splitting one team to a 7 am to 7 pm shift, and the other would remain at 9 am to 9
pm.
For providers, two APPs would move to a 7 am to 7 pm shift, and the remaining providers,
including the physician, would remain at 9 am to 9 pm.
These staffing changes, combined with
the new definition of Operating Hours described above, would increase advertised hours of 7 am
to 8 pm on weekdays.
At the same time, weekends and holidays would remain 9a-8p, with the
understanding that patients arriving close to 8p would be seen beyond the advertised closing
time.
An effort is underway to merge Occupational Medicine and Urgent Care into a combined
department at the Plaza.
This would provide an additional provider and nursing staff for a 7 am
to 4 pm shift, increasing the staffing available in the morning.
While this is still uncertain, it
would be expected to decrease the morning wait times and ensure the evening crew is in a good
position when staff departs at 7 pm.
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As a walk-in service, Urgent Care volumes are difficult to predict and largely reliant on
seasonal ebbs and surges in demand.
With this in mind, the two ways to increase volumes are
increasing utilization by appropriate patients and increasing capacity to handle the surges.
The
communication plan described above, and the expanded early morning hours are designed to
increase the utilization of Urgent Care hours by existing patients who currently make other
choices about their Care.
Adding Occupational Medicine Providers and nurses into Plaza Urgent
Care would increase the capacity to deal with high demand times.
This is anticipated to be
incredibly impactful since Occupational Medicine historically has an opposite pattern of
seasonality from Urgent Care.
At the current utilization rate, Urgent Care, on average, sees 12.5
patients per hour.
A two-hour increase in daily operation could be expected to gain 25 patients
per day if this rate remained constant.
The utilization increase would be expected to achieve
moderate gains, with the additional capacity expected to create further volume increases.
The cost associated with these proposed changes is minimal.
Costs include mainly one-
time marketing/communication and updates to the signage advertising Urgent Care hours.
The
only staffing required would be the Occupational Medicine APP and Nurse (0.6 full-time
employees each) to ensure two Occ Med Providers are on site each day to provide access to the
Scheduled Occ Med patients while assisting with the Urgent Care volume.
Revenue would be
expected to increase according to the additional visits.
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It is the recommendation of this group to change the Urgent Care hours to 7a-8p on
Weekdays and 9a-8p on Weekends/Holidays.
This should be accompanied by the recommended
Communication and Marketing efforts to publicize this change in the community and ensure
awareness of the change.
Finally, to achieve the most significant increase in volumes and
revenue, it is recommended that Occupational Medicine be co-located with Urgent Care.
This
should coincide with taking advantage of a coordinated Marketing effort.
This group proposes a
tentative date of Tuesday, June 27
th
, for these changes to occur.
Process
In developing this project, we needed to include key stakeholders: a physician leader,
nursing leader, imaging director, scheduling director, lab supervisor, pharmacy director, my
direct supervisor, who was the executive sponsor, and me as the manager of Urgent Care.
All
key stakeholders attended a series of meetings to discuss opportunities, goals, objectives,
milestones, measurement of success, and potential risk.
Hours were discussed.
Professionalism
during this process was essential for the project's success and to keep everything moving
forward.
First, everyone needed to be reliable in their attendance and to be prepared.
Reliability
is fundamental to success.
Groups are more efficient and effective when the stakeholders can
rely on one another to do their part (Herrity, 2022).
All stakeholders were present at all
meetings, or if they could not be present, to send a prepared replacement.
Proper etiquette was
practiced by all involved.
Speaking in turn, manners and polite conversation were used to show
respect to one another and value each other.
Everyone showed consideration to each other,
considering their specific situations, whether there was a conflict with staffing, resources, etc.
Those who are considerate exhibit thoughtfulness and empathy helps establish trust and a sense
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of understanding (Herrity, 2022).
Also, integrity is essential because it assures others that you
will always try to do what is right and fair.
Those with great integrity are always honest and
ethical (Herrity, 2022).
During the conversation and course of the project, the leaders, the executive sponsor, and
I demonstrated professional values by asking questions to bring understanding and awareness to
all involved.
Not necessarily asking questions seeking a solution or objective answer.
Asking
“why” questions were avoided.
Instead, ask those involved to expand on their ideas or topics to
understand better, avoid defensiveness, and genuinely understand.
Self-awareness was practiced
while in the discussion.
There were times in conversation when we thought things were going
one way, but we were proven wrong by not assuming or having a bias.
Professional values
should have been specifically addressed, pointed out, or requested, only demonstrated.
The mission statement of our healthcare organization states, "We are here for your whole
life.
To listen, then serve.
To guide, then heal.
Because health means everything.”
The project's
leaders aligned with the mission statement by listening and helping guide the stakeholders
through the project.
Completing this project will promote healing within the community by
allowing more access to their Urgent Care needs.
This was not explicitly addressed during the
span of the project but is assumed.
The most prominent strategy used by the leaders in the project was the use of positivity.
It is no secret that there are many struggles in healthcare today with staffing shortages, the
pandemic, and inflation, which is the push for all these margin enhancement projects.
Much
negativity comes with struggles which makes everything more complicated.
People generally
respond better to positive interactions (Colan, 2023).
Though some would argue that a negative
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response motivates people to perform, it also causes anxiety and frustration, which is not
motivating.
People tend to work harder and do more for those who appreciate them, listen, and
invest in them as individuals.
This creates a continuing cycle of strengthened positive behavior
and positive results (Colan, 2023).
Strategies used to coach individuals that worked well were positivity and reinforcing the
need to be prepared for all meetings to keep moving forward.
What could have been improved
upon is humility.
There were a lot of excellent ideas, work, and effort put forward.
Calling out
that work performed by specific individuals in the presentation to executive leadership would
have meant a lot to them.
The way it was presented showed that the project's leaders could get
the job done but needed to give credit where credit was all due.
The actual team effort could
have been showcased better for the gratification of this project and when thinking about future
projects (Herrity, 2022).
People remember poor experiences which carry forward.
If there were
one thing that had changed, it would be humility.
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References:
Herrity, J. (2022).
Guide to Professionalism in the Workplace.
10 Qualities of Professional
People.
Retrieved April 28, 2023, from
Guide to Professionalism in the Workplace | Indeed.com
Colan, L. (2023) The Power of Positive Coaching.
Inc.
Retrieved April 28, 2023, from
https://www.inc.com/lee-colan/the-power-of-positive-coaching.html