MBA THESIS HEALTHCARE

 MBA THESIS HEALTHCARE
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1: INTRODUCTION AND BACKGROUND
The United States has long been recognized as a nation with exorbitant healthcare costs, comparative to other countries. The National Institutes of Health recorded increased healthcare costs from $10.9 to $15.6 billion dollars between 1993 and 1999. Also, pharmaceutical research and development doubled to $24 billion dollars (National Academy Press 2001, pg. 2). Although very costly the quality of care is often not analogous to associated costs. This reality is further understood when observing the number of preventable hospital deaths per year. Due to the number of avoidable deaths, many individuals view the hospital as one of the most dangerous places to receive healthcare.

Alexander Pope asserted that making mistakes is a natural or human tendency. However, when human error results in the loss of thousands of lives and billions of dollars in healthcare costs, something must be done. That is why there has been a major push to implement quality and safety metrics within the American healthcare system. Scientific and technological advances are essential to improved quality and safety metrics. However increased access is equally important, if the healthcare system is to adequately service the population. The U.S. Census Bureau projected the number of uninsured Americans to be as high as forty million. As a disclaimer the number of uninsured Americans could be significantly less since the recent implementation of Obama Care (National Academy Press 2001, pg. 2).

Increased healthcare costs are attributed to the skyrocketing pharmaceutical costs, advanced technologies, and the evolving healthcare needs of patients. Additionally, medical errors are occurring with greater frequency due to fragmentation in the healthcare delivery model. Duplication of services, inexcusable time delays for care, and other ineffective processes also add significantly to costs (National Academy Press 2001, pg. 2).

In regards to safety measures hospitals need to reduce infections obtained while receiving treatment. As hospitals reduce infections obtained during patient visits, there would theoretically be less frequency of visits. Under a fee-for-service compensation structure this could adversely impact overall revenue. One compensation structure that could work concurrently with a strategy to reduce infection is the capitation or risk-sharing approach. This would require fewer resources to service patients while simultaneously reducing patient infections (National Academy Press 2001, pg. 193).

The bottom line is that healthcare organizations are responsible for reducing costs and are subsequently held to a higher level of accountability. Organizations like the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are enforcing hospital compliance. When hospitals are found out of compliance as evident by incidents of increased infection, safety problems, or procedural mistakes, there are fiscal repercussions.

Often they end up absorbing significant healthcare expenses related to patient hospitalization. In addition JCAHO can further penalize hospitals by regulating reimbursement rates from Medicaid and Medicare. There are five specific areas relative to hospital care that JCAHO evaluates. This includes chronic myocardial infarction, congestive heart failure, pneumonia, surgical techniques, and circumstances related to pregnancy (National Academy Press 2001, pg. 102-103).

The National Committee for Quality Assurance assesses how effective health plans are in managing chronic ailments relative to cardiovascular, cancer, and influenza. Additionally, the National Quality Forum is another organization pursuing comprehensive quality metrics and related goals (National Academy Press 2001, pgs. 102-103).

According to the Institute of Medicine (IOM) quality healthcare is safe, patient-centric, timely, and equitable. The IOM committees determined that two processes, guideline development and technology assessment are equally important. Recommended criteria in both processes include pervasiveness, practice variability, rate, and seriousness of illness. Cost mitigation and improved outcomes are also factors in establishing quality of care metrics (National Academy Press 2001, pg. 103).

Further, when addressing safety concerns companies are encouraged to establish a culture where reporting identified errors and potential hazards is normative practice. Frontline employees are an organizations greatest asset to improving relevant processes and guidelines. In order for systematic issues to permeate a work environment, acquisition, dissemination, and incorporation of best practices must become intentional. Even if ideas did not originate within the organization the integration of best healthcare practices should be the overriding goal (National Academy Press 2001, pg. 122).

Previous research has determined that improved communication could mitigate errors, incidents of readmission, and other medical complications. When operative communication occurs between physicians and allied professionals then outcomes should be positive. Effective communication is not solely limited to the healthcare field. Communication is at the heart of every successful relationships, whether it be business or personal. In healthcare many quality issues, errors, and discrepancies occur due to miscommunication of daily tasks. With the advent of Electronic medical records (EMR) patient information is more easily accessible. However, the availability of EMR systems does not eliminate the necessity of authentic face-to-face dialogue.

Antoine de Saint- Exupery compared successful leadership with ship building. He believed that successful leaders know how to ignite the fire and passion within others. Transformative leadership causes others to collect wood for ship building or do whatever work is necessary for goal attainment (Bartiromo, 2010 pg. 242). To translate that principle into an effective healthcare strategy the focus must be on development of people. Companies should focus on becoming aware of the challenges that frontline employees face. They should consequently develop strategic plans for workflow improvement and improved employee satisfaction. Preoccupation with current trends and innovation are important, yet suffer significantly without comparative human development.

Chapter 1.1 RESEARCH PROBLEMS
This thesis will explore the necessity of influential communication within a healthcare environment. Two factors quality care and patient safety are identified as variables dependent on authentic and efficient communication. Further, medical errors, complications, and readmission rates are usually attributed to lack of communication. This paper will explore causative factors hindering the nurse and physician relationship. Further examination will include identification of the variables hindering communication. Once discovered research will explore the associated impact on safety and quality care.

In hospitals throughout the country, a nurse will often hesitate to contact a doctor who has historically displayed incensed behavior. Nurses worry about informing doctors of their patients’ conditions or seeking their medical opinion regarding treatment. This reluctance is often attributed to fear of ridicule or embarrassment especially around colleagues and patients. The obvious downside is that lack of communication inadvertently places patients at greater risk. The absence of communication in a healthcare setting has existed for decades. In fact a 1990’s study found that poor communication has led to somewhere between 44,000 and 98,000 annual deaths.

Pitiable communication has also been identified as a leading factor of preventable deaths.

This has resulted in studies designed to improve communication due to its adverse impact on healthcare facilities and the general public. Although improving dialogue between physicians and other healthcare staff is important, there are equally important relationships. Future research should also consider physician and patient interaction, physician with physician relationships, and hospitals communicating with other hospitals (Taran 2011, pg. 86).

Enriched communication is not solely the responsibility of healthcare facilities. Medical and vocational schools need to address strategies for effective communication in a healthcare setting. Nurses often chafe at the expectation that they will be acquiescent when working with physicians. In contrast, physicians are typically viewed as imposing care providers with the majority of the power.

Nursing is also a predominantly female held occupation, while doctors are traditionally males. Although these statistics are rapidly changing, the success rate of nurse and physician communication is sorely lacking. Hospitals cannot completely revolutionize the way that nurses and physicians communicate overnight, however they can make positive changes. In-service training is a viable and cost-effective way to address this issue without directly blaming a specific stakeholder.

Assertiveness training should be taught in nursing schools and during hospital employee orientation. Primary benefits include improved patient safety and increased awareness concerning how lack of communication can negatively impact patient safety. Along with assertiveness training, team building workshops should also be integrated in orientations for doctors, nurses, and other healthcare personnel.

Hospitals should also hold meetings and social functions for all disciplines. Meetings should not only include nurse managers but also, staff nurses. If patient safety is the number one concern, then directly focusing on those involved in patient care should be the focus. Both physician and nurse leaders need to invest in the simplest, yet easily disregarded aspect of patient care which is communication.

A team based approach, where all healthcare professionals are free to express their input is the desired model. Hospitals should also engage in daily rounding in critical disciplines to ascertain workflow problems and get feedback from frontline employees. In departments such as intensive care and ER, feedback should come from respiratory therapists, pharmacists, social workers, nurses and physicians.

The value of group sharing, include improved collaboration among team members and better team morale. Within each department there should be established rules of engagement that ensure each team member feels comfortable voicing their concerns. Disruptive behavior should not be tolerated, while professional accountability ensures a positive and productive work environment. These are critical initial steps in the process of improving patient safety.

1.1 RESEARCH PURPOSE AND OBJECTIVES
The purpose of this research project is to analyze factors associated with rising healthcare costs and associated safety concerns. Consequently the research will inexorably conclude that inadequate communication is a prominent factor that must be allayed. Additionally, nurses, physicians, and other healthcare practitioners must be viewed as equal partners.

This requires a heightened awareness of how important each role and function is within the healthcare continuum. Doctors cannot properly diagnose patients without supportive frontline staff to identify and communicate symptoms associated with patient conditions. Likewise nurses and other healthcare providers need Doctors to provide insight and recommendations concerning appropriate treatment.

Additionally, research will reveal the need for hospitals to incorporate assertiveness and team building training. Ideally this training would take place during new employee orientation and subsequently during ongoing in-service training. This approach could improve participant engagement with other departments in a manner that also encourages safe practices. Assertiveness training provides an opportunity for respectful yet directive dialogue between doctors and nurses. The value of such training is that it creates a new paradigm where all stakeholders within the continuum of care are equally valued.

1.2 RESEARCH APPROACH AND METHOD
Research methodology is an examination of the lens through which a particular subject is understood. For example in the analysis of healthcare and healthcare delivery there are specific methodologies for analyzing the process for servicing patients. From the point of entry into the healthcare facility to the diagnosis of related issues, and recommendations, healthcare is complex. When looking at communication within a healthcare setting the interrelationship between various stakeholders becomes a central focus.

Specifically understanding the message-oriented process is critical to identifying causative factors of subsequent actions. If for example stakeholders feel valued in the process of the message oriented process then the workflow is generally viewed as more productive. Consequently if stakeholders feel hesitant or have minimal trust for the communication process then that impacts efficiency (Whaley, 2014).

In terms of methodology there are various approaches, including literary examination of interviews and focus groups, case studies, and ethnographic research. Additionally, interpersonal exchanges include narrative, conversational, physician-patient interaction, and content analysis. Also, casual exposition will include the assessment of experimental communication research and meta-analysis of existent medical data (Whaley, 2014).

1.3 DATA COLLECTION
Data collection will utilize a mixed method approach that considers both qualitative and quantitative data. For example in the qualitative examination the focus will be on focus groups, organic detailed interviews, observations, self-analysis, recording, and transcript examination (Whaley, 2014). This data collection process will enable researchers to better understand patterns that are currently existent within the healthcare setting. It will be important to glean information from various stakeholders in order to understand relevant relationship dynamics. The emergent narrative and themes will be appropriately complemented with amalgamated quantitative data.

Quantitative data will provide a comprehensive understanding of healthcare challenges by examining statistical and numerical data. For example one goal will be to drill down skyrocketing healthcare costs to the granular level of specific services. Where there are incidents of duplicated services or unnecessary services then critical questions need to be addressed. One such question would be why are superfluous services being provided within a healthcare facility for a large number of patients? Additionally, who is authorizing such services and are there checkpoints of accountability? When there are quantitative statistics that reveal elevated levels of hospital induced infections, then critical questions also need to be addressed. For example, where are the points of communication breakdown in the workflow process? Also, who are the persons that are ultimately responsible for sterilization procedures and what are barriers to effective service?

From a micro perspective the mixed method approach will be foundational to an effective research project. However there will also be the inclusion of macro methods such as ethnography. Currently there are numerous industries, using ethnographic strategies as part of a comprehensive research approach. Ethnography is qualitative in nature in the sense that it enables companies to find out pragmatic needs of patients (Anderson, 2009). So for example, when looking at healthcare it is not just an internal audit that needs to take place. While acknowledging the value of improving internal processes, it is equally important to understand how such processes impact patients directly.

Companies like Intel have found that becoming more enlightened about a customer’s needs relative to a product or service is critical. Without such information long-term planning becomes extremely difficult and laborious. In fact it could be argued that without such qualitative data emergent strategies are ineffective in addressing the primary needs of the patient-consumer. Intel found Ethnographic research so critical to their planning; they set up a business unit that focused on data collection using ethnographic strategies (Anderson, 2009).

1.4 STUDY OUTCOMES
When synthesizing study outcomes, there are diverse issues that are discovered and discussed. The healthcare industry as a whole is very complex and often involves efforts to appease numerous stakeholders. The National Institute of Health record has identified significant increase in healthcare costs over the years. Such increases include traditional operational expenses and also pharmaceutical research and development (National Academy Press 2001, pg. 2). In order for a healthcare company to remain profitable significant efforts must be made to develop its most significant asset, the employees.

In order to create and sustain an environment of safety and value organizations must carefully assess internal and external relationships. An example of an external relationship would be how the organization engages community and patient shareholders. Internal relationships would include an assessment of how physicians and nurses engage one another. Critical research questions include, “How much do physicians respect nurses and vice versa. At the surface level nurse abuse can appear to be isolated and an issue requiring minimal focus. However this report acknowledges the fact that there are systemic issues that must be addressed. Failure to appropriately address issues like nurse abuse can lead to staff burnout, high turnover rates, fiscal impact, and patient safety issues.

Within the context of discussing the aforementioned issues the report also seeks to carefully examine group dynamics. According to one report productivity and performance has historically been a significant focus of organizational behavior literature. This is especially important in healthcare as the continuum of care involves physicians, nurses, and a growing number of specialists. Two proposed group structures are egalitarian or hierarchical organizations. Generally a hierarchical structure is understood as a multi-tiered form of management. In this type of structure power is positional and naturally there is a correlation between the level of feedback and associated corporate position. In contrast an egalitarian style position is defined as one where all individuals are equal. Naturally it is assumed that in egalitarian system collaboration and engagement levels are higher.

It should be noted that hierarchical structures enhance coordination of efforts and could even be considered more systematic. Many organizations can attest to the fact that the improved coordination results in enhanced performance on established metrics. However, those supporting an egalitarian group would argue that similar coordination can occur in that setting. On philosophy is that satisfaction level can be identified based on the engagement of personality and organizational structure. In fact every organization should seek to find a reasonable measure of compatibility between organization and personality structure. This is because higher productivity and personal employee satisfaction are more likely (Edge & Remus, 1984).

Another component of organizational success is found in the practice and the study of six sigma principles. There was a study that took place where data was collected from a sample of 226 manufacturing plants. The implementation of six sigma addresses two areas of concern for healthcare organizations including quality practice and cultural implementatio