Essay on "Healthcare on Budget"

Essay 10 pages (3442 words) Sources: 16

[EXCERPT] . . . .

Hui & Ma et.al (2014) have showed that the quality of care and survival rates are not affected. Therefore, it is a quite sensible approach to spend on creating nurse led wards instead of creating acute patients beds in the hospital.

We are basically trying to promote the idea of a nurse led ward in order to reduce the problems that are being faced by the Hospital Authority. Researchers have shown that nurse led wards really do go on to improve nursing care. The nurses address this issue in a very timely and a proactive manner. They make their own goals and discuss their plan with the leaders and ultimately act upon it. This sort of method goes on to enhance the quality of care and effective communication between the patients and the nurses. Therefore, this denotes another benefit that this proposal would offer (Catangui & Slark, 2012)

How will services be managed?

The services will be managed by the adequate training of the nurses and the HCAs. As stated above, the doctors will be making alternative rounds to the nurse led wards. This means that the doctors will still be in charge of the wards. Therefore, there should not be any problems in the service of the quality of health care that would be delivered.

Financial Implications

Salary of a Doctor: $56,440 / month

Salary of a Registered Nurse: $26,960

Expenditure of one Acute Bed: $4,680

Fee of A & E: $990

It is known that being on the front line the nurses would not very comfortable with taking the rounds and providing a change of service. As mentioned be

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fore, chronic care involves majority of the interventions by the nurses and the hospital care assistants (Wagner, 2000; Frich, 2003) Keeping this in mind, there is a more severe need for nurses or hospital care assistants (HCAs) as opposed to doctors. The nurses that will be hired, they need to be trained to carry out the tasks that are the most needed in these settings.

Lastly, it should be noted that majority of the patients who are admitted in these wards should be monitored for their wounds (Kollef et.al, 1999) Seeing how most of these patents are bed bound, the nurses constantly need to take special note of their eating and their changing requirements. Even though many patients do have attendants with them, they still to be monitored by the nurses. The main focus therefore is on the nurses and this clearly demonstrates that there is need for trained nurses or trained HCAs.

The major initiative for a nurse led ward is present mainly because the idea is that already present nurses should be trained. These nurses should be well trained to take the rounds and implement care. The treatment protocol is not complicated and they basically have to follow the orders that have been placed by the doctors. This shows that the doctors can therefore take alternative rounds in the two nurses led wards. These patients are more in need of HCAs and trained nurses as opposed to doctors that are highly trained. Therefore, the main idea is to ensure that the nurses will be able to take control and properly look over the new nurse led ward.

The expenditure of one acute bed per day is around 5000 dollars and if that is multiplied by a whole month, that totals up to quite a large amount. It would not make sense to add more beds when the doctors are already overworked. Considering that one of the doctors did resign, there is a need for one more doctor. However, if one pair of the wards were completely changed into a nurse led wards, the need of the doctor would not be present anymore. This would therefore not only add further costs on the hospital but it would also alleviate the shortage of labor stress that is currently present.

Furthermore, there is a lot of upcoming cost for the dressing materials and heel protectors. If we were to add on more acute patient beds, we would require new furniture and new equipment. Every bed does need to have adequate machinery in order for it be used for the patient. This again highlights the fact that we would be much better off with the transition to a nurse led ward. Furthermore, the dressing materials and heel protectors are actually needed for majority of the bed bound patients. Seeing, as this is something that the hospital does need, it would be not considered extra spending. The presence of these things would enable the doctors to shift patients into nurse led wards. Ultimately, that would reduce the number of occupied beds and further reduce the stress that is present.

Another thing that need to be considered is the cost of training. The training that is held would go onto teach and train a large number of HCAs and nurses at the same time. This therefore shows that training itself would be beneficial because it would work in favor of our proposal to create a nurse led ward.

Association of stakeholders to proposal

The changes that have been implemented would improve the quality of care that the hospital provides. Economically, it is noted that this proposal would therefore also go on to reduce the hospital stay of the patients. It has been proved that the patients were satisfied with their overall experience on the nurse led ward (Williamson et.al, 2006) They rates their experience between excellent and satisfactory. This can go on to increase the overall profit that the hospital makes which would therefore attract more stakeholders.

Risks of the proposal

There are many risks involved in this proposal. As mentioned earlier, the nurses and the HCAs have to be trained in the proper way. They need to be aware of the responsibility that they have. Seeing how these wards will not be checked upon regularly by doctors, the nurses need to develop their own sense of leadership and responsibility. A possible risk of this proposal is that the nurses and HCAs don't accept the responsibility in the right way. Mistakes made by the personnel can provide results that counteract the efforts required in the entire proposal. The entire hospital team is hoping to improve the delivery of health care. However, errors made by the nursing staff could put increased pressure on the doctors and on the administration.

Another major risk involved in the implementation of this proposal is that of increased cost. A study carried out in Britain revealed that acute hospitals are not cost effective settings for nurse led intermediate care (Walsh et.al, 2005) Even though our scenario is quite different, it does raise questions about the costs of nurse led wards in our settings.

Targets and performance indicators

Certain performance indicators can be the overall cost of this change and the differences in total cost before and after the change. Furthermore, the length of hospital stay is also a reliable indicator for depicting that targets have been achieved or not.

Consequences if proposal is not implemented

The proposal is aiming to enhance the quality of service and decrease the workload on the employees in the hospital. There are many different consequences that can result if this proposal is not implemented. First and foremost, it should be seen that the hospital staff is short of one doctor. The shortage of doctors puts a strain not only on the physicians but also on the nursing staff as well. Hospitals, whether they deal with acute or post-acute medical care, should focus on improving the quality of health care in the entire country. The general outpatient clinic quota should improve so that people do not have to be turned away only because of the shortage of beds. If this proposal is not applied, it can result in increased workload. This would mean increased waiting time for the patients. It can also lead to more stress in the employees and more hospital errors made by the staff.

Alternative options

As mentioned before, there was the alternative choice of having two extra acute beds because of the congestion of the acute hospital. This would require for the hospital to close off one ward.

Opportunity Cost

The cessation of one ward would mean that the workload on the doctors and the nurses would increase. This is because it is likely that the number of beds per wards are increased. As it is stated above, the cost of acute bed in the Shatin hospital is quite expensive. The doctors and the nurses are trained and routinely used to caring for the chronically ill. The presence of acute hospital patients would not only increase the stress load it calls for extra training and treatment protocol. Seeing how these patients do present with acute symptoms, it be likely that more doctors are required that have that sort of training. Keeping this in mind, this alternative choice is not being considered. This is because adding acute beds will not… READ MORE

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Quoted Instructions for "Healthcare on Budget" Assignment:

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Marking criteria:

1. Introduction (10/60) ? Budget presentation on appropriate template (3) ? Budget period clearly stated(2) ? Describes setting in which budget is to be applied (5) 2 Budget (45/60) ? Budget is detailed and correct (30) ? Alternative options using opportunity cost analysis are discussed (10) ? Document shows sources of data used for forecasting expenditure (5) 3 Presentation (5/60) ? Uses correct grammer, spelling & punctuation ? Correct application of APA used for in-text citation and for the reference list

Details Develop a budget for a project, ward, unit or service using a budget template (you may use one from your own organization), in an environment of scarce resources. Consider alternative options using opportunity cost analysis. Annotate the document to show the sources of data used for forecasting the expenditure for the budget period.

I am working in a rehabilitation hospital (Shatin Hospital), which is run by the Hospital Authority, the main provider of public health care in Hong Kong. There is increasing of hospital service demand in HK, due to aging population, lack of hospital bed, shortage of manpower etc. Moreover, the rehabilitation hospital works with a regional acute hospital as a partner in the same territory. The patients will be transferred from the acute hospital and the acute hospital always asks for more bed from my hospital due to their bed crisis. However, Shatin hospital also faces the insufficient manpower and one doctor resigned recently. The opportunity cost for add two extra beds to each wards may not be succed. Therefore, I would like to propose the project to reform one pair of medical and geriatric wards to nurse-led wards.

Background: Each ward: 25 beds. There are 5 female wards and 5 male wards in M&G department. Each pair of wards has one ward manager, each wards has one doctor, one advance practice nurse and 9 nurses (RN & EN). The aim of the nurse-led ward to manage chronic health problem, chronic wound care, feeding management and end-of-life care. Financial implications? Salary of doctor: $56,440/month, registered nurse: $26,960 and 43,383, The expenditure of one acute bed: $4,680 per day, the fee of A&E is $990 Due to front line nurses are not confident on nurse round and service change, the training sessions need to provide for nurses. The cost for manpower is same, and it is needed to buy more heel protectors and dressing materials, because there are more patients are bedbound, and the patients who need more wound care. . Different headings For the assignment( suggested by lecturer) 1) Proposal title ? Hospital/department/ward/clinic ? Project description ? Location(s) of works, if applicable 2) Justifications for change a)Justification such as(the following list is not exhaustive) ? What is the service need- and why? ? What are the issues that impact on this need: issues like population growth, change in demographics, in social characteristics, in technology, in public expectation and others may be explored ? What is wrong in the existing practice that needs intervention? ? What changes need to be managed to make the service function well? ? What may happen if the proposal is not implemented? ? How will the proposal change the situation? ? What government policy issues does the proposal address? ? What are the dey anticipated benefits? ? Who benefits? How? When? ? How will the service be managed? ? How are the stakeholders engaged with the proposal? ? Have other agencies that are involved agreed to the proposal? ? The key risks associated with the current proposal. What is the impact of these risks? ? Include statistics, if available b) Targets and performance indicator ? Please express the above in a specific, measurable, achievable, relevant and timely manner, e.g. KPI c) Implications if the initiative is not implemented in the coming year and the years following d) what are the alternatives you have considered? e) alternatives explored to re-deploy existing resources 3) Financial implications A. Capital costs, e.g. ? construction, refurbishment, alteration, e.g. scope of works, work programme, cash flow, ? engineering equipment/medical equipment/furniture (F&E) - F&E descriptions and quantities - Justifications, eg consequences of the non-availability of the proposed equipment, mission critical to clinical service - Medical equipment/Furniture If new, please provide evidence-based supporting information e.g. an extract of a professional journal. If additional, please specify the existing equipment quantities, their annual utilization rates, patient caseload per year, any backup arrangements, etc. Cash flow. B. Recurrent costs - Staff training costs, if any - Cash flow - Other consumable costs, C. Fees and income, e.g. suggest fees to the management D. Appendices Please include as appendices all calculations, tables and other evidence needed to support your proposal

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