Category Archives: Academia

Academia, Health Care, Technology

SWOT Analysis: Day Kimball Healthcare

Day Kimball Healthcare (DKH) is a non-profit health care organization serving the northeastern Connecticut, southcentral Massachusetts and northwestern Rhode Island communities. The mission of DKH (2011) is “to meet the health needs of our community through our core values of clinical quality, customer service, fiscal responsibility and local control” (para. 4). A comprehensive health care system, DKH offers primary care and a multitude of medical and surgical specialties along with sophisticated diagnostics by offering a comprehensive network of more than 1,000 employees including more than 200 physicians, surgeons and specialists. DKH is comprised of Day Kimball Hospital, four community health care centers, Day Kimball HomeCare, Day Kimball Hospice & Palliative Care of Northeastern Connecticut, Day Kimball HomeMakers, and Physician Services of Northeast CT, LLC.

Services

DKH provides a host of services to the community, including:

  • primary medical care,

  • emergency medical care,

  • surgical care,

  • palliative and hospice care,

  • home health care, and

  • social services

DKH appears to strive towards providing a comprehensive health care solution to the community that is robust, yet limited in specialty, especially critical care, trauma, and pediatric services.

Environment

Population

The primary catchment area for DKH includes the Connecticut towns of Brooklyn, Canterbury, Eastford, Killingly, Plainfield, Pomfret, Putnam, Sterling, Thompson, and Woodstock, and the Rhode Island towns of Foster and Glocester. According to the available U.S. Census data (2010), the population served is nearly 92,000 with average growth in the last ten years of nearly 9%. The median age of the catchment population (37.8) is merely 3 months older than the median age of the Connecticut population (37.4). The median household income is $66,422 (CT: $67,034).

Competition

DKH is the primary health care provider within the defined catchment area. Some of the population, however, rely on three other community-level hospitals, Backus Hospital (Norwich, CT), Southbridge Hospital (Southbridge, MA), and Windham Hospital (Windham, CT). Additionally, some of the population with advanced disease processes rely strictly on the primary and emergency care services of the nearest urban centers (Worcester, MA, Hartford, CT, and Providence, RI), with many of DKH’s emergency patients transferred to these tertiary care centers for trauma, critical care, and pediatric specialties.

Environment

DKH, as a health care organization, can be adversely affected by patterns of infectious diseases within the community. As each season mounts, the health care system becomes overwhelmed and requires coordination between other health care facilities in the area.

Additionally, a large disaster would strain the resources of DKH; however, this would be a temporary issue, resolving as the disaster winds down. There is ample opportunity within the catchment area for a disaster to unfold, including traffic on the major highway that divides the catchment area as well as the number of large manufacturing entities in the area.

Assessment

Strengths. DKH provides comprehensive long-term health care to community members. DKH enjoys a strong and comprehensive relationship with a large network of physicians and other primary care providers.

Weaknesses. DKH has no intensivists, physicians with expertise in critical care, and provides very limited critical care service. As a result, DKH must transfer many cases to other facilities to rule in or rule out critical illnesses or injuries, which negatively affects earnings.

Another weakness lies in DKH’s reliance on electronic patient care reporting. DKH uses a number of patient care reporting platforms that do not integrate with each other. This creates a need for over-redundancy and opportunities for patient care errors. Further, a fully integrated system would allow for health care partners to access up-to-date patient care information without delay.

Opportunities. Opportunities exist for DKH to expand their services by further decentralizing the current services offered and concentrating on which scopes of service to expand or improve upon. By improving laboratory reporting standards and facilitating full integration of patient reporting, patients of DKH will be able to obtain a more standardized level of care throughout the health care continuum.

DKH should cultivate their relationship with the public by being more active and visible within the community performing screenings, vaccinations, blood drives, as well as other public relations endeavors.

Another opportunity exists with the patient population who suffer from critical illness or injury that is yet to be determined. These patients face risk in transport to tertiary care centers when, often times, the transfer is unwarranted by later findings. By cultivating relationships with specialties in the tertiary care centers, these patients could be more fully determined to need (or, not need) transfer to tertiary care centers, keeping the financial reward of caring for patients in-house while obtaining specialist coordination.

Threats. The largest threat to DKH, as with any organization, is its reputation within the community. Funding, which is largely based on governmental and private insurance providers, is also a considerable threat that must be managed continuously. However, other threats are significant and can be actively managed.

Pandemics are unlikely to occur but present catastrophic scenarios if they do, indeed, occur. Pandemic influenza, as well as other pandemic diseases, presents a situation of an increasing need for awareness and preparation.

Unpredictable weather in the northeastern Connecticut presents a likely and significant threat to the provision of health care. Recent and historical storms have proven to impede access and egress to and from patients both out in the community and at the hospital.

Discussion

This SWOT analysis is limited by the a posteriori knowledge and perceptions of the author, a paramedic who is active within the health care system, and it is limited in the scope of an academic exercise to practice SWOT analyses.

However, DKH has overcome many adversities in the past and continues to grow, but seemingly without proper direction. The efforts thus far seem disjointed and without a clear structure or coherent path into the future. DKH would benefit from an internal SWOT analysis that could be performed without the limitations inherent herein.

References

Day Kimball Healthcare. (2011). Day Kimball Healthcare. Retrieved from http://www.daykimball.org

U.S. Census Bureau. (2010). 2010 census data. Retrieved from http://www.census.gov/

Academia, Emergency Management, Politics, Society, Technology

Messaging as an Ongoing Process

Just after midnight on March 24, 1989, the Exxon Valdez ran aground in the Prince William Sound off of the Alaskan coast causing the 36th largest oil spill in history (Baker, n.d.; Fearn-Banks, 2011; Holusha, 1989; Moss, 2010). Though the initial ecological insult was severe, Exxon’s poor response to the emergency is noted as having the most significance (Baker, n.d.; Holusha, 1989). According to Fearn-Banks (2011), the initial public relations response was swift, but the public perception, especially with the obvious absence of CEO Lawrence G. Rawl from the public spotlight, was that the company did not view the incident with the importance that it deserved (Holusha, 1989). “The biggest mistake was that Exxon’s chairman … sent a succession of lower-ranking executives to Alaska to deal with the spill instead of going there himself and taking control of the situation in a forceful, highly visible way” (Holusha, 1989, para. 6). Rawl made comments about being technologically obsolete as a reason for not responding to the incident personally, and in a later television interview, Rawl explained that it was not the responsibility of the CEO to read specific response plans, then he went on to blame the media for the crisis (Baker, n.d.; Fearn-Banks, 2011).

According to Fearn-Banks (2011), Don Cornet, Exxon’s Alaska public relations coordinator, rushed to the scene and instituted a plan focused on the clean-up upon hearing of the incident; however, resources were scarce and the plan was slow to implement. Alaskan oil industry regulations held that the Alyeska Pipeline Service Company, an oil company consortium, was ultimately responsible for the initial response, which was soon taken over by Exxon. It was Alyeska’s involvement in the incident that introduced George Mason, an experienced crisis communications public relations expert for the company that represented Alyeska, into the spotlight. Mason worked with Cornet to streamline the media response and did much to limit the impact of Exxon’s poor media relations, even in light of Rawl’s disastrous commentary. Without the efforts of Mason, Cornet, and a few others, it appears that Exxon’s reputation would have suffered much more.

The primary issues identified in Exxon’s response to the Valdez incident, according to Baker (n.d.), are 1) a lack of resources and preparedness for a crisis of this magnitude, 2) failing to commit to prevention efforts in the future, and 3) the perceived indifference to the ecological shock.

According to Holusha (1989), Exxon’s response to the Alaskan spill was immediately identified as highlighting what not to do in responding to a crisis. Holusha compared Rawl’s messaging and response with that of the Ashland Oil spill and the Union Carbide incident in Bhopal, India, in which both CEOs responded immediately, availing themselves to the media to answer questions and respond to scrutiny.

The Exxon Valdez spill was significant, large, costly, and affected many industries and lifestyles in Alaska. Rawl’s response should have been immediate, and he should have taken responsibility to be apprised of all efforts being undertaken to rectify the situation. Legitimizing Rawl’s concerns of being a distraction to local efforts, he could have held frequent press conferences in the mainland United States, which would have limited the media’s need to send so many representatives directly to Alaska. This would have helped to show cooperation with the media as well as allow Rawl to address any concerns that the public might have. The messaging should have been that Exxon will do everything needed to return Alaska back to pre-spill status no matter the cost or manpower required.

Today, social media presents a unique opportunity for companies to address their public. Recently, Connecticut Light and Power utilized Facebook and Twitter, two popular social media programs, to provide real-time updates to their affected customers during a freak early snowstorm that put most of Connecticut without power for weeks (Singer, 2011; State of Connecticut, Department of Emergency Services and Public Protection, 2011). Though there are still concerns that Connecticut Light and Power were unprepared for such a crisis, without the deliberate effort to maintain communication with customers, the corporate image would have been much worse, as Exxon experienced.

It is a common precept in crisis communications that crises will occur and hopes can only be made to minimize their effect (Fearn-Banks, 2011). While preparing for such a crisis, a focus on communication and messaging should be paramount. The more the public trusts that the company will respond to the emergency effectively, the more apt they will be to acknowledge the difficulties involved in such a response. Messaging should be open, honest, and realistic. Every effort to use a multitude of media (e.g. radio, television, print, internet, telephone, et al.) to maintain a sense of transparency should be used to promote messages that accept responsibility and sets realistic goals. These communications, however, should not be unidirectional. A conversation needs to take place where the public can have their concerns and curiosity addressed in a fair and open environment.

By addressing the concerns of all stakeholders in a timely, open manner, corporate images will fare much better even in light of the worst crisis imaginable.

References

Baker, M. (n.d.). Companies in crisis – What not to do when it all goes wrong: Exxon Mobil and the Exxon Valdez. Retrieved from http://www.mallenbaker.net/csr/crisis03.html

Coombs, W. T. (2012). Ongoing crisis communication: Planning managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Fearn-Banks, K. (2011). “Textbook” crises. Crisis communications: a casebook approach (4th ed; pp. 90-109). New York, NY: Routledge.

Holusha, J. (1989, April 21). Exxon’s public-relations problem. New York Times. Retrieved from http://www.nytimes.com/1989/04/21/business/exxon-s-public-relations-problem.html

Moss, L. (2010, July 16). The 13 largest oil spills in history. Mother Nature Network. Retrieved from http://www.mnn.com/earth-matters/wilderness-resources/stories/the-13-largest-oil-spills-in-history

Singer, S. (2011, November 4). CT utility takes heat over winter storm response. News 8 WTNH. Retrieved from http://www.wtnh.com/dpp/weather/winter_weather/ct-utility-takes-heat-over-winter-storm-response-

State of Connecticut, Department of Emergency Services and Public Protection. (2011, November 8). Winter storm October 29, 2011 (Situation Report #49). Retrieved from http://advocacy.ccm-ct.org/Resources.ashx?id=802e4723-2e4a-4a61-896e-f51eafbbd4c0

Academia, Criminal Justice, Emergency Management, Public Health, Society

Coordinated Community Response to Special Populations

Being a victim of crime, especially a crime of a violent nature, one suddenly finds his or her self in a state of personal emergency that requires finely developed coping mechanisms in order to rationalize the situation. In addition to the need of a sound mind, a sound body is required in order to defend one’s self from harm in all but the most benign cases (Roberts & Yeager, 2009). The elderly population is characterized as having the predisposition of declining mental acuity as well as declining health and increasing frailty, as many of the elderly have disabilities related to their advanced development (Heisler, 2007). It could be stated that the elderly make for the perfect victim. However valid this statement may or may not be, it stands to reason that the elderly are at risk for being taken advantage of, at risk of injury from others, and at risk for both emotional and physical decline due to unwarranted stress (Heisler, 2007).

Elder abuse, which includes physical abuse, sexual abuse, emotional/psychological abuse, financial and material exploitation, neglect, and abandonment, “is being recognized as a … complex societal problem” (Heisler, 2007, p. 161). Heisler (2007) states that “in physical abuse cases, men are usually the abusers” (p. 169), yet it stated that men only account for 53% of the abuse, which is much closer to ‘half’ than ‘usually’, so it seems that both men and women are just as likely to abuse. The National Center on Elder Abuse (as cited in Heisler, 2007) also describes “self-neglect” as a type of abuse; however, this appears to fall under neglect and abandonment. Elder self-neglect should not be treated as a crime but should be addressed with the elder’s emotional and psychological well-being in mind.

The elderly are a vulnerable population due to their complex and specific needs and tend not to report abuse for fear of losing their support structure and further undermining their independence. According to Acierno et al. (2010), Podnieks (as cited in Heisler, 2007) and Wolf (as cited in Heisler, 2007), the one-year prevalence of elder abuse appears to fall between 4-5.6%, though the exact numbers have been difficult to quantify. It is this difficulty in identifying the abuse accurately that creates difficulty in responding to the crime. It is for this reason that every state and Washington, D.C., has enacted legislation that mandates the reporting of suspected elderly abuse by certain authorities (e.g. doctors, nurses, police, EMS, social workers, et al.).

In order to further develop coordinated community responses to elderly abuse, we must further understand the prevalence and intricacies of the abuse and its particular effects on the victims. It is imperative to bolster social support with prevention initiatives in order to address the prevalence of elder abuse in all of its forms.

References
Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. American Journal of Public Health, 100(2), 292-297. doi:10.2105/AJPH.2009.163089

Heisler, C. J. (2007). Elder abuse. In R. C. Davis, A. J. Lurigio, & S. Herman (Eds.), Victims of crime (3rd ed.; pp. 161-188). Thousand Oaks, CA: Sage.

Roberts, A. R. & Yeager, K. R. (2009). Pocket guide to crisis intervention. New York, NY: Oxford University Press.

Academia, Criminal Justice, Emergency Management, Public Health, Society

Coordinated Community Response – Terrorism, Hate Crimes

In a previous paper, I describe a coordinated community response to individual crime; however, when considering terrorism and, to some degree, hate crimes, we need to understand the more comprehensive needs of effected communities more so than the individual, yet, we still need to address individual needs (Schadone, 2011). According to a U.S. Department of Justice (2000) report on responding to victim needs after a terror event, comprehensive victim assistance centers should be centralized for ease of identification and resource management. This report acknowledges victims, family, and responders as potential users of victim assistance resources.

Coordinated community response programs should also be comprehensive and modular in order to provide services during normal day-to-day operations and to be able to coordinate for larger undertakings, such as those in the wake of large-scale emergencies. The U.S. Department of Justice (2000) report recommends being mindful of victim rights and including victim services representatives in planning, ensuring timely death notifications to family of the deceased, creating centralized centers to provide information, crisis counseling, and privacy, planning for transitioning short-term mental health counseling to long-term mental health care, streamlining victim compensation programs, organizing committees to ensure that unmet needs are identified with provisions of responding to these needs are created, creating an emergency fund for immediate payment for resources or victim compensation when other directed funds are inadequate or delayed, and creating processes for recruiting and preparing volunteers to assist in response efforts.

According to Roberts and Yeager (2009), crisis intervention counselors should take some specific steps in counseling individual victims of large-scale events. Initially, triage and remove victims from the scene as soon as possible to limit exposure to the aftermath of the event, considering the breadth of possible injuries and always taking into account the potential for responders’ needs following their exposure. Next, victims should be assessed medically to ensure that all physical health needs are identified and addressed, including their level of responsiveness, both in general and in light of the recent trauma. At this phase of the response, crisis counselors could assist other responders by obtaining demographic information (i.e. name, address, phone numbers, next of kin, medical history, current medications, and allergies) of victims being prepared for treatment and transport. Talking to and reassuring victims in a general sense would also be helpful by connecting to the victim on a personal level and establishing a rapport, acknowledging the victim’s concerns, and grounding the individual while ensuring that he or she knows that he or she is now safe. Further into the response, provide directed support to victims while allowing them to express their ordeals while providing them opportunities to acknowledge the reality of the situation. Some may benefit by providing assistance to other victims while others may require lengthy counseling sessions in order to move forward.

Any coordinated community response for large-scale incidents need to focus on health and safety, mental health, financial health, and the preservation of rights during the response. These coordinated community response programs should be comprehensive and modular while both giving and receiving assistance to and from state and federal victim assistance programs that might also be effective during the immediate aftermath of the event.

References
Roberts, A. R. & Yeager, K. R. (2009). Pocket guide to crisis intervention. New York, NY: Oxford University Press.

Schadone, M. (2011, November 6). Coordinated community response to crime. Unpublished Manuscript. Walden University, Minneapolis, MN.

U.S. Department of Justice, Office of Justice Programs. (2010, October). Responding to terrorism victims: Oklahoma City and beyond. Retrieved from http://www.ojp.usdoj.gov/ ovc/publications/infores/respterrorism/welcome.html

Academia, Emergency Management, Society

The Importance of Planning

To borrow from the motto of the Boy Scouts of America (2011), “Be prepared!” There is no possible way to fully predict with perfect accuracy when and where a crisis will develop. However, with some foresight, the adoption of a comprehensive crisis communication plan will allow an immediate response to any emergency, disaster, or other crisis that might arise. Gray (2008) discusses how JetBlue might have benefited from such a plan. JetBlue, if they had focused on developing a crisis communication plan, might have uncovered the not unlikely possibility of a major storm grounding many of its passengers. In this case, JetBlue would have been in a more proactive position to mitigate the effects such a storm might produce on passengers and their east coast operations. According to Fearn-Banks (2011), the impending storm prediction would have been a warning sign, or prodrome, that JetBlue could have responded to in order to prevent the crisis. Had JetBlue contacted the passengers prior to their arrival at the airports, they might have been able to secure better and more comfortable accommodations than the airports had to offer. Additionally, the company would have presented themselves proactively instead of taking the defensive posture noted by Gray.

In December 1984, Union Carbide, a pesticide production company, was the subject of the worst industrial accident in history. At their plant in Bhopal, India, an employee purposefully allowed water into large tanks of a chemical called methyl isocyanate (MICN) which caused a chemical reaction (according to Union Carbide management), bursting the tanks and releasing MICN gas into the environment killing more than 3,000 people (some estimates exceed 25,000 dead) and injuring 100 times that amount (Venkatasubramanian, 2011). According to Muller (2001), MICN was stored in large above ground tanks, a water valve was connected to the tanks, and employees had largely unrestricted access to these tanks and valves. When liquid MICN and water are mixed, MICN rapidly expands to a gaseous state and can quickly overwhelm holding tanks. Had Union Carbide conducted an investigation of potential crises while constructing a crisis communication plan, these circumstances might have been uncovered and considered prior to the accident, allowing company officials the opportunity to mitigate the potentially deadly situation and avoid the catastrophe in 1984. Additionally, had this crisis occurred regardless of mitigation, the company would have been poised to provide helpful instructions and recommendations to public safety officials and the public to minimize the loss of life. Union Carbide was eventually sued for billions of dollars, which it has never paid.

Another incident that might have benefited from a crisis communication plan is the Massey Energy Upper Big Branch mine explosion that occurred in West Virginia on April 5, 2010. Venkatasubramanian (2011) describes this explosion as the worst mining accident in four decades, killing 29 people. Like the Union Carbide example above, Massey Energy initially tried passing the blame to employees and single system failures, but eventually the company closed its Kentucky Freedom Energy Mine #1, and the CEO, Don Blankenship, stepped down. This after being confronted with the over 600 safety violations in 2009 and 2010. Again, the implementation of a crisis communication plan would have focused on potential accidents and allowed a window for mitigation and prevention. Upon completion of the effort, when the accident occurred, there would have been clear directives on how to proceed, which might have helped to save the company’s reputation; although, in this case, that is unclear.

Only when a company’s management realizes that safety is important and that crises do occur can they set forth means of mitigating their risk. One important way to mitigate risk is to consider that no matter the attempts at prevention, errors and failures can always occur and it is best to be prepared for the worst-case scenarios in hopes that they never do occur. By being prepared for the worst case scenarios, mainly by having drafted crisis communication plans along with incident action plans, the company representative has focus and direction on how to proceed with response efforts both publicly and internally. The benefits are appearing with a unified message of adequately responding and recovering from the crisis, and bringing a sense of strength and direction to that effort that the public, employees, and shareholders alike can appreciate and find faith. It is always best to be prepared.

References

Boy Scouts of America. (2011, March). Overview of Boy Scouts of America. Retrieved from http://www.scouting.org/About/FactSheets/OverviewofBSA.aspx

Fearn-Banks, K. (2011). Crisis communications: a casebook approach (4th ed.). New York, NY: Routledge.

Gray, S. (2008). Without crisis plan, your reputation could be at risk. Las Vegas Business Press, 25(8), 22. Retrieved from http://www.ebscohost.com/academic/regional-business-news

Muller, R. (2001). A significant toxic event: The Union Carbide pesticide plant disaster in Bhopal, India, 1984. Rural and Remote Environmental Health, 1(10). Retrieved from http://www.tropmed.org/rreh/vol1_10.htm

Venkatasubramanian, V. (2011). Systemic failures: Challenges and opportunities in risk management in complex systems. AIChE Journal, 57(1), 2-9. doi:10.1002/aic.12495

Academia, Emergency Management, Society

Defining Crisis

A crisis is any problem that has a significant impact. Most simply, a crisis is a decision-point of change, for better or worse. For example, a new father seeing his child for the first time might have a crisis of faith. A beautiful and healthy child may trigger thoughts of awe and trigger a divine revelation; whereas, a seriously ill child may bring feelings of doubt and religious contempt. In the field of crisis management, Coombs (2012) defines crisis as “the perception of an unpredictable event that threatens important expectancies of stakeholders and can seriously impact an organization’s performance and generate negative outcomes” (p. 2). In this definition, Coombs suggests that crises are both negative and unpredictable events that effect others. While I agree with the scope of the definition, as I stated above, crises do not necessarily have to be negative events, and frequently, they can be predicted. Predictable negative crises are usually caused by negligent management, such as economic crises (Berg & Pattillo, 1998; Compagnon, 2011; Feldstein, 2010; Roubini, 2010).

A crisis usually develops from a less significant issue and, if understood and contemplated, can be mitigated early (Coombs, 2012). A crisis stemming from an issue finds a causal relationship with risk. Risk can be categorized by human, systematic, and process or random (Youndt, Snell, Dean, & Lepak, 1996). Human and systematic risk can be mitigated easily; however, process risk is inherent and requires substantial process change to minimize.

The British Petroleum Deepwater Horizon event, which occurred on April 20, 2010, was said to have been fraught with risk of all three types. A New York Times article by Barstow, Rohde, and Saul (2010) describes the event and attempts to elucidate what went wrong. Initially, according to the article, there was a blowout of the Macondo Prospect well, a risk that is inherent to drilling, especially in deep water. Next, every single “formidable and redundant defenses against even the worst blowout” (para. 10) failed. This was certainly a failure of process errors (geological “bursts” causing the well blowout), systematic errors (“One emergency system alone was controlled by 30 buttons” [para. 18]), and human errors (“members of the crew hesitated and did not take the decisive steps needed. Communications fell apart, warning signs were missed and crew members in critical areas failed to coordinate a response” [para. 15]).

On a micro-organizational level (the rig), these failures are evident and allowed risk to develop into an issue, which developed into a crisis. On a macro-organizational level, however, the response seemed to be swift, but the focal response to the incident and the public relations response appeared very disjointed, which was compounded by both the media and the federal government, that is, until the U.S. Coast Guard took control. It was apparent very early that both British Petroleum and the federal government were concerned with reputation over response and recovery from the focal incident. This translated to poor support for both by the public. I believe the U.S. Coast Guard is the only managing entity involved in the response to have managed to maintain dignity throughout the effort.

Crisis management is promoted as a multifaceted approach to mitigate, alleviate, respond to, and recover from crises of different types and scope. Although there are many aspects to organizations that require attention during these efforts, it needs to be understood that some have higher priorities than others, and reputation is a culmination of all of these.

References

Barstow, D., Rohde, D., & Saul, S. (2010, December 25). Deepwater Horizon’s final hours. New York Times. Retrieved from http://www.nytimes.com/2010/12/26/us/26spill.html

Berg, A. & Pattillo, C. (1998). Are currency crises predictable: a test (Working paper #98/154). International Monetary Fund. Retrieved from http://books.google.com/

Compagnon, D. (2011). A predictable tragedy: Robert Mugabe and the collapse of Zimbabwe. Philadelphia, PA: University of Pennsylvania Press.

Coombs, W. T. (2012). Ongoing crisis communications: planning, managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Feldstein, M. (2010, June 14). A predictable crisis: Europe’s single currency was bound to break down. The Weekly Standard, 15(37), 1-3. Retrieved from http://www.weeklystandard.com/articles/predictable-crisis

Roubini, N. (2010, May 17). All crises are predictable: Contrary to beliefs, history shows there’s nothing new in debt or inflation. Gulf News. Retrieved from http://gulfnews.com/business/features/all-crises-are-predictable-1.627708

Youndt, M. A., Snell, S. A., Dean, J. W., & Lepak, D. P. (1996). Human resources management, manufacturing strategy, and firm performance. The Academy of Management Journal, 39(4), 836-866. doi:10.2307/256714

Academia, Emergency Medical Services, Health Care, Public Health

Human Resources & Challenges in Health Care

The function of human resources is not without its challenges and difficulties. No matter the industry or organization, acquiring and managing a pool of employees can be overwhelming (Thompson, 2012). Human resources managers in health care organizations seem to face more challenges than most. From nursing and physician shortages to attracting innovative and contemporary researchers, health care organizations seem to search within thinning pools of prospective employees, yet still demand the best and brightest (Keenan, 2003; Lewis, 2010; Thompson, 2012).

One of the most challenging issues to health care over the last few decades has been a significant nationwide nursing shortage (Keenan, 2003; Lewis, 2010). Thompson (2012) outlines both a declining skilled workforce and an increasing population contributing to the problem. Both Keenan (2003) and Lewis (2010) cite the aging babyboomer population adding to the increased need for nurses through 2020 and beyond. Novel human resources strategies can result in an augmented workforce designed to meet the continually growing impact these forces have on health care organizations, specifically those with emergency departments.

One novel strategy includes consideration of other highly-skilled clinicians that do not traditionally work in hospitals. As Oglesby (2007) considers the possibility, paramedics are, by far, one of the best examples. By introducing paramedics into the emergency department, a hospital can redistribute the nurses to clinical areas more suited towards their training, decrease the patient-to-nurse ratios (thereby increasing patient safety and maximizing outcomes), and tap into a new pool of prospective employees that are well-suited to rise to the stressful demands of the emergency department (Keenan, 2003; Swain, Hoyle, & Long, 2010). Additionally, organizations employing paramedics can augment both their emergency department operations and home health care operations by sending paramedics to certain patients to mitigate their complaints and minimize the number of inappropriate patient transports to the emergency department (Swain, Hoyle, & Long, 2010). This alone would decrease emergency department overcrowding and maximize revenue and efficiency in the delivery of care. Additionally, turn-over rates should be significantly lower with a more productive work environment where stress is managed, outcomes are met, and patients are care for more effectively.

In conclusion, intelligent and novel planning of the workforce can, itself, lead to increases in recruitment and retention; however, efforts still need to focus on each individually in order to attract, maintain, and develop a first-class workforce (Thompson, 2012).

References

Keenan, P. (2003). The nursing workforce shortage: causes, consequences, proposed solutions (Issue brief #619). The Commonwealth Fund. Retrieved from http://mobile.commonwealthfund.org/

Lewis, L. (2010). Oregon takes the lead in addressing the nursing shortage: A collaborative effort to recruit and educate nurses. American Journal of Nursing, 110(3), 51-54. doi:10.1097/01.NAJ.0000368955.26377.e1

Oglesby, R. (2007). Recruitment and retention benefits of EMT—Paramedic utilization during ED nursing shortages. Journal of Emergency Nursing, 33(1), 21-25. doi:10.1016/j.jen.2006.10.009

Swain, A. H., Hoyle, S. R., & Long, A. W. (2010). The changing face of prehospital care in New Zealand: the role of extended care paramedics. Journal of the New Zealand Medical Association, 123(1309), 11-14. Retrieved from http://journal.nzma.org.nz/

Thompson, J. M. (2012). The strategic management of human resources. In S. B. Buckbinder & N. H. Shanks, Introduction to Healthcare Management (Custom ed.; pp. 81-118). Sudbury, MA: Jones & Bartlett.

Academia, Culture, Emergency Management, Emergency Medical Services

Practical Use of Strategic Planning

 In this writing, I will describe the similarities and differences of planning versus strategic planning, and I will use these concepts to compare and contrast two very different strategic organizational plans within the health care industry. In my view, strategic planning should be bold, effective, prescient, and ethical, and the reader should keep these attributes in mind when considering the plans for themselves.

Planning is described as the directed implementation of the “blueprint for the future” (McConnell, 2012), or the means of expressing the organizational vision in order to achieve the organizational goals; whereas, strategic planning institutes planning with a consideration and focus towards the forces, whether or not controllable, that might both help and hinder the desired outcomes (Casciani, 2012). One example of an uncontrollable force, especially in health care, are the expectations of the patient or client. Crawford et al. (2002) provides a discussion on the increased propensity to involve patient views in the strategic planning of health care organizations, though at the time of the writing, there was no evidence as to the effect that the involvement of these views provided. Caution must be exercised when eliciting input from the client or patient. For instance, many patients complain about the amount of time that it takes at emergency departments for test results to be returned. As impressive as it would be to have test results returned within just a few minutes, this should not be attempted to the detriment of the accuracy of the tests. Perhaps, in this instance, considering the role of point-of-care testing might be more beneficial than attempting a costly overhaul of the laboratory processes. Approaching problems as they apply to an open system, looking from outside in, provides a better perspective than regarding the organization as an isolated microcosm.

To be effective, strategic planning must be all-encompassing and address the goals of each functional unit, or microsystem, to bring them into alignment with the plans of the macro organization (Kosnik & Espinosa, 2003). To wit, as an organization can only be measured by the outcomes of the integrated microsystems, an analysis of each or any functional unit can tell much about the goals and visions guiding the organization.

Children’s Hospital and Regional Medical Center

The Children’s Hospital and Regional Medical Center (Children’s; 2006), located in Seattle Washington, provides the first of two strategic plans I will review. On the opening pages, as with most strategic plans, the organization defines its mission and vision, and they are certainly bold statements including the elimination of pediatric disease and being the best children’s specialty care center. The only thing that I wish was stated on these first pages is some sort of organizational value statement. The value statement does much to intertwine an ethical approach to the mission and vision. However, I do not doubt the ethical approach Children’s relies on, which is evident by the whole of the plan.

Children’s (2006) is a true regional medical center that serves much of the northwest portion of the United States, including Alaska. An argument could be made that Children’s serves such a vital role to the region that it is too important to fail, yet the organization still seeks to ensure financial stability and “secure Children’s financial future” (p. 5). In health care, especially in today’s political climate, the future of funding sources are unclear, and the most ethical approach to the organizational delivery of health care is to provide it without burden to the community it serves. Children’s exemplifies this approach by maintaining charitable foundation to “expand philanthropy to the community” (p. 16), as well as ensuring sound and responsible investments and maximizing efficiency under cost controls while still ensuring quality and safety improvements.

Additionally, Children’s (2006) focuses its efforts at being the best, which means attracting the best clinicians, performing cutting-edge research, and providing the best care to achieve the best outcomes possible setting the standard for health care across the nation. Children’s holds a bold, effective, prescient, and ethical strategic plan that outlines some goals of many of the microsystems within the organization.

U.C. Davis Health System

The U.C. Davis Health System (2011) strategic plan, unlike the Children’s (2006) plan, immediately outlines the values, or “guiding principles” (p. 3), of the organization. Financially, however, U.C. Davis Health Systems seems less focused on self-reliance, financial security, and community involvement than Children’s and more focused on their stated goal of socially responsible environmental stewardship.

Although the U.C. Davis Health System (2011) strategic plan uses the word bold on the front cover, I find it to be less so and without many specifics and, instead, relying on generalized language that might promote the vision but does nothing to engage it.

It is apparent in the U.C. Davis Health System (2011) strategic plan that they wish to become a leader in many different areas while attracting the best workforce. This is a commendable, bold, and ethical position that helps to ensure quality and safety in the delivery of health care at U.C. Davis Health Systems.

Discussion

Many different variables drive the production of strategic plans, including politics, community, workforce, investments, geography, and the current status quo of health care delivery. Many of these differences can be seen immediately when comparing various strategic plans, yet by virtue of being a health care organization, many of the stated goals will be similar. Without being informed as to the climate of the organizational operation, it is difficult to appreciate the potential each plan has in regard to success or failure.

As a health care manager, the strategic plan is an obvious resource when deciding on possible employment. As a potential administrator, the strategic plan offers a view into how the administration seeks to direct the operation of the organization. Being responsible to help implement these plans, one must consider the alignment of his or her personal values with those of the organization. A manager might find it difficult to lead in an environment that demonstrates and promotes a different value system.

Strategic plans offer a significant advantage to organizations during their growth providing a clearly written prescription as to what is important to the organization so that it may guide decision-makers to develop and enhance programs to provide a cohesive effort towards future prosperity and relevance.

References

Casciani, S. J. (2012). Strategic planning. In S. B. Buchbinder & N. H. Shanks, Introduction to healthcare management (Laureate Education, Inc., Custom ed.; pp. 3-23). Sudbury, MA: Jones and Bartlett.

Children’s Hospital and Regional Medical Center. (2006). Our children deserve the best: Laying the foundation for the next 100 years (Strategic plan overview). Retrieved from http://www.seattlechildrens.org/pdf/strategic_plan.pdf

Crawford, M. J., Rutter, D., Manley, C., Weaver, T., Bhui, K., Fulop, N., & Tyrer, P. (2002). Systematic review of involving patients in the planning and development of health care. British Medical Journal, 325(7375), 1263-1267. doi:10.1136/bmj.325.7375.1263

Kosnik, L. K. & Espinosa, J. A. (2003). Microsystems in health care: Part 7. The microsystem as a platform for merging strategic planning and operations. Joint Commission Journal on Quality and Safety, 29(9), 452-459.

McConnell, C. R. (2012). Planning. In S. B. Buchbinder & N. H. Shanks, Introduction to healthcare management (Laureate Education, Inc., Custom ed.; pp. 131-139). Sudbury, MA: Jones and Bartlett.

University of California, Davis Health System. (2011). 2011-2016 strategic plan: Creating a healthier world through bold innovation. Retrieved from http://www.ucdmc.ucdavis.edu/ strategicplan/2011StrategicPlan.pdf

Academia, Culture, Emergency Management, Emergency Medical Services, Health Care, Politics, Public Health

Prior Proper Planning …

… Prevents Poor Performance

I am in the midst of planning an ad hoc merger of a number of local emergency medical service agencies into a single regional provider to reduce overall costs while maximizing revenue, improve training and the delivery of care, and to streamline the operational processes that support our providers in the field. Unfortunately, I have found that there are many obstacles that need to be dealt with at every step before moving on to the next. My research has certainly opened my eyes to developing a useful approach to these problems.

Planning “[provides] the appropriate focus and direction for … organizations” (Zuckerman, 2006, p. 3). Without planning, organizations risk stagnation and obsolescence. For any organization to succeed (and continue to do so), the strategy needs to focus both on the contemporary traditional needs as well as those anticipated in the future, but this focus needs to be comprehensive. Bartling (1997) writes of 25 different pitfalls any health care organization might face when considering strategic planning. These 25 pitfalls are just some of the issues I hope to avoid.

One of the largest difficulties in planning for emergency medical systems, however, is the sense of ‘fiefdom’, or an assertion of organizational ownership — in a truly feudal sense. A fiefdom is a literal power trip. In this area, there are 10 towns with an average of two ambulances each, and each department’s administration will fight tooth and nail to keep the organization from outgrowing them. What is interesting about the area is that many of the members of one department work for at least two of the other departments, also. This is because the pay is so meager they have to work as many hours as possible, and there is no chance of working more than 32 hours at any one service in any given week. The pay is low as is the quality of care. This needs to change, but how do I create an amalgumated organization from the bits and pieces that I have to work with? Add to that my lack of formal authority in this process. My vision is to reduce the number of ambulances by staffing eight ambulances at all times and tactically positioning them around the region. This alone would create 48 well-paid jobs, using the same 40 people who currently job share across organizational lines.

In reviewing the available resources, I have learned that there is no particular process or flow-chart pathway to effective planning (Bartling, 1997; Begun & Kaissi, 2005; Zuckerman, 2006). Critical forward thinking is needed, instead. Some of the particular issues that Bartling (1997) discusses and I foresee might be particular to my planning process are: inadequate planning, short-sightedness, underestimating the complexity of the process, post-merger angst, analysis paralysis, and lack of evaluative criteria, to name a few. Politics plays a large role in many of these issues I mention.

Inadequate planning, short-sightedness, and a lack of evaluative criteria are closely related. I see in the present that the system does not work as well as it should (short-sightedness), and I want to develop a plan that can be implemented immediately (probably suffering inadequate planning). This would leave me with a fragmented system devoid of vision and, therefore, crippled from improving (lacking that evaluative criteria). These are pitfalls that I need to avoid. These issues would give rise to the others dooming my effort to failure and, possibly, leaving the system in even worse shape than it began.

Perhaps, my only chance of fulfilling this process is to first perform a limited situational assessment by identifying the mission, vision, and values of all of the stakeholders and show how a streamlined process can better fulfill their visions (Casciani, 2012). By gaining stakeholder support, I might better leverage my idea against those who fear change.

References

Bartling, A. (1997). 25 pitfalls of strategic planning. Healthcare Executive, 12(5), 20–23.

Begun, J. & Kaissi, A. (2005). An exploratory study of healthcare strategic planning in two metropolitan areas. Journal of Healthcare Management, 50(4), 264–274.

Casciani, S. J. (2012). Strategic planning. In S. B. Buckbinder & N. H. Shanks (Eds.), Introduction to healthcare management (Custom ed.; pp. 3-23). Sudbury, MA: Jones & Bartlett.

Zuckerman, A. (2006). Advancing the state of the art in healthcare strategic planning. Frontiers of Health Services Management, 23(2), 3–15.

Academia, Emergency Medical Services, Health Care

Health Care Quality and Safety

Health care is a service devoted, by definition, to those who are vulnerable. People seek out health-related services during stressful times and may be easily swayed into trying less than effective methods, even ‘snake oil’ remedies, for treating their ails and pain. This being the case, the health care provider has a moral obligation to advocate for the patient. Advocacy entails considering only what is in the best interest of others, even to the detriment of one’s self. Patient advocacy helps to ensure both health care quality and safety. The Institute of Medicine defines health care as “[the] degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge” (as cited in Savage & Williams, 2012, p. 26). Savage and Williams (2012) discuss the importance of effective and efficient delivery of health care, which means avoiding overuse (providing services to those who will least benefit) and underuse (failing to provide services to those that would benefit) stating, “quality is important in health care because there are limited resources to improve the health of both individuals and the population as a whole” (p. 72).

According to Savage and Williams (2012), all stakeholders are affected by the level of quality in health care. From a patient’s perspective, health care delivery should be aimed at addressing the patient’s problem with the least invasive, yet most effective, therapy possible. Delivering health care is a high-risk endeavor that focuses the risk towards the patient, potentially causing harm and great suffering. The provider, driven by the desire to help without harming, would benefit greatly by the development of ‘best practices’, or evidence-based practice, in order to help the most people with the available resources. Additionally, providers wish to be paid a fair rate in exchange for the services performed, and this can only occur in an efficient system with little waste to impact revenue. On the other hand, third-party payors, the most prolific purchasers of health care, demand the most effective and efficient services in return for their payment in order to control the costs of their own services. Third-party payors, like Medicare, Blue Cross, and others, have such a large client base that they are able to effectively negotiate health care services for lower rates.

As a health care manager, it is increasingly important to ensure quality and safety in the delivery of health services. Medical malpractice litigation, according to Savage and Williams (2012), is costly to practitioners and organizations, even though it does little to deter poor quality. Rather than relying on the courts to make forceful recommendations, an effective manager can use tools already available to promote best practice within their organization. For instance, continuous quality improvement (CQI) programs promote systematic, data-driven process improvements focused by the customer’s perceptions. CQI can uncover interferring processes and can make modest to significant improvements that can indirectly improve other, linear processes, thereby, making greater improvements, overall.

References

Savage, G. T. & Williams, E. S. (2012). Performance improvement in health care: The quest to achieve quality. In S. B. Buckbinder, N. H. Shanks, & C. R. McConnell (Eds.), Introduction to healthcare management (Custom ed.; pp. 25-79). Sudbury, MA: Jones & Bartlett.