Mod 8 Capstone PowerPoint Final

Editor's Notes

• #2: Pocahontas Memorial Hospital: A Feasibility Study Helen M. Chagnon MGT 100-Q1529 Critical Issues in Management Dr. C. J. Leyland Southern New Hampshire University November 22, 2015
• #3: Feasibility Study Highlights The highlights of this feasibility study will include: An introduction about Pocahontas Memorial Hospital; its current and recommended changes to its mission, vision, values, and goals; assessments regarding environmental challenges, access to proper care, and technological needs; both market and SWOT analyses; and recommendations and strategies for PMH’s organizational success.
• #4: Introduction: Pocahontas Memorial Hospital Pocahontas Memorial Hospital (PMH) has seen its share of successes and adversity over the years. Originally established in 1906 in Marlinton, a town in Pocahontas County, PMH achieved memorial status to honor World War I veterans in 1926. The hospital has almost always been plagued with financial problems, the building was destroyed in 1930 due to a furnace fire and reopened in 1932, and PMH has almost closed its doors on several occasions, only to be saved by the community and employees through fundraising, donations, and even sacrificing pay. PMH still faces challenges, such as poor care access, difficulty in providing appropriate healthcare services, wasteful spending, and an overused emergency room (ER), but its strong connection to the citizens of Pocahontas County and persistence to serve them well will help in the establishment of a much needed comprehensive satellite clinic and in achieving general organizational success (Pocahontas Memorial Hospital, 2013; Pocahontas Memorial Hospital, 2015). This feasibility study was conducted in order to assess and analyze PMH’s current station within its community and market, and recommend the steps it must take in order to systematically and appropriately create, establish, and sustain a comprehensive satellite clinic in the northern portion of Pocahontas County, an area in dire need of medical services.
• #5: Mission, Vision, Values, and Goals Mission Statement Mission statements establish an organization’s identity and purpose, which assists in developing strategies and plans to realize that purpose (MindToolsVideos, 2011; Gow, 2009; Innovation Business, 2015). PMH’s current mission statement includes important factors, such as that it is the community’s first choice for healthcare, provides excellence and education through collaboration, and has a strong commitment to customer service. However, this statement lacks measurements for success and a specific purpose. Therefore, PMH will need to create a mission statement that is aligned with a strategic plan for a new, comprehensive satellite clinic, such as, “Pocahontas Memorial Hospital’s mission is to offer high quality healthcare that is both affordable and accessible to our community, to learn and educate, and to inspire hope and well-being. To make this possible, we must find ways in which to expand care services while still lowering care costs and improving care quality and patient safety. We will accomplish these goals through strategic planning initiatives and the management of professional, financial, and organizational growth.” Vision A vision statement provides an organization with a sense of direction, sending out a message of positivity and strength. Currently, PMH has no specific vision statement other than its “pillars” and “principles,” which only describe its core values rather than explain how they relate to its organizational vision (Pocahontas Memorial Hospital, 2015, “Our Core Values,” paras. 4-5). A vision statement that includes emotion and humanity as well as its current efforts towards a satellite clinic could read, “Pocahontas Memorial Hospital strives to be a superior healthcare organization through our commitment to improving the access and quality of care for our valued community. We will accomplish this through the responsible financial and personal investment in our employees, facilities, services, and technological advancements, thereby assisting our patients in experiencing the happiness, comfort, safety, and support they deserve.” Values While PMH has clearly outlined its values through its “Five Pillars” (people, service, quality, finance, and growth) and its “Nine Principles” (excellence, measurement, service, leadership, employees, accountability, behavior, communication, and success), the hospital has not prioritized them, nor connected them to a vision statement (Pocahontas Memorial Hospital, 2015, “Our Core Values,” paras. 4-5). In the previous vision statement recommendation, its values are not only aligned with its vision, but also reflect its new commitment to a satellite clinic and prioritizes its patients through the validation of both their physical and emotional needs. PMH may also wish to change “people” listed in its pillars to “patients,” further empowering them to advocate for their own health, quality of life, and acknowledge their high value to the facility. It would also benefit PMH to expand on its pillars by breaking each one down and showcasing its commitment to responsible financial investments, solvency, stewardship, technology, compliance, and sustainability. Goals In order for PMH to fully realize its goal of opening a satellite clinic while reaching and maintaining financial solvency and properly serving its community, market and SWOT analyses must be conducted. These important tools will help PMH determine whether the clinic is feasible.
• #6: Market Analysis A market analysis will provide the information PMH and its rural community needs in order to determine whether this project is possible. A project team must be assembled and will use the gathered data to create recommendations for PMH’s board of directors and senior executives. A set of guidelines must be put in place to ensure only applicable data is collected for the market analysis, thereby generating appropriate recommendations for PMH and ensuring the feasibility of opening a comprehensive satellite clinic in the northern part of Pocahontas County (Kerr, 2015). Illustration In this illustration, the Five C’s concept has been applied to the determination of the feasibility of PMH opening a satellite clinic. As seen above, these five elements play a key role in determining the possibility of reaching an end goal for any organization. PMH must uncover what is valuable to its target market, and take into account patient satisfaction; determine levels of competitors, threats, opportunities, and other perspectives; focus on its strengths and weaknesses, goals, skills, and resources at its disposal; realize collaborative and shared interests as well as understand its place in the supply chain; and take into account the legal, financial, social, and technological implications as well as trends that offer opportunities (Shi & Singh, 2013).
• #7: General Overview: Pocahontas County Porter’s Five Forces Utilizing the Porter’s Five Forces analysis will enable PMH to create a framework for assessing the levels of competition and create a solid foundation for the development of a successful business strategy. Proper Assessment PMH’s market analysis should target patients from the northern part of Pocahontas County. The hospital is located in the southern portion, which is where half the population lives. Due to the low population in the northern part of the county, residents within this area lack adequate access to healthcare and are often forced to go to the emergency room (ER) in the southern area, causing a financial burden on PMH and risking insolvency. This offers an opportunity to target the potential market in this part of the county; a comprehensive satellite healthcare clinic in the northern part of the county would relieve stress on staff, positively impact care costs, and increase the quality and level of healthcare for all Pocahontas County residents (County Health Roadmaps & Rankings, 2015; Pocahontas Memorial Hospital, 2013). PMH is experiencing many of the same problems as other rural hospitals: a significant shortage of healthcare providers, and severe difficulty in recruiting and retaining new physicians who have experience in rural medicine. This places a strain on PMH, since it cannot employ enough clinical staff to provide quality care to patients (Pocahontas Memorial Hospital, 2013). Recruitment and retention strategies would need to be utilized to adequately staff the satellite clinic for it to qualify for Medicaid and Medicare reimbursements; while this is initially expensive, PMH must realize the costs of hiring new medical staff will be matched with the increase of reimbursements as well as lower unnecessary care costs (Mareck, 2011). Financial figures can be realized through a financial feasibility report (Duke & Health Resources and Services Administration, 2004). Included within the feasibility report will be Health IT upgrades, training, and implementations necessary to secure patient data through electronic health records (EHR), online communication, and telehealth tools. These interventions will enable the satellite clinic to better connect patients and providers. They play a significant role in the everyday practice of rural clinics like PMH that have transformed their infrastructure through the use of Health IT, allowing them to continue to compete in the healthcare market (Schaeffer, 2014; Duke & Health Resources and Services Administration, 2004). PMH’s market analysis will not only focus upon internal issues, but also external forces. These important factors should be identified, and they include such things as competition and position within the market. Davis Memorial Hospital (DMH) is the largest competitor to PMH due to logistics, its merger with a larger hospital system, and added resources (McMillion & Fulks, 2009). Since there is a dire need for a clinic in the northern area of Pocahontas County that DMH does not currently serve, the hospital’s position within the market is an excellent one. Outcomes Before the market analysis can begin, PMH must define its outcomes. Setting objectives and goals allows administrative leaders and the board of directors to provide a specified course for the data, backed by proper research and acquired through accurate methods, vital to the market analysis. Trends, regulations, market segments, patient needs, and competition must all be analyzed and considered. A team comprised of different stakeholders, including PMH’s clinical staff and patients, should be included in the project. These different perspectives offer crucial information that will help determine the feasibility of building and establishing a satellite clinic. Meaningful tools, such as surveys, questionnaires, and interviews are certainly helpful, but may prove to be expensive for a rural area like Pocahontas County, particularly if these methods are paper-based and require postage. Internet and phone communication should be utilized instead, and the gathering of pertinent information through data mining and other research methods can also prove to be significant and cost-effective (Kerr, 2015; Rathjens, 2014). Trends One of the major trends in healthcare right now is the use of technology, specifically EHRs, eHealth, and telemedicine. These viable resources are how communication and information technologies can be applied across the entire range of functions that affect health and well-being, how rural facilities can attract needed employees, and can easily offer important medical information over the Internet. The benefits of eHealth include key healthcare advancements, increased operational efficiency, the ability to offer care from anywhere, patient empowerment and advocacy, and substantial increases in the quality of patient care and safety (Schaeffer, 2014). Healthcare providers are the catalyst and driving force behind eHealth initiatives and practices; these benefits would not occur without physicians and other healthcare practitioners’ use and acceptance. Telehealth connects patient and physicians, cultivates personal relationships, and expands networks. Extending professional development and practice of IT technologies and initiatives ensures its continued and growing acceptance and utilization. The pushing for and embracing of technology, utilization of the Internet, and acceptance of eHealth initiatives in healthcare are crucial to PMH’s forward movement, place within the market, meeting patient needs, and positive health outcomes. The addition of funding from the Health Information Technology for Economic and Clinical Health (HITECH) Act will encourage, secure, and further support Health IT development (HealthIT.gov, 2014). PMH must apply for these funds immediately. The more user-friendly, financially supported, and secure they are, the more PMH health providers and their patients will want to use these critical, medical technologies (Shi & Singh, 2013; Li, Talaei-Khoei, Seale, Ray, & MacIntyre, 2013; Schaeffer, 2014). Pocahontas County Residents The residents of Pocahontas County are in an area that is financially depressed, housing low-income families that are usually uninsured, must pay for services out-of-pocket, and routinely struggle with major economic barriers. Due to these reasons, PMH’s ER is often crowded and overused. These visits are expensive, both for PMH as well as the patient, and efforts towards reimbursement and payment collections are almost always futile (County Health Roadmaps & Rankings, 2015; Pocahontas Memorial Hospital, 2013). The Affordable Care Act’s (ACA) regulations will continue to expand the mix of payers through more available, accessible, and affordable insurance options. Changes in healthcare regulations will increase the demand for medical services, since increases in coverage translate to patients seeking better, more scheduled medical visits. This attracts patients and increases patient loads; expanded coverage lessens ER visits and increases non-emergency care, thereby attracting new clinical staff and students from area medical schools. With the establishment of PMH’s clinic, more insured clients, and new coverage regulations, patient educators, also called patient navigators, will be needed to help patients understand their coverage and its benefits. By leading each patient through his or her care journey, navigators educate clients in how to meet and maximize their benefits, follow up with them to encourage proactive and preventive care, and ensure that they are using medical services appropriately. This guarantees reimbursement payments, intelligent use of resources, and quality care. It also eliminates unnecessary treatments and ER visits (Russell, 2013). Recruiting and Retaining Staff PMH will need a plan in place to recruit and retain new physicians and other clinical staff. Beyond new telehealth initiatives to provide and expand services, improve patient care, and give access to lacking specialists, other strategies must be implemented. For example, physicians and providers appreciate educational opportunities and meaningful responsibilities. Increased access to current research and advancements through Health IT technology and embarking on a partnership with an area medical school would be excellent places to start. One such school could be the West Virginia School of Osteopathic Medicine. This school focuses specifically on providing health care to rural areas like Pocahontas County. Offering students opportunities to work in PMH’s new satellite clinic would be the perfect partnership (West Virginia School of Osteopathic Medicine, 2015; Mareck, 2011; Schaeffer, 2014). Competitors Even though PMH is the only hospital that serves the small Pocahontas County community, the facility is still overwhelmed by the number of patients regularly seen. The establishment of a satellite clinic should reduce the strain these patients place on both staff and hospital resources and increase its market share. Counties that surround Pocahontas County share many of its characteristics – financial depression, demographics, poor health outcomes – and these areas with hospitals will be similar to PMH. PMH’s biggest competition is Davis Memorial Hospital (DMH). DMH is part of a larger health system northeast of Pocahontas County, and serves Randolph County. Due to the fact that it is a larger hospital, has the resources to manage and attract more patients, and is part of a more comprehensive system, DMH has the ability to improve services and offer lower care costs. Therefore, a satellite clinic is crucial to securing PMH’s market (McMillion & Fulks, 2009).
• #8: SWOT Analysis SWOT Analysis Illustration This illustration shows the internal and external factors that can have both positive and negative effects on any organization. A SWOT analysis must be conducted by PMH to assist its facility with strategic assessment and planning. This analysis will provide the hospital with the realistic and objective investigation it needs to help better understand both the internal and external forces that directly affect its staff, patients, and industry regulations. A SWOT analysis can assist PMH in uncovering what works best for its organization and what works against it. It will allow the hospital to create new and update existing marketing strategies to cultivate positive outcomes, leading to continued progress, the meeting of patient needs, and both organizational and community-driven growth (Virtualstrategist., 2008; Gandolf, 2013).
• #9: Strengths One of the main strengths associated with PMH is its incredible community support system. In healthcare, patient satisfaction is a considerable indication of how well a facility is doing and if it is offering excellent care. PMH has incredibly high patient satisfaction ratings – as a matter of fact, some of the best ratings within the industry (Shi & Singh, 2013; Pocahontas Memorial Hospital, 2015). Community members have even gone so far as to offer financial support through community events and fundraisers during times of financial instability and natural disasters that threatened the hospital's future and solvency (Pocahontas Memorial Hospital, 2013). In this way, the people of Pocahontas County are PMH’s biggest strength. PMH does not discriminate, and its staff’s altruistic nature – treating all patients, regardless of financial stability – is just one of its many positive attributes associated with its standards of behavior. PMH employees are professional, committed, hardworking, compassionate, and respectful. There is no doubt that these characteristics are why the hospital has such high patient satisfaction ratings and why the community has always been so eager to help PMH when it faced adversity (Pocahontas Memorial Hospital, 2015; Pocahontas Memorial Hospital, 2013).
• #10: Weaknesses Most rural hospitals like PMH have a considerable lack of staff – in both hiring and retention (Mareck, 2011). This is PMH’s major weakness, and it is obvious the hospital needs to address this area immediately. Other weaknesses include an over or incorrect use of the emergency room (ER), leading to crowding, ineffective care services and treatments, and a lack of proper reimbursement for the hospital. Patients often cannot afford other forms of preventive healthcare; they also struggle to pay medical bills as well. These issues are the catalyst for the creation and building of a comprehensive, satellite care clinic. Due to significant staffing shortages, many of the clinical staff, especially nurses, suffer from burnout. Workplace stress and burnout ultimately leads to high turnover rates. Combining this with an overcrowded and overused ER, this results in the hospital barely retaining nurses while also losing money from a lack of reimbursements due to non-paying patients (McMillion & Fulks, 2009; Pocahontas Memorial Hospital, 2013). If PMH is unable to provide sufficient staff, it will be difficult for the facility to meet the standards and regulations of the new provisions under the Affordable Care Act (ACA). The passage of the ACA requires hospitals to ensure they are giving high quality healthcare access to every patient. The low staffing levels currently at PMH will not permit this; due to its weakness in attracting and retaining quality healthcare professionals to work in its remote rural location, PMH is significantly threatened in its ability to continue as is (Shi & Singh, 2013).
• #11: Opportunities The opportunities that exist for PMH are based upon its capability to enter into a new market in the northern part of Pocahontas County, which has no hospital. This is the main reason why so many patients are currently getting non-emergency services at PMH’s ER. With the addition of a satellite clinic, PMH can scale down the sheer number of ER patients, saving itself significant money, simply because many of these patients cannot pay for the medical services they receive (Pocahontas Memorial Hospital, 2013). Due to the passage of the ACA, many patients in the northern area of Pocahontas County are now eligible for Medicaid and Medicare. This will guarantee that the clinic receives appropriate reimbursements. Harmonizing its payer mix with the utilization of new medical technology will allow the satellite clinic to keep in contact with and communicating effectively with the main hospital (Shi & Singh, 2013; Schaeffer, 2014). PMH will increase its revenues, ensuring that it will secure financial solvency.
• #12: Threats As mentioned previously, Pocahontas County struggles with a depressed economy, making it difficult for patients to fully realize positive health outcomes and to pay for appropriate care services and treatments. However, a significant threat that PMH faces in its attempt to establish its comprehensive satellite healthcare clinic is technology implementation – specifically, the requirement by the federal government that all hospitals enforce and maintain electronic healthcare records (EHRs). Major technological initiatives like this are often very expensive for larger hospitals to implement, never mind a rural hospital that struggles financially. Clinical staff often have difficulty with EHRs, since this technology is fairly new and is just becoming mainstreamed. Therefore, proper training and professional development, online security measures, the licensing of software, and other elements will need to be undertaken, resulting in PMH’s need for the money to pay for it all. It will be critical to strike a balance between these new technological upgrades and the increase in funds from the Medicaid and Medicare reimbursements. Additional funds from outside sources (such as federal grants) should be considered as well (Li, Talaei-Khoei, Seale, Ray, & MacIntyre, 2013; Schaeffer, 2014; Shi & Singh, 2013). One final threat is PMH’s biggest rival – Davis Memorial Hospital (DMH). DMH is in the neighboring Randolph County, and merged with other larger hospitals to create a large network with increased funds and resources, 21st century technologies, and has the greater capability to attract and retain medical staff. If DMH turns out to be the preferred choice for patients in Pocahontas County, it may force PMH to also seek a merger with a bigger healthcare system in order to survive the competition within its market (McMillion & Fulks, 2009).
• #13: Recommendations Strategies for Attracting Healthcare Employees Proactive recruitment strategies are vital to the recruitment and retention of rural healthcare employees. Offering the latest technological tools, encouraging community participation, and making good use of outreach and relationship strategies entices both fresh and veteran medical employees. Embarking on a sincere effort to get to know potential candidates and medical students as well as offer organizational perspectives on its needs and goals fosters genuine connections, promotes the facility’s strengths, and provides an avenue by which others can help to eliminate organizational weaknesses and provide patients better care. This approach is incredibly effective at building personal, meaningful relationships before employees officially take a position in a hospital like Pocahontas Memorial Hospital (PMH). In this way, potential employees learn more about and better understand the medical institution, building an appreciation and connection. Current employees guide and teach possible candidates for employment, provide hands-on, worthwhile experiences, and cultivate the best learning environment possible. Finding the right fit for both the hospital and the employee is paramount to recruiting and retaining high-quality medical staff.
• #14: Medical Technology Initiatives Attracting new doctors and medical staff new to the healthcare career market should be PMH’s primary focus; while veteran clinicians are still welcome candidates for employment, hospitals usually have a much higher rate of medical students applying to needed positions (Mareck, 2011). Doctors and nurses want to feel comfortable in their new responsibilities, and access to current Health IT tools, software, and care approaches are what many of them are trained on and are expecting to utilize when taking a new position. Electronic health records (EHRs) and other technologies must be incorporated into the everyday routine of the satellite clinic. Most medical staff would not want to take a technological step backwards, not just for their own comfort levels, but to ensure the safety and high quality of care for their patients (CareTechTV, 2012). Therefore, PMH must first solidify the financial means to promote, implement, and train current and future staff on the latest technological upgrades and initiatives. Since PMH’s relationship with the residents of Pocahontas County is so strong, asking for community input and involvement in the forms of questionnaires, interviews, and even financial assistance through fundraisers – particularly from those in the market it would serve, the northern area – would be necessary. However, it is well known that most members of the community struggle financially; PMH must immediately apply for funding from the Health Information Technology for Economic and Clinical Health (HITECH) Act. This will encourage, secure, and further support Health IT development and maintenance (HealthIT.gov, 2014; Li, Talaei-Khoei, Seale, Ray, & MacIntyre, 2013; Mareck, 2011; Schaeffer, 2014). Beyond new eHealth and telehealth initiatives to provide and expand services, improve patient care, and give access to lacking specialists, other strategies must be implemented. For example, physicians and providers appreciate educational opportunities and meaningful responsibilities. Increased access to current research and advancements through Health IT technology and embarking on a partnership with area medical schools are excellent strategies. Medical School Partnerships Establishing relationships with nearby medical schools has many benefits for both PMH and academic institutions: access to cutting-edge medical services, keeping current clinical employees up-to-date on new research and treatments, a chance to offer unique, hands-on experiences to students specializing in rural healthcare, and making meaningful connections and increasing the probability these students may become new additions to PMH’s staff. Students from these schools are shown a window into real, rural medicinal practice, helping them to better understand the particular challenges and benefits rural hospitals like PMH face. Necessary healthcare employees can be enticed through loan-payment and scholarship programs, extra funding, and supplementary opportunities (Traynor, 2011; Mareck, 2011). One such school could be the West Virginia School of Osteopathic Medicine, a medical school in close proximity to PMH. This school focuses specifically on providing health care to rural areas like Pocahontas County. Offering students opportunities to learn and work in PMH’s new satellite clinic would be the perfect partnership, since it provides the hospital a way in which to recruit fresh employees, have access to the latest medical research and treatments, and build relationships with specialized instructors (Slagle, 2013; West Virginia School of Osteopathic Medicine, 2015; Mareck, 2011). Community Involvement and Social Media Opportunities Social networking and media opportunities can have a dramatic impact on PMH’s efforts to establish and promote its comprehensive satellite clinic and need for qualified medical staff. Marketing materials should not be isolated to brochures and commercials. In this day and age, social media is a powerful tool, and PMH should take advantage of sites like Facebook, YouTube, Linkedin, and Twitter to offer its organization a chance to reach out in effective, financially sound ways. Expanding its website is also a wonderful way in which to distribute and display important information, educate the public about its satellite clinic, organizational strengths, and outstanding staff, and create a huge marketing presence online (Kolu & Parsons, 1993; Lake, 2014). PMH can go beyond putting advertisements for needed medical staff in newspapers and magazines – social media channels like focused websites from medical schools, specialized blogs written by medical students and clinicians, and professional networking sites like Linkedin can target the exact audience for whom PMH is searching. For example, the hospital could create a Twitter account that actively and routinely advertises open positions in both its hospital and satellite clinic (Wipro Healthcare, 2010). PMH can provide Pocahontas County and surrounding communities with an overview of their hospital’s goal of a comprehensive satellite clinic, and a new mission and vision that appropriately reflect its new journey. The hospital can keep the public informed with the latest news about job openings and clinic construction, provide weekly or monthly newsletters to online subscribers, create and implement special events to bring their community together and educate them on the benefits of patronizing PMH, and share opportunities to donate or join its facility (Lake, 2014; Wipro Healthcare, 2010). Just as Health IT is a critical tool for healthcare professionals, social media extends the Health IT world to the community through online education, qualitative and quantitative assessments, questionnaires, and interviews, facilitating and maintaining its high customer ratings and offering opportunities for feedback. PMH could offer significant, online, patient education materials, state its renewed focus on preventive care, list new medical treatments and research, and provide other general health information to its current and potential patients (Wipro Healthcare, 2010). Better educated, less apathetic, and effectively connected patients lead to happier, more valued, and exceptional medical staff. Sincerity and Care Finally, physicians and other healthcare staff have families, feelings, and personal lives that all need attention. Those employees making the transition to a new career at PMH, either from a medical school or previous clinical position, will need the time to adjust and become comfortable with the community and way of life in Pocahontas County – especially if they are new to the area. PMH must create a safe, warm environment that values, respects, and strives to understand employees and their families’ needs (Mareck, 2011; Rural Assistance Center, 2015). Competitive salaries, insurance benefits (dental, healthcare, vision, and life), medical malpractice coverage, paid licensing fees, low or covered association dues, as well as student loan repayments and forgiveness, paid sick time and maternity/paternity leave, and ample retirement plans and packages are all significant options for the recruitment and retention of staff. Some nontraditional options include generous relocation offers that can include spousal employment, deals on vehicle purchases or leases, childcare coverage, low-interest mortgage rates or low rental costs, and free smartphones, tablets, and laptops for both business and home use (Slagle, 2013; Rural Assistance Center, 2015).
• #15: Social Intelligence Social tools and networking offer incredible opportunities for healthcare facilities and organizations that are creating and putting new marketing, recruitment, and retention strategies into action. An overwhelming presence in today’s technologically connected world, social media and a strong online presence have a critical effect on strategic planning and initiatives. Pocahontas Memorial Hospital (PMH) must make concerted efforts towards social intelligence as well as making a vital, unique, and up-to-date connection with significant stakeholders, current and potential employees, and the people of Pocahontas County. General Information and Marketing PMH should begin their journey to social intelligence through the use of social media services. Healthcare organizations that use targeted channels such as Facebook, Twitter, and YouTube open up their opportunities to reach new and current patients, potential candidates for employment, and the community as a whole. PMH’s online presence would enhance its plans for a comprehensive satellite clinic considerably by providing important information about the hospital’s goals for extending services to the northern area of Pocahontas County; plans for the physical and logistical construction of the clinic, including updates from groundbreaking to opening day; a list of services, treatments, and products offered through both the hospital and the new clinic; and the dissemination of important data about community health trends, cutting edge treatments, preventive care, and other general and specialized health information (Rural Assistance Center, 2015; Wipro Healthcare, 2010; Schaeffer, 2014). PMH’s website should also be appropriately updated and maintained on a regular basis. PMH can effectively sell itself to those potential patients that may not be aware of its new clinic, and inform them of the services both the hospital and clinic offer, changes to the hospital’s mission and vision, opportunities for community events and support, and reasons why PMH and its clinic are the best choices for the people of Pocahontas County (Kolu & Parsons, 1993; Lake, 2014). Social intelligence is vital when companies endeavor to successfully brand themselves. Branding allows firms a means by which to give themselves a competitive edge. Through a strong online presence, healthcare firms can make connections to appropriately measure their marketing status in real time, construct new visibility and sales strategies, and make themselves much more accessible to their target markets. To further deepen its patient connection and community relationship, PMH should utilize methods that include email and newsletter subscriptions, discounts and coupons for care services and products, contests and community events, and even recipes or other wellness and general health recommendations (Lake, 2014; Wipro Healthcare, 2010). Recruitment and Retention Hospitals and other healthcare firms that utilize social media, blogs, employment websites (such as Monster and Career Builder), and professional networking sites (such as LinkedIn) target future employees and candidates. PMH must take advantage of the dramatic impact social intelligence will have on the establishment and promotion of its comprehensive satellite clinic and need for qualified medical staff. Healthcare IT is essential for today’s potential clinicians – they do not wish to work in facilities that do not offer the technological tools on which they have been trained, including social media mechanisms (Mareck, 2011; CareTechTV, 2012). For example, the hospital should update its website and also create Twitter and Facebook accounts that routinely advertise open positions in both its hospital and new satellite clinic as well as tout its positive impact on the community (Wipro Healthcare, 2010; Slagle, 2013). Not only should PMH actively promote its own online presence, but must also vigorously pursue and examine others’ in the search for potential employees. Connecting with area medical schools is a great place to start, and PMH must set up online advertising agreements with these schools that actively promote positions within its facilities (Rural Assistance Center, 2015). Publicizing attractive assets and perks such as competitive salaries, benefits, investment or retirement plans, and student loan repayments and forgiveness are sure to draw more potential recruits (Slagle, 2013). PMH can also reach out to more distant medical schools that specialize in rural medicine and offer special relocation packages, spousal employment, low-interest mortgage and affordable rent, and signing bonuses to those students willing to move to Pocahontas County (Kolu & Parsons, 1993; Lake, 2014; Wipro Healthcare, 2010). Education, Advocacy, and Feedback Since the passage of the Affordable Care Act (ACA), healthcare facilities have an obligation and a responsibility to promote preventive care services and recommendations for their patients and the general community. Social media and online websites provide an excellent platform by which hospitals like PMH can medically educate its community, offer suggestions for healthy choices and improving general wellbeing, and provide imperative and specialized material about chronic conditions, illnesses, and treatments, empowering patients to advocate for their own health and care journeys (Kash, Spaulding, Johnson, Gamm, & Hulefeld, 2014). Social media tools are perfect for the education of both patients and healthcare employees: physicians and other clinical staff provide important medical information in a general format for current and potential patients, and patients provide meaningful and relevant feedback to staff and organizations. In this way, patients and employees assist and teach each other about essential factors for both personal and organizational success. Educating patients about the benefits of preventive health and offering them the opportunity to provide important feedback is paramount to any healthcare facility. Utilizing online forums that permit inquiries, educate about campaigns designed to combat communicable diseases, highlight hospital strengths, offer workable solutions and suggestions for positive change, and provide chances for consumers to complete questionnaires, reviews, and surveys that compile patient satisfaction scores assists PMH through the full planning, working, and assessment phases of its full range of care services – for the hospital and its new clinic. Educating and interacting with patients sends the message that they are important and valuable to PMH (Kash, Spaulding, Johnson, Gamm, & Hulefeld, 2014). Further interaction with patients and the general community can include the use of inquiry forms, blogs, and even real-time responses from staff. Patients can email their doctors, consult with nurses (such as the Ask-a-Nurse or NurseWise programs), or offer important data about the effectiveness of their negative or positive recovery and treatment efforts as well as their side effects (New Hampshire Healthy Families, 2015; Kash, Spaulding, Johnson, Gamm, & Hulefeld, 2014). All of these methods lead up to saving quite a bit of money and time, since patients can ask about concerns before visiting the ER or their physician’s office, making uninformed decisions about their lifestyle choices or treatment plans, or even find they should visit the ER in times they may not realize their health is in jeopardy (Kash, Spaulding, Johnson, Gamm, & Hulefeld, 2014; Thornlow, 2008). For example, a patient may log into his physician’s online question forum, asking a nurse about severe indigestion. When prompted to list his full range of symptoms, the nurse realizes this patient may be having a heart attack, and strongly suggests he visit the ER immediately. He arrives and is diagnosed as having a mild heart attack; he is put on an appropriate care plan immediately, and makes a full recovery. Had he not consulted with this nurse in real time, this patient may not have even realized he was in any danger, would not have gone to the ER, therefore leading to future, more critical medical issues, and costing more in care services – or even funeral arrangements. Online services also allow patients to keep track of their own medical history, make and change appointments, pay outstanding bills and copays, and search for more affordable laboratory and surgical procedures outside of PMH’s capabilities (Kash, Spaulding, Johnson, Gamm, & Hulefeld, 2014). Finally, not only can a strong online presence educate and provide resources for the people of Pocahontas County, it can provide the same for its employees and potential candidates. PMH will be able to effectively collaborate and consult with other hospitals and physicians on the latest research, methods, treatments and services and encourage peer discourse. This approach provides its clinicians with a wealth of information to assist them professionally and helps PMH offer the best possible, high-quality, innovative care and health recommendations to its patients and the community (Thornlow, 2008; Li, Talaei-Khoei, Seale, Ray, & MacIntyre, 2013).
• #16: Strategic Initiatives and Financial Management The planning and implementation of strategic initiatives in regards to financial management is incredibly useful for the guidance of any healthcare organization. Pocahontas Memorial Hospital (PMH) must use relevant planning methods that match its rural placement, patient and community needs, plans for building a comprehensive satellite clinic, and the recruitment and retention of healthcare personnel. The process of strategic planning for appropriate financial management should be systematic, logical, comprehensive, holistic, and follow a set procedure that considers and prioritizes both short and long-term goals and objectives. This will permit a healthcare facility like PMH to target meaningful and enduring organizational change and transformation for the success of both its hospital and new satellite clinic. Varied Strategies Many rural hospitals struggle with financial management. PMH is no different – however, there are strategic initiatives that will facilitate success and solvency for both the hospital as well as its comprehensive satellite clinic. By consulting with experts in the field of small, rural hospital and clinical management, PMH can learn a great deal about what is working for other similar organizations. PMH should utilize a variety of different strategies to tackle financial issues head on, therefore cutting unnecessary medical costs, containing necessary financial responsibilities, and increasing revenue. Daniel Griess, CEO of Box Butte General Hospital in Nebraska, is one such expert from whom PMH can learn. According to Griess, hospitals like PMH must make a concerted effort towards controlling patient volume and expenses by keeping its chargemaster up to date, a list that outlines the official hospital charging rate for services, procedures, and products; following all regulations and standards; creating a strategy for recruiting and retaining employees; training all staff in efficiency and cost control; keeping a firm payer mix; and seeking out banks to assist patients in making proper payments (Burns, 2014; Gapenski & Pink, 2003). Chargemaster Review PMH must first determine whether its current list of rates is both appropriate and current. Once this has been established, the chargemaster for both the hospital and the satellite clinic must be reviewed on a regularly scheduled basis, such as once a year. Creating and maintaining a comprehensive and relevant chargemaster should be done through careful analysis and consideration of Pocahontas County’s statistics, specifically, its high poverty rate, lower health insurance coverage, Medicare and Medicaid coverage, and self-pay patients (Burns, 2014). Regulations Faced with significant challenges in regards to the Affordable Care Act (ACA), PMH will need to ready itself for continuing changes as policymakers reform healthcare coverage for all Americans (Kash, Spaulding, Johnson, Gamm, & Hulefeld, 2014). The ACA now requires all U.S. citizens to be insured, which will have a substantial effect on PMH’s costs and revenue. Under its Medicaid eligibility expansion, the ACA is mandating that individuals will have government coverage and will be offering subsidies to facilitate the purchasing of policies through a public exchange (James, Gellad, & Primack, 2014). This healthcare coverage makes seeing a physician or specialist more affordable for each patient since a third party will pay for the patient’s care and services. Therefore, PMH will see a vast increase in revenue through these reimbursements, as well as a reduction in the number of non-paying consumers. In order to properly prepare for this influx of third party payments, PMH must hire more employees to remain in compliance with payers’ standards. One example includes how the ACA has established numerous standards through the Physician Quality Reporting Initiative (PQRI). In order to quality for and receive Medicare reimbursements, hospitals must meet these 138 standards. If even one standard is not met, reimbursement amounts may be reduced or even denied (James, Gellad, & Primack, 2014). In this way, regulations can prove to provide significant challenges for PMH, since the hospital will need a large amount of resources to meet compliance standards. This could put a financial strain on PMH as well as command sharp increases in staff effort and time. Therefore, in order for PMH to meet ACA regulations, there must be a strategic plan in place for the recruitment, retention, and training of clinical and administrative staff to help ease the transition (Gapenski & Pink, 2003). Recruitment, Retention and Training Proactive strategies are crucial to the recruitment and retention of rural healthcare employees. Offering the latest technological tools, encouraging community participation, and making good use of outreach and relationship strategies entices vital medical employees. A sincere effort to get to know potential candidates and medical students as well as offer organizational perspectives on PMH’s goals fosters genuine relationships, promotes the hospital’s strengths, and provides a way by which others can help to eliminate PMH’s weaknesses and provide patients better care. New recruits will demand current Health IT to ensure the safety and highest quality of care for their patients (CareTechTV, 2012). Therefore, PMH must first secure the financing to purchase, implement, and maintain appropriate and current medical technologies, such as telehealth tools and electronic health record (EHR) software. PMH must then positively act to promote, launch, and train staff on these latest technological upgrades and initiatives. Since PMH’s relationship with its community is strong, input and involvement in financial assistance through fundraisers – particularly from those in the market it would serve, the northern area – would be welcome. However, it is well known that most members of the community struggle financially, so PMH must immediately apply for funding from the Health Information Technology for Economic and Clinical Health (HITECH) Act. This will encourage, secure, and further support Health IT development, training, and maintenance (HealthIT.gov, 2014; Li, Talaei-Khoei, Seale, Ray, & MacIntyre, 2013; Mareck, 2011; Schaeffer, 2014). Bank Partnerships In order to assist patients who pay for services out-of-pocket, PMH could partner with a local bank in Pocahontas County that would set up a system by which they could pay for their care in installments. The downside is that PMH would have to guarantee the loans; should patients default, the hospital would be forced to repay the bank (Burns, 2014). However, patients of PMH and community members value the hospital – with some of the highest customer service ratings around as well as a strong, positive relationship with the people of Pocahontas County, PMH should anticipate only a very small percentage of patients who would default (Pocahontas Memorial Hospital, 2013). Corporate Alliance As a last resort, should PMH not be able to afford some of its implementations and investments, a corporate alliance may offer some great benefits without the worry of losing autonomy. Some examples of corporate alliances include industry trade groups (less binding, fewer benefits), and hospital alliances (more binding, greater benefits). Alliances could provide PMH with purchasing power, leased equipment, data management, capital acquisition, marketing tools and services, and a more comprehensive range of healthcare for its patients (Gapenski & Pink, 2003). Best Choice: Lean Healthcare Approach Lean Healthcare is a strategic plan to reduce costs, eliminate waste, improve work and patient flow, and improve a hospital’s morale, productivity, and bottom line. By integrating human resource development, organizational transformation, and aligning the overall strategy, culture and execution of a healthcare facility, Lean works without utilizing mindless tools and reducing staff. This patient-focused strategy works especially well for rural hospitals, due to its altruistic focus on their patients: patients are highly valued. These consumers determine the value of services, therefore, demand comes directly from their healthcare needs. Lean also incorporates many of the previously mentioned strategies into one, streamlined program that is easy to use, administration and employee-friendly, and produces actual, documented results (Roberts, 2013). PMH should employ the Lean Healthcare approach, which will permit the hospital to determine its valued work against that which is non-valued, giving it the opportunity to truly prioritize its goals. For example, where are the sources of waste? One answer: the overuse of the emergency room (ER). By approaching this from a patient’s perspective, how could PMH begin to reduce this waste issue yet still bring the utmost value to its patients’ care needs? Once PMH comes to the realization that wasting resources, money, and patient’s time also wastes employee skill and efforts, it can begin to provide meaningful solutions that reduce and eliminate mistakes and errors, waiting times and delays, busy work that provides no real value, overproduction and excess materials, the needless transporting of both patients and supplies, and unnecessary services that do not add value to its patients perspectives (Roberts, 2013). Tools for the Lean strategy include elements such as the standardization of protocols, value stream mapping, visual management, 5S Process (sort, set, shine, standardize, and sustain), A3 Thinking and Problem Solving, Kanban (Pull System), and Poka-Yoke (Error Proofing). Lean works at utilizing best practices through an individual organization’s perspective and circumstances, therefore providing a flexible, hospital-specific system that can actually be used – not a one-size-fits-all (that does not really fit) program. The Lean Healthcare strategy for financial management and organizational success is not a quick fix, nor is it an easy out. Yet, PMH has the drive and initiative to put such a strategy to work. As Roberts (2013) stated, Lean assists rural hospitals like PMH with “building a new healthcare system... with the ultimate goal to establish a new culture” (slide 15).
• #17: Summary This feasibility study explored and assessed the establishment of a comprehensive satellite clinic for PMH. This study found that, in order for the hospital to remain competitive, serve the people of Pocahontas County properly, and maintain its market share, a clinic should be opened in the northern area of the county. Internal and external barriers and challenges were evaluated, and both market and SWOT analyses were conducted. This study recommends that PMH should utilize appropriate strategic initiatives – specifically, the Lean Strategy – to develop new mission and vision statements that accurately reflect its new goal and intentions, improve the recruitment and retention of clinical and administrative staff in both its hospital and clinic, initiate an upgrade and investment in medical technologies to bring PMH into the 21st century, embark on partnerships with area medical schools, and harness the power and impact of social networking and media. Should PMH follow through with these recommendations, the success of its organization and establishment of a new clinic is inevitable.
• #18: Thank you very much for reviewing this presentation.