NRS 451 Research a Health Care Organization or Network that Spans Several States with in the United States (United Healthcare, Vanguard, Banner Health, etc.)
NRS 451 Research a Health Care Organization or Network that Spans Several States with in the United States (United Healthcare, Vanguard, Banner Health, etc
United HealthCare is the largest medical insurance company in the US. The company gives insurance covers to people who have the risk of getting cancer. The company has done many experiments on their premium payments physically, and it had to discourage the physical cost of premiums from drug sales. It encourages the oncologists to purchase drugs (George, 2016). Although the objective is not just to reduce the cost of drugs, they had to help curb the overuse of cancer drugs. Their bundle payment depends on specific stages of cancer. The techniques of the program hoped that bundled payment would help improve the outcome and give quality care. The United HealthCare has an excellent capacity of the base finance, which allows it to finance all the requirements by the clients. The company is trying to provide the very best service to its clients.
Cognizant of the role that training plays when it comes to improving a nurse’s competencies in EBP and thus empowering them to contribute to the development of EBP, here are certain strategies that can be undertaken from both an organizational level, to the larger professional level. At the organizational level, the organization can organize for opportunities where their nurses can get trained on evidence based practice. On the greater professional levels, professional bodies such as the ANA and the ANCC have developed certification program for nurses. By including components of evidence based practice in the certification exams, this ensures that nurses will prepare and apprise themselves on EBP and thus, in order to earn the certification, they will have to be competent in EBP. Alternatively, the institutions can include a whole different certification for EBP, where nurses will specifically be trained on EBP, tested on the same and thus, their competency will be proven by their certification. This will ultimately improve their ability to participate in the development and implementation of EBP.
Organization’s Readiness
The United HealthCare is willing to make sure everything concerning cancer to be dealt with quickly. They have come up with some measures which will make things easy for the citizens. The United Health care is ready to do everything that is required to make their clients access the medical cover with ease. They have reduced the premium payment to ensure the cost is affordable to everyone. They have lowered it to some percentage depending on the income of individuals and the risks exposure by an individual. Before the UHC determines the bundled payments, it checks on the 19 conditions of which the pilots are given a yearly analysis and debate before coming up with the set standard of a bundle (Kumar, 2016). This is because different oncologists deliver the service based on the National Comprehensive Cancer Network (NCCN). The NCCN instructs people to go for chemotherapy after breast cancer surgery. The UHC payment is based on the scheduled fee, which doesn’t exclude the expense of the drug reimbursement and the actual drug costs.
The ASCO, which is a wing on the UHC, was more concerned and supportive of the experiment, this pilot program is helpful and innovative in a manner that can solve complex problems. The ASCO came up with strategies that aimed at separating the payment for medical care attention provided to patients. This would help in the provision of medicine to a patient who will treat their diseases. By separating the payment, the company helped individual groups have easy access to the medical facilities. This was done because some cancer medicine is too expensive and unaffordable to some citizens. The patients would pay their bundles with ease as required by the United Healthcare.
The other thing the UHC did was to do frequent therapies because patients go through different stages while battling cancer that is 15%-20% of patients with a unique experience. There is some toxic or more rapid progression where a person needs to make some changes (Toebes & Hallo de Wolf, 2015). The United HealthCare needs to establish consistency between 80%-85% of the patient to create efficiency and reducing the costs and increasing the patient’s safety. For over ten years, Kansas City, which is a cancer center, treated people, and many people visited the clinical path. The clinic received 19 stages and different cancer categories. This was due to the measures which the UHC had come up with to help people access the cancer health care services and the therapies which reduced the cancer rates to some percentage in the US.
Strategic Plan To Improve The Network Operation
The United HealthCare has some plans which are aimed at achieving the objectives of the company at large. The UHC has assessed all the strength, weakness, opportunities, and threats about the organization and finally coming up with a strategy which will help it run smoothly to achieve the goals. The UHC has some practices in the pilot that will aid in building efficiencies giving out the appropriate care. The UHC chairman Roy Page P.H.D said that “Doctors and chefs in the kitchen are the same.” All the piloting techniques would make it easy for the flow of medicine on the pathways. It will also facilitate the easy movement of staff and cancer patients in the US.
The biggest problem the UHC is facing is financial problems. It’s tough for them to provide all the requirements at a go to many patients as the cancer treatments are costly. Hence, they formulated the pooling of the resources, which implies the collection of premiums together and later on disburse on treatment (George, 2016). This was due to the increased financial burden on the patients. Cancer drugs are costly and can cost over tens of thousands of dollars in the process of treatment and always needs 20% co-payments, which many cants afford. The IMS health gave out a highlight on the sale of chemotherapy drugs in the pharmacy. This may cost over 20 billion since the cost of cancer care is rapidly rising at a speed that many American citizens can’t sustain. The UHC formulated a pool where the patients will be paying bundles that they can afford and later be used to treat them (Kumar, 2016). Still, they are focused on cutting costs when possible. This is solely to make cancer care be accessed easily by all American citizens.
The organization is facing many issues from a different dimension; they include; The patients cannot afford the money required by the company, which is a big challenge to citizens and the company despite trying hard to lower all costs. The other problem is the increased number of coverage, which leads to exhaustion of the available resources. This is making it hard and goes beyond the budget of healthcare to serve people. The ratio of the available resources to the people with common cancer is at a deficit. The other problem that the company face is the chronic state of patients, which requires a lot of money (Toebes & Hallo de Wolf, 2015). Many patients are at a chronic condition, which becomes too expensive for the company; this poses a significant challenge to the organization. Despite all the problems the healthcare has some plans to counter these problems.
Inventory Management decisions model
In the past, healthcare didn’t have much focus on the inventories. However, the US government implemented diagnostic groups that led to pre-fix levels of compensation. These systems help to contain the rising cost of managing diseases in the US. This paper address the issues of inventory hence the involvement of this model (George, 2016). Since managing cancer is expensive to the company, there is the necessity of inventory tools. The biggest problem being cost in the managing of cancer there is the need for comparing the inventory cost and service levels of the business. In comparing the inventory policies, we focus on the latest sequence of outsourcing to distribute the non-critical medical supplies directly. This model will help in solving all the financial problems experienced by United HealthCare.
Conclusion
In summary, the United HealthCare is playing a significant role in ensuring all patients with cancer can access the medical facilities. The UHC came up with measures that will help to reduce the premium payments by the citizens. The company provided some pilot services to make the operation of cancer easy, and the movement of medicine be faster. Even though the company is facing many problems like affordability, chronic state, and financial issues, they do all they can to provide the services to their clients. They have made sure many cancer patients go for chemotherapy and get medical attention.
Referrence(s)
George, M. (2016). Healthcare Norms under Universal Healthcare (UHC) for
Maharashtra. Journal Of Health Management, 18(4), 569-583. https://doi.org/10.1177/0972063416666163
Kumar, P. (2016). How to strengthen primary health care. Journal of family medicine and
primary care, 5(3), 543.
Toebes, B., & Hallo de Wolf, A. (2015). Private Sector Involvement in Healthcare and UHC:
Assessment in Light of the Right to the Highest Attainable Standard of Health. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.2649845
Research a health care organization or network that spans several states with in the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade.
Prepare a 1,000-1,250 word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following:
Describe the health care organization or network.
Describe the organization’s overall readiness based on your findings.
Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.
Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan.
Propose a theory or model that could be used to support implementation of the strategic plan for this organization. Explain why this theory or model is best.
ou are required to cite a minimum of three sources to complete this assignment. Sources must be appropriate for the assignment and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Health organizations operate in a changing and intricate environment due to healthcare reforms and changes focused on meeting increased care demands, the need to lower costs, and ensure patient care quality. Imperatively, these entities require an effective operational strategy and a well-crafted strategic plan to meet the present and future care demands. These organizations must evaluate their operations to identify underlying issues and opportunities that are essential to their long-term success (Buchbinder et al., 2019). The purpose of this paper is to evaluate Providence Health as one of the leading national healthcare systems operating across the country. The paper describes the organization and evaluates its readiness and offers a strategic plan to help it in network growth, management of its resources, and patient satisfaction. It also looks at potential issues in the organizational culture that may impact the realization of the proposed strategic plan.
Description of Providence Health & Services (Providence)
Providence Health and Services (Providence) is a not-for-profit Catholic healthcare organization that operates multiple facilities and clinics across the seven western states and headquartered in Renton, Washington. The health system operates in Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. The health system was founded in 1859 by the Sisters of Providence, a Catholic nun congregation founded in Montreal, Quebec Canada (Providence, 2023). Providence Health and Services was created formally on 1 January 2006 after the merger of Providence Health System, the progenitor firm, and Providence Services. The system runs 52 hospitals and 950 clinics. It also boasts over 120,000 caregivers or employees with over 36,000 nurses and 23,000 physicians who include specialists. The health system engages in research with over 1,700 published research studies. The system also covers 1.9 million lives and sees more than 28 million patient visits. It has also established nursing schools and a university to train its healthcare providers.
Providence also boasts 17 supportive housing facilities and offers one health plan for all its patients and communities that it serves. The plan shows that the system is keen on providing care to patients irrespective of their background based on its mission statement of expressing God’s healing love witnessed through the ministry of Jesus and being steadfast in serving all, especially the poor and vulnerable. Providence uses its voice to advocate for vulnerable populations that include low-income families and the uninsured (Providence, 2023b). The organization focuses on treating patients holistically through their minds, body, and soul or spirit. The care it offers is consistent with its core values of compassion, dignity, justice, integrity, and excellence. The organization uses these core values at every stage of care delivery; from diagnosis to treatment and even health promotion.
Organization’s Readiness Based on the Findings
Organizations demonstrate their readiness to meet diverse patient needs through innovative approaches and responding to changes and transformations in healthcare delivery, especially in dealing with emerging issues and increased deployment of health technologies to deliver care (Dearing, 2018). Based on the evaluation of Providence Health, it is evident that the organization is ready to meet the ever-changing and dynamic patient needs and health promotion. Firstly, Providence’s core values and mission statement demonstrate its readiness to serve communities and patients irrespective of their socioeconomic status. The organization welcomes input from community members and current patients to enhance new care pathways and innovate novel products and services as well as help offer a better digital experience through the provision of virtual health (Providence, 2023). These surveys offer data that the organization analyzes to help initiate new care approaches, policies, and processes to enhance patient satisfaction and promote positive patient outcomes. The system has also invested in virtual health to expand access and lower the cost of care, especially for vulnerable and uninsured individuals and households.
Secondly, Providence collaborates through its affiliate family with facilities in West Texas and New Mexico, California, and Washington. These facilities offer comprehensive healthcare to patients and advance best practices and continue the organization’s over-a-century tradition of serving the poor and vulnerable in the community. The expanded network and specialty facilities across the seven states demonstrate the health system’s focus on being ready to meet the growing patient and health population needs across the age and care continuum. The system has one plan that incorporates all patients, irrespective of their status, as an illustration of its overall readiness (Providence, 2023b) Studies are categorical that healthcare demand will increase due to aging, and rising population; especially fueled by immigration and diverse patients that will implore providers to integrate culturally-sensitive care (Mannion & Davies, 2018).
Strategic Plan on Network Growth, Nurse Staffing, Resource Management & Patient Satisfaction
A strategic plan is a general pathway that offers an organization direction to attain its set goals and align them with the established mission and vision. The strategic plan entails an action plan and timelines to reach the set goals (Buchbinder et al., 2019). Providence Health can leverage the proposed strategic plan to address network growth, nurse staffing, management of resources, and patient satisfaction.
The analysis of its network shows that the organization has a strong foundation that can accelerate its growth, especially through collaboration. To expand its network, the organization must focus on specialty clinics in areas that do not have sufficient services. Getting rural areas in Alaska, Oregon, and New Mexico would provide new growth opportunities for the health system. The organization can also partner with more educational institutions to conduct more research on ways to serve the needs of different populations or demographics. The growth of its network implies a rise in the number of its workforce, especially nurses (Greiner et al., 2021). As the system boasts over 36,000 nurses, it should ensure that they are specialized in different areas to improve service delivery to certain populations. Managing nurses using an integrated system will also help to improve efficiency by assigning them based on case demands. Such a system leads to the effective allocation of resources and available nursing staff without causing burnout, turnover, and any associated levels of fatigue. The system can also leverage increased deployment of technology to enhance access for patients, especially those with chronic conditions and in remote areas who need close monitoring.
Patient satisfaction should remain a top priority for Providence Health. Satisfied patients lead to a better reputation and increase the number of people served as well as attract new talent to the system. A core strategy for improving patient satisfaction levels is to educate nurses on the use of evidence-based practice approaches to offer quality care and leverage technologies to improve access (Westwood et al., 2018). By increasing the resources used in the network, customers can get quality care at any time and anywhere. Tracking patient health, offering timely solutions to issues that emerge, and adopting technologies and tools are also effective strategies to attain patient satisfaction based on the services provided by the system.
Issues with the Organizational Culture & Impact on Strategic Planning
Providence Health operates in seven states and it can face two critical issues that may affect the overall attainment of the strategic plan. These include managing a diverse culture of its employees, patients, and the communities that it serves, especially in expanding services, and communication. Multicultural organizations encounter conflicts that may affect the overall quality of services delivered (Mannion & Davies, 2018). Again, the provision of culturally competent and sensitive care is critical in healthcare to meet unique patient needs and satisfaction. Imperatively, the health system that can address cultural issues and improve cultural skills within their workforce and operations can enhance their operational and workplace environment and quality of care for their customers.
Effective communication between employees working in the network may also be a challenge because of the size of the workforce and their situation in different states. The implication is that the organization must focus on how to standardize or adapt its communication based on its core values and mission, irrespective of the health facility and clinic’s location (Meesala & Paul, 2018). If it does not configure and manage the communication system well, coordination of the parties in the network can be a problem and this leads to conflicts or inefficient patient care.
Model to Support the Implementation of Providence’s Strategic Plan
The evaluation shows the need for improved interconnectivity and coordination within the healthcare system. As such, the most appropriate model to support the implementation is the systems theory which proposes that organizations as entities are made up of functional and interconnected systems that are influenced by the environment in which they operate (Anderson, 2018). Strategic plans to expand the network should address the changing markets they seek to enter and meet patient needs. Again, change models like Lewin’s change process are critical to aiding the system theory to improve the attainment of the set goals. Therefore, the adoption of resources, human capital, and operations in these new market environments is essential to the success of strategic planning.
Conclusion
Health systems should evaluate their strategic positions and develop strategic plans to meet the rising care demand and needs of patients. The analysis of Providence Health and Services (Providence) shows that the organization is ready to meet the healthcare needs of diverse populations that it serves across the seven states. The paper develops a strategic plan that entails looking at network growth and nurse staffing as well as resource management and patient satisfaction to make the organization better placed to remain competitive and attain its mission, goals, and objectives.
References
Anderson, B. R. (2018). Improving health care by embracing Systems Theory. The Journal of
thoracic and cardiovascular surgery, 152(2), 593-594. DOI: 10.1016/j.jtcvs.2016.03.029.
Buchbinder, S. B., Shanks, N. H., & Kite, B. J. (2019). Introduction to health care management.
Jones & Bartlett Learning.
Dearing, J. W. (2018). Organizational readiness tools for global health intervention: A review.
Frontiers in Public Health, 6(56), 1-6. DOI: 10.3389/fpubh.2018.00056.
Greiner, J., Naik, H., Liu, D., & Ballouk, H. (2021, June). Learning from the first wave: Lessons
about managing patient flow and resource utilization on medical wards at providence health during the COVID-19 pandemic. Healthcare, 9(2): 100530. DOI: 10.1016/j.hjdsi.2021.100530
Mannion, R., & Davies, H. (2018). Understanding organizational culture for healthcare quality
improvement. BMJ, 363, k4907. DOI: https://doi.org/10.1136/bmj.k4907
Meesala, A., & Paul, J. (2018). Service quality, consumer satisfaction and loyalty in hospitals:
Thinking for the future. Journal of Retailing and Consumer Services, 40, 261-269. https://doi.org/10.1016/j.jretconser.2016.10.011
Providence Health (2023). About Us. https://www.providence.org/about
Providence Health (2023b). Providence Health Plan. https://www.providencehealthplan.com/
Westwood, G., Richardson, A., Latter, S., Macleod Clark, J., & Fader, M. (2018). Building
clinical academic leadership capacity: sustainability through partnership. Journal of
Research in Nursing, 23(4), 346-357. https://doi.org/10.1177/1744987117748348
Health Organization Evaluation – Rubric
Criteria Description
Health Care Organization or Network
5. Excellent
27 points
Health care organization or network is clearly and accurately described.
4. Good
22.95 points
Health care organization or network is described. Some detail is needed for clarity.
3. Satisfactory
20.25 points
Health care organization or network is summarized. Some information is needed. There are minor inaccuracies related to the representation of the organization or network.
2. Less Than Satisfactory
17.55 points
Health care organization or network is partially presented. There are significant omissions and inaccuracies.
1. Unsatisfactory
0 points
Health care organization or network is not described.
Criteria Description
Assessment of Overall Organizational Readiness
5. Excellent
27 points
Assessment of overall organizational readiness is described in detail. Degree of organizational readiness is established. Strong evidence and rationale support the assessment.
4. Good
22.95 points
Assessment of overall organizational readiness is described. Degree of organizational readiness is generally established. Some evidence or rationale is needed for support.
3. Satisfactory
20.25 points
Assessment of overall organizational readiness is summarized. Degree of organizational readiness is partially established. More information, rationale, and support are needed.
2. Less Than Satisfactory
17.55 points
Assessment of overall organizational readiness is partially presented. There are significant omissions. Degree of organizational readiness is not established.
1. Unsatisfactory
0 points
Assessment of overall organizational readiness is omitted.
Criteria Description
Strategic Plan
5. Excellent
36 points
The strategic plan is well developed. Network growth, nurse staffing, resource management, and patient satisfaction are addressed in detail. The plan is supported with strong evidence and rationale.
4. Good
30.6 points
The strategic plan addresses network growth, nurse staffing, resource management, and patient satisfaction. Some evidence or rationale is needed for support.
3. Satisfactory
27 points
The strategic plan generally addresses network growth, nurse staffing, resource management, and patient satisfaction. More information, rationale, and support are needed.
2. Less Than Satisfactory
23.4 points
Strategic plan is partially presented. Plan contains major omissions. The plan fails to address issues outlined in the assignment criteria.
1. Unsatisfactory
0 points
Strategic plan is omitted.
Criteria Description
Identification of Current or Potential Issues in Organizational Culture and Impact of These to Strategic Plan
5. Excellent
27 points
Current or potential issues in the organizational culture are clearly identified. The potential impact of these on the strategic plan is thoroughly described and supported with evidence and rationale.
4. Good
22.95 points
Current or potential issues in the organizational culture and the potential impact of these on the strategic plan are discussed. Some evidence or rationale is needed.
3. Satisfactory
20.25 points
Current or potential issues in the organizational culture are generally discussed. The impact of these on the strategic plan is summarized. Evidence and rationale are needed to support claims.
2. Less Than Satisfactory
17.55 points
Current or potential issues in the organizational culture are partially summarized. The potential impact of these on the strategic plan is unclear. There are omissions and inaccuracies throughout.
1. Unsatisfactory
0 points
Current or potential issues in the organizational culture and the impact of these to strategic plan are omitted.
Criteria Description
Theory or Model to Support Implementation of Strategic Plan
5. Excellent
27 points
Theory or model to support strategic plan implementation is proposed. The theory or model demonstrates strong support for implementation of the strategic plan for the organization. Compelling rationale supports why the theory or model is the best choice.
4. Good
22.95 points
Theory or model to support strategic plan implementation is proposed. The theory or model demonstrates support for implementation of the strategic plan for the organization. General rationale is provided for why the theory or model is the best choice.
3. Satisfactory
20.25 points
Theory or model to support strategic plan implementation is proposed. The theory or model demonstrates some support for implementation of the strategic plan for the organization. It is unclear why this theory or model is the best choice. More information is needed.
2. Less Than Satisfactory
17.55 points
Theory or model to support strategic plan implementation is partially described. It is unclear how the theory or model would support implementation of strategic plan for the organization.
1. Unsatisfactory
0 points
Theory or model to support strategic plan implementation is omitted.
Criteria Description
Thesis Development and Purpose
5. Excellent
9 points
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
4. Good
7.65 points
Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.
3. Satisfactory
6.75 points
Thesis is apparent and appropriate to purpose.
2. Less Than Satisfactory
5.85 points
Thesis is insufficiently developed or vague. Purpose is not clear.
1. Unsatisfactory
0 points
Paper lacks any discernible overall purpose or organizing claim.
Criteria Description
Argument Logic and Construction
5. Excellent
9 points
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
4. Good
7.65 points
Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.
3. Satisfactory
6.75 points
Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.
2. Less Than Satisfactory
5.85 points
Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.
1. Unsatisfactory
0 points
Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.
Criteria Description
Mechanics of Writing (includes spelling, punctuation, grammar, language use)
5. Excellent
9 points
Writer is clearly in command of standard, written, academic English.
4. Good
7.65 points
Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.
3. Satisfactory
6.75 points
Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.
2. Less Than Satisfactory
5.85 points
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.
1. Unsatisfactory
0 points
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.
Criteria Description
Paper Format (use of appropriate style for the major and assignment)
5. Excellent
3.6 points
All format elements are correct.
4. Good
3.06 points
Appropriate template is fully used. There are virtually no errors in formatting style.
3. Satisfactory
2.7 points
Appropriate template is used. Formatting is correct, although some minor errors may be present.
2. Less Than Satisfactory
2.34 points
Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.
1. Unsatisfactory
0 points
Template is not used appropriately, or documentation format is rarely followed correctly.
Criteria Description
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
5. Excellent
5.4 points
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
4. Good
4.59 points
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
3. Satisfactory
4.05 points
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
2. Less Than Satisfactory
3.51 points
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.
1. Unsatisfactory
0 points
Sources are not documented.
Total 180 points