Wrongdoing in healthcare organizations

Wrongdoing in healthcare organizations can be linked to a lack of integrity, which may be the result of cultural flaws. The Gallup Management online Journal identifies lower overall healthcare expenses. This means that Patient Centered Care (PCC) business methods actively engage all stakeholders, decreasing waste of hospital material and staff resources (Josepha, 2011). Lower healthcare costs lead to fewer process delays, increased patient education efforts, and fewer diagnostic testing and referrals.

Compliant and ethical business practices in healthcare organizations support patient-centered care. Hospitals can keep trusting doctors and nurses to keep patients safe during surgeries, to reduce medical complications and other costs which are related to the length of hospital stay, and to handle long-term choric care, this is essential in the enhancement of PCC. The named factors can be made possible if business ethical practices are practiced even in the healthcare system. It is up to the healthcare providers to gather data from a comprehensive survey of ethical standards then buy those policies that are fit within the supply chain of healthcare (Small D and Small R, 2011). Business ethics practices can be maintained in healthcare organization through adhering to the rigorous public standards and maintaining a strong ethical internal control covering all the activities.

b) Regulatory requirements

The essence of healthcare regulation standards is to make sure there is compliance and to provide a safe healthcare to enhance PCC. Healthcare regulatory agencies have a role in monitoring facilities and practitioners and deliver crucial information concerning any changes made in the healthcare system. The regulatory agencies also make sure the services provided to patients are of good quality, promotion of the safety of patients and ensure there is legal compliance. Different regulatory bodies offer public protection from various health risks and offer a number of programs for the welfare and health of the public. The development and implementation of healthcare regulations is done by all levels of the government and by private organizations (Josepha, 2011). The levels of government regulatory agencies such as the Federal, state and local agencies formulate rules and regulations for the health care industry, and their oversight is mandatory. Other regulatory agencies in the healthcare system perform accreditation and make requirements for voluntary participation (Virani & Registered Nurses’ Association of Ontario, 2002). These agencies are still crucial since they deliver rankings or certification of quality and serve as supplementary oversight, ensuring that health care organizations promote PCC.

Other Regulatory requirements mandates that should be included in PCC practices in healthcare organizations have already shown a great impact to PCC. The health Information Technology for Economic and Clinic health Act has consistently increased measures meant to advance the electronic engagement of patients throughout the healthcare system (Virani & Registered Nurses’ Association of Ontario, 2002). The Act has also resulted in patients contributing to their own data with nurses required to incorporate patient-generated health data. The Affordable Care Act and the Medicare Access and CHIP registration Reauthorization Act (MACRA) are other health regulation Acts (Josepha, 2011). The Centre for Medicare and Medicaid Services (CMS) oversees the majority of the regulations which are directly related to the health care system. Through several programs, CMS provides government-subsidized medical coverage. These programs promote PCC, and they include Medicare for the elderly and disabled, Medicaid for lower-income persons and families and the State Children’s Health Insurance Program (SCHIP) for health insurance covering children who are below 19 years. The responsibility of ensuring adherence to the Health Insurance Portability and Accountability Act (HIPAA) is also with the CMS (Small D and Small R, 2011). HIPAA works to minimize costs while safeguarding patients and offering improved medical care; it is the main piece of health care regulation which was established to increase the competence and efficacy of the health care system. The Agency for Healthcare Research and Quality (AHRQ) conducts research meant to improve the quality of health care, reducing costs and addressing patient safety and medical errors. The main goal of all these regulatory agencies in healthcare is to promote PCC

c) Reimbursement

Health Reimbursement Arrangement (HRA) is an employee health benefit given by some employers in the Cleveland Clinic (Cleveland Clinic, 2017). This arrangement reimburses employees for their out-of-pocket medical expenses, it is however not offered as the exclusive benefit, but must be part of a group health insurance plan. The reimbursement system in healthcare is a very complex framework of procuring payment for services. The challenge faced in the Cleveland reimbursement system is that government regulations pertaining healthcare reimbursement change frequently, the government payers occasionally change on a day-to-day basis. Reimbursement arrangements offered to promote PCC in Cleveland Clinic include retail charges where Payers have a “maximum allowed payment” for every CPT code, which is the beginning point of deciding what they will pay. The payer can adjust the maximum allowed payment and include claim edits which are used to exempt payment for some services and make payment rules that mostly minimize payments for some services offered in the hospital.

Other reimbursement services in Cleveland Clinic include the application of a ”claim edit” that removes payment for vaccine administration when the physician bills for the vaccine itself, this reduces the payment when the physician performs more than one procedure during the same visit (Cleveland Clinic, 2017). The patient then pays the doctor the difference between this payer-calculated overall amount allowed for the medical services and procedures and the sum owned by the patient.

2. Cleveland Clinic Healthcare Setting

Cleveland Clinic is a combination of medical hospitals, institutes, and services. Cleveland healthcare system is always centered on the slogan ”patients first!” (Cleveland Clinic, 2017). Since 1921, the founders of the clinic had a goal of patient-focused environment that provided quality care to patients, research into their problems, and continuous training to healthcare providers. For over nine decades, Cleveland Clinic has evolved to be the second best healthcare provider in the United States offering ‘best in class patient experience,” (Cleveland Clinic, 2017). The clinic has many healthcare Personnel including; 2000 employed doctors, 11000 registered nurses, more than 800 advanced practice nurses and 30000 other employees. These medical personnel are spread all over continents.

3. Strengths and Weaknesses of Cleveland Clinic

i. Leadership/operations

Cleveland Clinic has a Clear statement of commitment to Patient Family Centered Care and Patients and family partnerships (Cleveland Clinic, 2017).. The clinic is driven by accountability and effective measurement of PFCC.

However, it has a non-uniform inclusion of patient/family in hospital policies given that it widespread in continents with a large task force.

ii. Mission, vision, values

Patient Family Centered Care included in Mission, Vision, and Values of the clinic. The clinic has a shared vision of serving leader, relationship-based care and thinking of action. The Bill of rights for patients and families spells out the rights of patients and their responsibilities.

iii. Advisors

To enhance transparency and welfare of patients, the Cleveland Clinic includes patients in the hospital committee which allows them to participate in quality rounds. There is also the existence of patient/family advising the council.

iv. Quality improvement

The clinic considers the voice of patients in its operational goals, families take part in safety meetings, and they are interviewed as part of the work- rounds. The participation of patients in task forces is however not uniform since the appropriate selection, and equitable criteria has not yet been established for the attendance of patients to meetings.

v. Personnel

There is a high expectation of collaboration with patients in job descriptions, and patients take part in interview teams and staff/physicians prepared for and supported in PFCC. It is however not recommended in Cleveland clinic for patients or family to welcome new staffs at the orientation of new employees.

vi. Environment and design

The environment support patient and family presence as well as interdisciplinary collaboration.

vii. Information and education

The web portal provides specific resources for patients and family. Also, patients and family are encouraged to use resource room. It is not recommended in the clinics for patients and Families to serve as educators for clinicians and other staff.

viii. Diversity and Disparities

There is a careful measurement in terms of race and families are provided with timely interpreter services. Navigator minority programs are offered, however, educational materials especially electronic resources have not been appropriate at different literacy levels.

ix. Charting and documentation

Patients and families have full access to paper and electronic records and they are able to chart

x. Care support

Patients and family receive medical updates at any visit, and they can activate rapid response systems. It is not allowed in the clinic for the family to be present during rescue events; this might be done to reduce the risk accidents to the family. Full support is offered to patients and families.

xi. Care

Patients and family engage with clinicians in collaborative goal setting, patients are carefully listened to and are actively involved in care planning. Physician, family and patients partnership is highly recommended.

4. Area of improvement

Educational materials to be updated in appropriate literacy levels to make it easier for all patients and their families are well updated without excluding patients and families of other cultures.

5. Strategy to increase patient’s centeredness

The strategy used is translation of the educational materials to different languages. As directions for clinics and medicinal services suppliers are updated, all patient materials must also be updated and appropriated to patients in a dialect they can get it. It is broadly recognized that lacking access to data and medicinal services benefits unfavorably influences the nature of social insurance and can have genuine, even life debilitating, outcomes.

6. Application of system theory

This theory explains that all parts of an organization are interdependent and connected, thus is one part of the system gets affected, the other parts are affected as well. Thus, failure to update the educational materials and excluding patients and families in other cultures might end up affecting the overall performance of every department in Cleveland Clinic. The systems theory further elaborates that the organization is an open system that interacts with the environment and it is continually improving, thus to promote PCC, there should be an open system (Virani & Registered Nurses’ Association of Ontario, 2002).

The system theory can be applied through the use of mixed group us to attain a rich understanding of how the change is perceived in different points of view. Secondly, this system can be applicable in the above strategy through the use of processes that will enhance collaboration across units, generation of a holistic view of that which must be done to offer the clinic a secure future. Furthermore, helping the leadership team of Cleveland to understand that they don’t have all the necessary data to manage to change the desires of the organization. Systems theory ensures that the clinic stays eternally sensitive and not just insulated in their perspectives (Josepha, 2011).

7. Financial implications of implementing the strategy

Interpreting educational materials to different languages is costly. Taking care of almost every patient in their local dialect way is quite a challenge and implementing this strategy has serious financial implications. This strategy may result in increased medical expenses in Cleveland clinic since the extra money needed to implement the strategy might be passed on to the patients in terms of increased medical charges.

8. Evaluating the effectiveness of the strategy

Several methods can be used to assess the effectiveness of this strategy in Cleveland Clinic. One of the main effective ways is by feedback from patients and families on whether the approach has impacted them positively. This can be done through a simple questionnaire where patients and families can indicate their level of satisfaction or dissatisfaction with the updated educational materials. The strategy can be termed as effective if both patients and families indicate a high level of satisfaction that the translation strategy has helped improve their care. If the patients and families indicate that they are dissatisfied with them strategy, this shows that it is not effective.

9. A multidisciplinary team to help in the strategy

A multidisciplinary team is crucial in the promotion of PCC. For effective implementation of this strategy, potential members who should be included are patients who will help in identifying most frequent cultures visiting Cleveland hospitals. Secondly, language translators should be included to help in the translation of the materials and the hospital communications department to aid in help in updating the educational materials and communicating to the Cleveland organization. Thirdly, healthcare providers who will aid in identifying patient’s needs that need to be included in the educational materials before and after translation should also be part of the team.

10. How cultural diversity in a team supports patient-centered, culturally competent care

When cultural competence and diversity is embraced in health care, the overall quality of care can be improved. Understanding cultural diversity in healthcare promotes PCC since it helps reduce health disparities. When the health professionals in a country keep pace with the changing demographics, it reduces disparities in the access of health and promotes positive results (Virani & Registered Nurses’ Association of Ontario, 2002). Equal care will be offered even to minority groups since there will be equality in provider-patient communication, and health literacy issues. Interacting with a health care professional is such a personal relationship that it’s vital since the individual values of co-workers can be properly understood. There are many social benefits attached to cultural diversity, and they include increased trust, understanding and mutual respect between patients and Cleveland clinic, Secondly, it promotes participation of all members of the community and enhances community participation in issues of health care. Thirdly, it enhances the responsibility for the health of both patients and families and helps them in their care.

The health benefits of cultural diversity include: Improves patient data collection, promotes preventive care by patients, minimizes care inequalities in the patient population, promotes cost savings through the reduction in medical errors, the number of treatments and legal costs and it decreases the number of unused medical visits. Cultural diversity in a team has other vital business benefits which support patient-centered and culturally competent care (Woods et. al, 2008). They include incorporation of various points of view, ideas and policies into the decision-making process. Secondly, it minimizes bottlenecks which slow progress and Increases efficiency of care services. Lastly, it Increases the market share of the organization

11. Leadership style used in team development.

The main aspects of the leadership role include influencing group activities and managing change. I will use a leadership style that is developed within a healthcare which is associated with enhancements in patient care or the performance of the clinic. I will employ supportive leadership which states helps in establishing relationships with employees and increases the likelihood that they will be positively influenced and motivated to work towards goals. Since the healthcare system is made up of various professional groups and departments, these systems are complex; thus I will employ the leadership style which capitalizes on performing and efficiency in the use of when designing management processes while inspiring my team to work towards common goals.

I will also use transformational leadership which puts more emphasis that people work more effectively when they have a sense of mission. I will communicate my visions to the team in a meaningful manner and create joint purpose and unity in PCC promotion. As a transformational leader, I will be able to motivate performance beyond the expectations of Cleveland Clinic using my ability to influence the team’s attitudes. Throughout my application of transformational leadership, I will also lead in a collaborative manner. This means that I will communicate information to my team so as to allow them to make their own informed decisions. Through collaborative leadership style, healthcare management will be improved through advocating for dialogue between various stakeholders, sharing knowledge and experiences; and minimizing the level of difficulty within the clinic (Woods et. al, 2008). I will involve in an active way all the persons having different levels of responsibility so as to involve them in the leadership process. Collaborative healthcare leadership is effective where many different parties are encouraged to work together so as to implement effective practices and processes which are aimed at enhancing PCC. By using collaborative team leadership, the understanding of various cultures will be promoted, and the integration among numerous stakeholders will be facilitated, persons are unified through shared visions and values (Woods et. al, 2008). I will model collaborative behaviors among the team members in order to increase their motivation levels and encourage interdependency between the healthcare providers in the clinic so as to enhance PCC.

12. How the team will work together

To counter the challenge of non- uniform inclusion of patient/family in hospital policies, the team will work collaboratively where tasks are equally distributed amongst them to ensure each member has a duty to do. Also, through teamwork, each member’s effort will be appreciated thus motivating them since they can see that their efforts are recognized.

13. Ways through which the team will communicate the strategy and the outcomes intended in the organization.

I will use effective communication strategy which strongly advocates for teamwork to enhance coordination and cooperation. Healthcare industry is full of risks thus when there is effective teamwork in the team; success will be evident in the clinic since team goals of promoting PCC will be achieved, efficiency and errors will be minimal. When the team will communicate the strategy though supportive and collaborative behavior, this will ensure all patient and families are uniformly involved in healthcare practices, without any form of discrimination.

When the team practices effective communication between patients, families and the entire healthcare providers the outcomes of the strategy will be evident in the improved PCC (Small D and Small R, 2011). When the team embraces effective communication, the outcomes will be evident in the decisions made by patients and families concerning their health since the decisions will be informed. Through clearly stipulated team goals and addressed concerns of both patients and family members, the outcomes of the strategy can be evident; also future conflicts and problems will be prevented. By using effective communication, the team will better understand the illness of the patients thus provide excellent care. The aim of any provider-patient interaction is creating and maintaining efficient working relationships which support healing and mutual trust. Another outcome of the strategy will be evident in increased patient and family satisfaction and a decrease in the feeling of isolation and family members and patients. Effective communication provides patient with the information from their caregivers to help them understand their diagnoses, to expect the likely impacts of the illness on their plans, and to participate in establishing a treatment plan which reflects their personal values

14. The tool used to develop the self-assessment skills in the team

To develop the self-assessment skill on the team, mind tools are used. Team work has a dramatic impact on how any organization performs, thus it is crucial to develop tools which can assess the team’s performance. A team cannot be expected to perform well when it’s just formed; it takes time to form a team (Small D and Small R, 2011). Team members go through several stages as they transform from being strangers to a united group having a common goal. The stages which a team goes through include Forming, Storming, Norming, and Performing. Mind tools entail giving feedback; team members are assessed through asking them vital team questions where they are supposed to give feedback. Feedback gotten from team members can help strengthening the team since all the loopholes, weakness and challenges faced by the team can be dealt with. Mind tools used in self-assessment of the team helps in keeping the performance of the team high and well-Integrated. It is crucial to articulate the team’s vision so as to develop a high performing team. Through assessing each member of the team to know how well they are aware of the vision of the team and the entire organization motivates and directs them to reach the goals of the team. Assessing each member of the team on the matters of the overall purpose and vision of the team helps to keep them alert and ready to fulfill those goals (Josepha, 2011). The vision of the team spells out the objectives of the team which is in line with those of the organization; these objectives help to keep the team focused.

References

Cleveland Clinic (2017). Available at: http://my.clevelandclinic.org/

Josepha, P.M., (2011). ”Delivering Patient-centered Care in the Midst of a Cultural Conflict: the Role of cultural competence.” The online Journal of Issues in Nursing

Small, D., and Small, R., (2011). ”Patients first! Engaging the hearts and minds of nurses with Patient-centered practice model.” The online Journal of issues in Nursing, vol.16.No 2, Manuscript 2

Virani, T., & Registered Nurses’ Association of Ontario. (2002). Client centred care. Toronto: Registered Nurses Association of Ontario = L’Associationdes infirmières et infirmiers autorisés de l’Ontario.

Woods, R. T., Keady, J., & Seddon, D. (2008). Involving families in care homes: A relationship- centred approach to dementia care. London: Jessica Kingsley Publishers.