MHA 624 Week 6 Final Paper
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Executive Summary Ashford General Hospital has been face
with a nursing shortage due to retirement, low retention rates, nurses feeling
exhausted and overworked. This nursing shortage is not only affecting Ashford
General Hospital, it is also affecting many hospitals within the United States.
Nursing shortages has not only affected the safety of the nurses that are being
overworked, the shortage has also affected patient satisfaction which could
potentially cause a financial burden for the organization as well as human
resource issues. In order to doctor this nursing shortage and possible future
crisis, a proposal for change has to be implemented immediately. Ashford
General Hospital leadership and stakeholders have to put together this
strategic plan that would provide patient with good quality care by addressing
the nursing shortage. This will be done by joining forces with nursing colleges
and universities which will provide the organization with nursing student
support for exchange for training/ education by experienced professionals as
well as the commitment to work for the organization upon graduation. This
strategy have been successful at five other hospital, however three of the
hospitals are located within the Bay area of California such as John Muir
Medical Center in Walnut Creek, Washington Hospital and Eden Medical Center in
Castro Valley.
In addition to satisfying the nursing shortage and patient
care, the new strategies will also give the hospital more of an opportunity to
become more diverse, ethically and culturally which will impact and benefit not
only the organization but it will benefit the patients as well as the
community. Ashford General Hospital newly implemented plan will also provide
support management which will assist the staff and leadership with
understanding the mission and vision of the organization as well as how
understanding how these changes will benefit the hospital, staff and patients.
Leadership will also provide viable information which will generate into monthly
reports that will show the growth of the organization as well as short comings
throughout this process and will allow direction on adjustments if needed as a
way to fully manage the operations, finance and business of Ashford General
Hospital.
Introduction
Many hospitals within the United States including Ashford
General Hospital are facing challenges with the Staffing of nursing and nursing
shortages that continue to increase. According to John Hopkins of Nursing, this
nursing shortage has become a global issue (Walker,2010). There are many
stakeholders that are affected by the nursing shortage, such as the nurses,
patients, physicians, administrators, as well as the insurance companies. This
major nursing shortage stem from thousands of baby boomers that have retired,
will retire, younger nurses leaving due to being overworked, stress and
becoming burned out (Cook,2015).This can result in higher mortality rates,
increased nurse burn-out rates, increased medical errors, higher readmission
rates as well as negligence and malpractice lawsuits (American Association of
College of Nursing, 2014).
In addition patients’ dissatisfaction as well as employee
dissatisfaction can lead to the organization experiencing financial strain.
When patients are not satisfied with their care, they may feel that they are
not receiving the best quality of care; which ultimately can lead them to other
health care organizations as well as dissatisfied staff. The importance of
Ashford General Hospital new proposal is vital to the growth and success of the
organization. Therefore through new leadership, support management,
communication and motivation, Ashford will use resources to implement changes
throughout its system. This proposal will discuss the solutions that have been
implemented at five hospitals within the United Stated that can assist with thesame
issues that Ashford General Hospital is currently experiencing in order to
increase nursing staff, improve patient satisfaction and increase support
management throughout the organization.
Current Issues Ashford General Hospital is Experiencing
Ashford General Hospital has been experiencing a nursing
shortage, therefore to resolve this shortage issue and prevent further nursing
staffing issues in the future; Ashford General Hospital has turned to other
organizations that have once experienced these same problems for guidance to
resolve this matter. However before our Ashford's leadership team can began to
correct the issue of the nursing shortage, the problem had to be completely
dissected by doing so the hospital administration leadership first began by
utilizing the classical analytical problem solving method which involves
defining the problem, generating alternative solutions, evaluating
alternatives, implementing and following up on solutions as well as obtaining
and providing feedback (Frates,2014).
Ashford General Hospital leadership teams have been aware of
the increasingly nursing shortage for sometime but were unsure on how to
effectively address the situation. However as the new Chief Executive Officer,
I have put together two teams to aid in addressing the nursing shortage among
other issues that have arisen due to the shortage. The first team consists of
leadership, hospital executives, administration, physicians and nurses which
will assist with help analyze the current state of the organization as well as
assist with the new strategic plan. The other team will consist of human
resources, finance department, marketing, quality assurance, patient safety and
patient advocacy. With the assistance of all of these stakeholders, it was
found that 70% of the nursing staff was heading forwards retirement and nursing
burn-out rates were sky rocketing which has caused financial hardship for Ashford
General Hospital due to increasing leave of absence and vacations. This has
caused the organization to spend excess dollars paying out for disability,
vacation as well as paying short term workers and registry in order to fulfill
needs while staff is away on leave.
Describe Solutions Implemented at other Hospitals Facing the
Same Issues
As previously mentioned the nursing shortages are not
uncommon in the United States during this time of the changing faces of health
care. Ashford’s marketing team and executive teams have researched hospitals
around the United States and found several of the same issues that were
resolved with many different strategies. Ashland Healthcare Center in Wichita
Kansas experienced a nursing shortage as well as a severe shortage of qualified
health care physicians, small staff, heavier workloads and less pay in this rural
area (Szabo,2011). Although Ashland Healthcare Center is located in a small
rural area, this organization was able to resolve the shortage issue with using
resources to bring other willing professional that were looking for a change.
Because it has been identified that rural areas are a historically struggle to
recruit and retain well trained health professionals, the Ashland Health care
Center proactively outsource and reach out to professionals in other states
that are looking to relocate and work in rural areas in order to resolve the
shortage of nurses and other professionals (Szabo,2011).
The other organizations found to have these same issues are
located in the Bay area just as Ashford General Hospital. These organizations
include John Muir Medical Center, Washington Hospital and Eden Medical Center.
John Muir Medical Center in Walnut Creek, Washington Hospital and Eden Medical
Center in Castro Valley implemented this strategy as a solution to their
nursing shortage. These three hospitals in the California Bay area have been
successful bypairing the new student nurses with a nurse manager who serves as
the new nurses mentor and coach, guiding, directing, and supervising the new
nurse within a designated unit (Childers,2015). The collaboration between the
hospitals and schools helped to fulfill the need of the increasing nursing
shortage as well as provide new nursing graduates with support and additional
training in a complex clinical environment, which resulted in an increased
nurse’s retention rate of 75 %( Childers,2015).
Making Changes within an organization to address issues such
as nursing shortages and patient satisfaction also involves the organization
contribution to the community (Frates,2014).This mandate for nonprofit
hospitals to justify their exemption from corporate income and property taxes
is a public relations opportunity in disguise because it allows hospitals to be
explicit about how fulfilling their mission benefits their community
(Frates,2014).Cheyenne Regional Medical Center in Wyoming experienced a nursing
shortage, but in order to remedy the shortage residency programs were offered
to nursing students. The Cheyenne Regional Medical Center hired new college
graduates, reached out to the foreign nursing programs such as the Filipino nursing
programs as well as encourages the Licensed Practical Nurses on staff to earn
their nursing degrees in return of the medical center contribution of $5,000
per year (Orr,2015). The above mentioned efforts provide insight on the
importance of upholding their mission to provide the best care to the
stakeholders (patients and workers) and community.
Describe Two Solutions That Are The Most Viable to Ashford
General Hospital to Implement Within The Next Two Years:
Leaders can impact the capacity to foster change and
innovation, and the role of first level leaders- those who supervise
effectiveness (Aarons,Ehrhart,Farahnak&Hurlburt, 2015). Therefore Ashford
General Hospital will began to close the huge gap of the nursing shortage by
implementing a education assistance program that would allow nursing students
and graduates an opportunity to receive education funding and clinical training
in return for a commit to work for the organization. Ashford General Hospital
will began to close the gap of the nursing shortage by joining forces with
nursing schools and universities as an incentive to offer top notch clinical
training from experienced nurses in return for the new nursing graduates to
commit to working for the organization. This will provide top quality hands on
training, education, and help boost the confidence of new nurses in training by
combining clinical experience with classroom experience which will aid in
decreasing the nurse burn-out rates. Ashford General Hospital will also
implement quality improvement to ensure that the new strategizing to fill the
nursing shortage is providing the organization with the support needed to
address patient satisfaction, patient safety and the organizations finances.
The quality improvement will support the administrators and leaders to ensure
that Ashford General Hospital is financially able to continue to expand on
their collaboration efforts with nursing schools and universities as well as
offer tuition assistance to nurses that commitment to working for the organization.
Quality improvement is will address patient care and safety prior to problems
occurring as well as providing a guide that would essentially assist the top
leaders of the organization from a business and financial stand point. Quality
improvement will provide an opportunity for Ashford’s administrators and
leaders to expand services where it may be needed and remove services that are
not needed in order to improve the quality of care and properly allot funds for
services. The organization will utilize this method to enhance the
effectiveness of intervention strategies by providing professional development,
clinical documentation, risk management, patient safety as well as quality
improvement (Frates,2014). By implementing quality improvement it will assist
will closing the nurse shortage gaps, bringing on new nurses to educate and
hire them will all aid in increasing the patient satisfaction scores as well as
preventing patient safety mishaps. Lastly improving communication by
effectively communicating, properly documenting, providing feedback to staff
and teaching the proper protocols to patient safety, encourage and motivated
staff to help provide quality patient care. “Motivation is influenced by the
value of the reward and expected probability of the effort resulting in the
reward which encourage employees to performance higher and take pride in their
work” (Frates, 2014).
Stakeholder Analysis:
As part of the new plan that is beginning proposed at
Ashford General Hospital to help remedy the current issues that the
organization is faced with, it is recognized that the stakeholder’s involvement
is very importance. Stakeholders attributes include power, legitimacy, urgency,
interest, influence, resistance and feedback among multiple stakeholders (Yip,Phaal&
Probert,2014). Therefore both internal, external and interface stakeholders
will be part of the collaboration throughout the new plan. The internal
stakeholders will include the executives, managers, administrative leaders,
physicians and the director of nursing. The interface and external stakeholders
will consist of human resources, finance department, marketing, quality
assurance a, patient advocacy and community organizations such as local nursing
colleges and universities with in the Bay area. Both stakeholder groups is an
important part of the strategic
planning process, which is especially useful in generating
knowledge of relevant individuals, groups, and organizations in order to
understand their interests, agendas, interrelationships, resources and
vulnerabilities (Frates,2014). Because many people will be impacted by the
dynamics of change at Ashford General Hospital, the organization will carefully
and diligently work with both stakeholder groups while implementing this
change.
There are many questions that must be considered when
implementing changes to an healthcare organization such as, who is impacted,
what change processes may be required, what fiscal impact would occur and will
there be any ethical, legal, and diversity risk factors involved with the new
Ashford General Hospital plan. This current nursing shortage is currently
impacting the existing nurses on staff and other personnel at Ashford Hospital,
by having to work a heavier duty load and longer hours in order to get the
required work done which is causing them to fall short on patient care. The
patients are being impacted do to the hospital short comings on the nursing
staff as well as the quality of care. This issue can result in patient safety
mishaps, negligence as well as possible fatalities which will further put the
organization in turmoil with possible lawsuits. In order to reassure patient
safety as well as nursing safety needs and manpower, the current process must
be revised.
This change requires all stakeholders within the
organization to come together and implement education assistance programs
specifically in the nursing field for those who are looking to advance their
careers and become nurses. However, this incentive is attached to a promise and
committed to those in the program to dedicate at least four years with the
organization as working nurses. Another change would be to join forces with
surrounding nursing schools so that students can receive clinical training as
well as classroom education as another incentive to assist with closing the
nursing shortage gap. Lastly, the organization will strengthen the quality
assurance process as well as patient advocacy in order to ensure that patient
safety is put at the top priority which is in line with the mission and vision
of Ashford General Hospital.
What Fiscal Impact Would Occur and What Are The Ethical,
Legal, and Diversity Risk Factors Involved?
The current issues with the shortage are creating fiscal
impact because of the increased personnel costs due to a lack of nursing
stability. The fact that Ashford General Hospital has resulted to utilizing per
diem and traveling nurses to fulfill the short term nursing needs in order to
fill in staffing shortages has created fiscal concerns. By utilizing traveling
nurses, this have not only began to affect the finances of the organization but
has also created ethical concerns to patient care. Outsourcing created
conflicts of interest between organizational concerns for fiscal soundness and
professional ethical commitments to patient care and the patient welfare (
Bristol,2005). These are examples of why implementing a new strategic plan to
revamp the nursing shortage would benefit the organization as a whole. Also by
becoming a learning/teaching organization this will allow everyone to be more
cautious, conscious and accountable for delivering the best quality care. This
will also decrease and prevent lawsuits, malpractices and workers compensation
because of nurse’s injuries due to overworking and taking on heavier patient loads.
However by implementing the new plan this will allow risk
factors and early indicators to mobilize ethics consultations and earl
interventions which would prevent conflicts and enhance quality of care
(Pavlish,Brown-Saltzman,Hersh,Shirk,Nudelman, &Olga, 2011). This new plan
will positively affect the finances of Ashford General Hospital. This will
increase the patient population due to high patient satisfaction, increased
qualified and stable nursing staff as well as increased funding provided by
communities for education funding. This new plan will prevent the increased
utilization of outsourcing in healthcare which poses a variety of ethical and
strategic problems by the growing use of per diem contract
"paragraph" to provide patient care services in place of the
hospital's regular healthcare team, whose salaries and
benefits often represent significant portions of institutional budgets
(Bristol,2005).
Conclusion
Ashford General Hospital is faced with the challenge of
nursing shortages that continue to have increased over many years and will
continue to increase as baby boomers retire. This can result in higher
mortality rates, increased nurse burn-out rates, increased medical errors,
higher readmission rates as well as negligence and malpractice lawsuits
(American Association of College of Nursing, 2014). Therefore in order for
Ashford General Hospital to begin to close the gap of the nursing shortage, the
organization has turned to many hospitals within the United States for
guidance.
They helped with this growing issue such as providing
tuition reimbursement in return for the new nursing graduates commitment to
work at Ashford General Hospital, collaborating with nursing colleges and
universities in order to allow hands on training as well as classroom
assistance and lastly, provide professional development for staff members that
are looking to earn a degree in nursing. These new strategies will not only
assist with the nursing shortage but it will provide quality improvement,
quality assurance, improve patient satisfaction scores and patient safety
improvements.
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