The impact of Business Practices, Regulatory Requirements and, Reimbursement on patient centered


  • The impact of Business Practices, Regulatory Requirements and, Reimbursement on patient centered care

Patient centered care (PCC) has received significant attention in the USA, following the Institute of Medicine (IOM) publication, “Crossing the Quality Chasm.” From thereon, business, regulatory bodies and health care practitioners have integrated patient centered care approaches as integral practice for the provision of quality care (Johnson et al., 2008). To begin with, the government which is the regulatory body enacted the Affordable Care Act which has made mandatory provisions for business that operate within the health sector (National Academy for State Health Policy, 2012). For instance, health care organizations have been mandated to adopt the Electronic Health Records and comply with the Health Information Technology for Economic and Clinical Health (HITECH) to essentially foster patient centered care. Moreover, ACA dictates that hospitals use public reporting framework, and performance payments to encourage patient centered care. The ACA was essentially passed to make health care affordable, improve insurance coverage and in so doing promote patient centered care. The center for Medicare and Medicaid Services, provide a range of fiduciary as well as private health care plans that have made insurance coverage affordable and, accessible.
Primary care systems that have adopted the patient-centered medical home (PCMH)model receive reimbursements and bonuses. A primal feature of this model is to provide comprehensive health care by partnering with patients, families, primary care providers, specialists and community support groups. Furthermore, health care organizations with Managed Care plans have a variety of incentives that promote patient centered care as well as cut on operating costs. For instance, health care givers from nonpublic institutions are reimbursed for services offed. In addition, incentives such as bonuses are given to health care givers with the least number of referrals, and also those that provide quality care at the lowest cost possible in attending to patients. Health care organizations utilize a plethora of ways from evidenced based research and practice to partnering with patient centered networks (such as the Institute of Patient- and Family-Centered Care) to improve quality care, and patient’s outcomes (Johnson, 2012).
Altogether, Mandatory policies from the government have made business organizations increasingly conscious of the need of patient centered care. Organizations related to the delivery of care are incorporating performance indicators, patient charters, accountability measures, patient feedbacks, and patient informed policies to promote patient centered care.
B). Refer to the attached PDF form
1). Valley View Hospital
Valley view hospital is a health care company that is located in Colorado. It is part of the Planettree network that primarily seeks to attain comfortable patient experience. The hospital provides holistic approach to care that integrates compassionate care, and clinical expertise. In respect to patient centered care, the hospital has been recognized by the consumer Report, as a leading caregiver in patient centered care, a recognition that recognizes patient achievement, dignity, comfort, and wellbeing.
2).Strengths and Weakness
Valley View Hospital is deeply rooted in the provision of patient centered care. The mission and vision statement clearly articulates this phenomenon. This is also replicated in almost all the major facets of the health institution. For instance, the hospital’s website highlights that patient centered care transcends also to the patient’s family.For example, the institution has in place a number of care models that are supportive of the relationships between family members, the patients and caregivers. Besides, the ups, it is difficult to comprehend the extent to which the family is involved in the day to day management of the hospitals. Until recently, literature has supported the inclusion of families during hospital round ups, and even unlimited visitation hours for them. While, there is evidence that supports the involvement of families in the advisory council, there is little information that points that policies if any that have been implemented are from family in the advisory committee. This is to however, not mean that the same is lacking, it could be that information relating to the same has not been included. Nonetheless, these are areas that be improved.
C.1). Intervention Strategy
In light of the above discussion, integrating families right from hospital round ups, volunteer options, having unlimited visitation hours to having their views integrated in the hospital’s policies seems as the best strategy to fully integrating the family (Coleman et al., 2014). An effective strategy should therefore focus on changing the behavior of the mentioned above with, the aim of; i) empowering families and patients to confidently speak up on issues related to patient centered care; (this can include training on communication skills, coaching on confidence) ii) Enable management and staff to provide resources, and avenues for patients and families to be able to contribute to matters relating to patient centered care; iii) Equip staff with the required skills to enable them to appropriately handle patients and families’ views (for example, communication skills and as cultural competency skills).
2) Managing Change; Lewin’s change Model
Empirical evidence affirms centered care has a positive effect in the delivery of health care as well as almost all major organization metrics (Sullivan, 2012). This, combined with the mandatory mandate from regulatory frameworks have forced health care organizations to consider patient centered care as an essential aspect in their business. However, incorporating new trend or bringing change is always challenging. change is mostly met with resistance out of the fear of the unknown, pay, status, skills been made obsolete, and psychological reasons such as stress and frustrations (Sullivan, 2012). A possible barrier in our case, relates to refusal of patients and family to voluntary participate, and contribute in hospital activities. On the other hand, caregivers may be hesitant to engage family and patients. Furthermore, management may also be reluctant to provide the necessary support, and resources. Lewin’s 3 step change model can be used to understand human behavior in the process of change (Pearson et al., 2005).
Lewin, proposed a three stage model; unfreezing, moving to new stage and refreezing. The unfreezing stage calls for in-depth communication using multichannel approach as it involves establishing the change process by establishing the vision and the change plan. Setting these helps in the transitioning of the systems, structures and procedures as well reduce resistance to change (Roussel, 2013). The second stage is the moving stage, in this stage, management should put the new system in place by modifying the system that exists to support the new system. Resources should be availed in this stage, communication is also key and leaders should act as the role models. The Refreezing stage is the last phase of the transition. Essentially, this stage involves consolidation of change process in line with organizational structures, culture and procedures so that change becomes embedded in the organization.
3) Financial Implications
Integrating change calls for a multidisciplinary team that needs considerable funds, time and resources. The team may require training and coaching that is expensive, time costly as well as likely to result in lowered productivity either from overworking or underworking. There may also be the need to use both financial and non-financial incentives to encourage participation of members, in terms of snacks, bonuses and the likes. Lastly, change is an ongoing process which is to mean that the organization will need to set aside, finances, resources, time, and front line employees to cultivate the needed change.
4) Evaluation
Having a behavioral connotation, then a continuous evaluation system will be adopted for this system. A questionnaire can be used to collect timely insights on the new system right from the planning stage to implementation. A qualitative and quantitative model with relevant questions such as patient satisfaction scores, questions on the involvement of patients and families, availability of resources, effective communication, collaboration, policies and so many other related questions can be adopted to measure the progress, the contribution of the system to the planned objectives plus any benefits therein. Variables similar to the institute of patient centered care can be adopted for this tool. Most importantly, the tool should be able to evaluate the system’s ability to execute a plethora of functions that support the orientation patient centered care, as well as identify and reports the faults in the system for improvements.
D). Members to be included and Roles to be played

  • Executive board- head of all the operations, will be responsible for allocating resources and setting up the strategies to be met.
  • Project Managers; plan the entire system of change, they monitor performance, set the roles and responsibilities of members
  • Management Team; Various departmental heads will be responsible for overseeing implementation of the change system
  • Clinical heads; Front line staff that interact with the system, they include nurse, physicians, lab technician, and so on. They can provide important information on the effect of the system and also point out to strategies to improve the faults.
  • Family and patients Representatives; represent the patients and families’ views and opinions.

D. (1). Multicultural Diversity
Statistics show that demographics in the USA are changing with the number of minorities set to surpass the white population in the near future (Institute for Diversity in Health Management, 2018). Out of this, there is a need to have a multidisciplinary and multicultural team of professionals to cater for the different needs of these patients. A multi-cultural team is culturally competent and equipped with the necessary skills that enable them to provide effective care. Furthermore, members of such a team can come in handy to provide translation services when needed as well as provide cultural sensitive care in the context of their culture and that of the patient. It gets better when the caregivers share a similar culture to those of the patients and families, as patients tend to be open and honest to their own (Crocker et al., 2012). Aside, from the aspect of unity, a multi diverse team is also able to identify and supplement the strengths and weaknesses in the team members and in so doing improve delivery of quality care.
D. (2). Transformational leaders
Literature on change management identify that effective leadership is perquisite for successful change system. Research in and out of health care attribute suggest that transformational leaders possess the right skills to implement change because they are concerned with transforming the objectives of the organization as well as those of the individual subordinates (Greene et al., 2012). Transformational leaders are characterized as having the following four major aspects; ability to intellectually stimulate the subordinates; ability to provide motivation, show individualized concern, and ultimately provide idealized influence on the subordinates. From this perspective, such a leader can train new learners, while also instill trust and commitment as well as professional values such as team work (Pearson et al., 2005). Accountability, responsibility and etcetera. Their ability to transform the organization is pegged on their ability to communicate the vision such as to converge organizational goals to individual goals and in so doing have a unified work environment whilst eliminating resistance to change.
D. (3). How Will the Team Work Together?
The Myers-Briggs Type Indicator (MBTI) tool can be utilized to help identify individual personalities as well as their preferred style of working. This is important as individuals have different personalities which need to complement and not contradict each other in the team setting (Pearson et al., 2005). After assessing the preferred roles, the project manager in charge will designate tasks, timelines and deliverables. Administrative members will be in charge of coordinating meeting and communication (multichannel) in alignment with the strategies. The team members will perform their tasks and provide feedback to the immediate supervisor. A pilot test can be used to collect important information on users’ needs which shall be integrated in the final system.
D. (4). Communicating the Strategy
Communication should be integrated in all facets of the change process. To begin with, communication should be initialized prior to the proposal of the system (Sullivan, 2012). This will make stakeholders understand the proposed system, and in so doing mitigate the resistance to change. Communication should be multichannel such that front line staff can disseminate the information verbally. Other avenues such as blogs, patient’s portals, social media platforms, notice boards, emails, and the likes should also be utilized for communication, and feedback. Open and honest communication should be the panacea of team meetings. Most importantly the team should align its activities in line with evidence based practice from case study and prior research. Documentation is also critical. Every aspect of the change process should be documented and communicated to all the stakeholders.
D. (5). Team Assessment
The team is assessed to measure its strengths and weakness. Assessment can take various forms; formal or informal, and also done over number of platforms such as emailing, and in person in sessions. A notable aspect in selecting an assessment tool is to align the tools to the needs and objectives of the organization. There isn’t a standard tool for measuring team effectiveness as organizational needs and objectives vary widely. Therefore, a customized team self-assessment tool can be utilized in this scenario. With this said, this study shall have a customized form of the team self-assessment tool that has a number of questions that assess team’s strength, and weakness. It was developed out of a survey that compared the practices of Berkeley team in respect to twenty-one best established practices of creative and productive teams. The model is free and comes with a worksheet that is not only simple to use but also highlights distinct practices to focus on to improve aspects such as planning, communication and coordination.
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