Decision Making Case Study HCS/514 Managing in Today’s Health Care Organizations Instructor: Darlene Cantu Camille F. Fuller Decision Making Case Study Health care is one of the largest growing industries in the country. Technology and medical advancements attribute to the constant changes in the health care industry. The economy also continues to change, and with the changing economy health care cost continue to rise. Companies across the nation have either closed or moved to other countries. El Paso County Clinic is struggling to keep the doors open.
Buduget cuts have affected the clinic tremendously. The El Paso County Clinic’s budget has been cut by 15%. The population affected by the budget cuts are Medicaid recepients. Medicaid recepients have a two-fold problem; reduction of benefits, and the reduction of services at the clinic. El Paso County Clinic’s recent budget cuts will force the administration to reduce and eliminate services. The El Paso County Clinic must address the current budget cuts by reducing, and or eliminating services, and continue to provide quality health care.
The El Paso County Clinic has appointed a team to address the budget cut issues. The team will use the Informed Decision Toolbox to decide what is best for the clinic and the clients. The first step is to frame the question. The team will gather necessary information and frame questions regarding which services to eliminate, and which services to reduce. In framing these questions the specifics must be stated. What are the most utilized services in the clinic? How will service cuts and elimination affect the clients? What services can be outsourced to other facilities that accept Medicaid?
Can lab test, and or raidology be outsourced? Are there any jobs that can be combined without affecting quality services to the clients? Specific questions pertaining to nonessential personnel. Can the custodial personel be downsized? Do the Medicaid recipients of the clinic have other resources available to them? What is the average patient visit time? Can the clinic afford to cut down the patient visit time? Can the clinic operate under shorter office hours? Step 2, after framing the questions is finding sources of information.
After carefully examining the information concerning the budget cuts, the team will make a list of avenues to investigate to gather necessary information. Each question asked should have evidence based information from creditable sources. The information can come from employees, patients, suppliers, and the surrounding community. “The focus of the Informed Decisions Toolbox is on finding research evidence. Colloquial evidence can be obtained from the experience and judgment of colleagues, friends,customers, suppliers, and others.
Information provided in organizational reports, trade journals,strategic planning sessions, offsite retreats, office meetings, and other settings may provideuseful colloquial evidence” (Rundall, 2007 pg 335). Step3-5 consist of evaluating the evidence found to support the questions to support the informed decision. The accuracy of the information gives the team a base for making a good decision. The information should be applicable to the questions asked by the team. Information that is not applicable is not relevent, therefore hinders the informed decision. The information gathered by the team should be able to be put into action.
The actionable information should be able to give the team projected outcomes within set timelines. When the team evaluates the information the team should also assess each point researched. For example, is the accuracy of the information applicable and actionable to the questions asked to come to an informed decision? Step 6 is the final step in Rundall’s Informed Decision Toolbox. The team must determine the adequacy of the information gathered for the needs, values and context of the organization. The decision made by the team will affect the final outcome of the budget.
The outcome of the decision will also affect the services of the clinic and the patients, therefore the accuracy of the information must fall within the guidelines set at the begining of the informed decision process. The Informed Decision Toolbox is used to assist decison maker in making the appropriate decisions pertaining to the budget cuts in the clinic. The decision must also meet the needs of the patients patronize the clinic. The most useful tool in the process is framing the question. Framing the questions direct the team to carefully look at the functionality of the clinic.
Framing the question also causes the team to analyze each service and process within the clinic. Framing the question also assist the team in uncovering processes, and resources that can be either restructured or eliminated. Framing the question can also lead to other questions pertaining to the same situation but more indept. For example, what services can be outsoures? The question forces the team to examine all services within the clinic leading to more questions. Framing the questions makes the team accountable for the information gathered to make the informed decision. The team is accountable to one another as well as the clinic.
Framing the questions demonstrates the importance of research and accurate information. Based on the budget cuts the goal of this process is to assist decision makers in making the appropriate budget cuts, however still meeting the needs of those who are serviced by the clinic. The step that has proven to be most useful in the process is step 1: framing the question. Framing the question will force decision makers to actually evaluate what it is that they would like to accomplish, as well as look at the organization with a microscope to determine the questions that need to be asked.
This can lead to additional questions that can be valuable and also with asking the questions, this can lead the organization to accountability, as well as knowledge transfer. For example, the questions can lead to answers within the decision making team that will lead them to become accountable to one another and the organization. The knowledge transfer is also a result because the questions are the stepping point to gain the necessary knowledge. Step 1 is also an example of why it is important ask and research the questions.
As a result of the decision makers using the informed decisions toolbox, decision makers were able to make several final decisions that will allow for the clinic to still service the patients and work within the budget constraints. The decision makers reduced the level of services provided, as in the past they would see all patients that would come thru, and now a program has been implemented that has limited the services to the following: Minor cuts, sprains, ear infections, sore throats, cold symptoms, flu like symptoms, flu shots and all other minor health issues.
All emergency criteria patients are immediately referred to the nearest emergency department at the local hospital. Also, the clinic went from a six day schedule to a five day schedule thus reducing overtime. All laboratory work which was done in house has now been outsourced and the lab can bill directly to Medicare. This helped with the budget cuts and the turnaround time was more efficient then what was being done in house. The lab is within short walking distance of the clinic to service patients.
The laboratory technicians employed by the clinic were employed by the new lab working with the clinic so no layoffs were involved. The utilities were also reduced as a result of the lab closing. Janitorial services were also reduced by 16% going from a 24 a day monthly schedule to a 20 day monthly schedule. Employees were called together explaining the issue of the budget cuts and as a result there would be a freeze on raises until further notice, however no layoffs would occur.
This was a decision that was well received by the employees realizing how the state of the current economy and the impact on the health care system. Utilizing the informed decision toolbox focuses decision makers to dig for the facts. When facing budget cuts as many agencies have with the state of the current economy it seems that it would not be as challenging to go through and make decision based on cost and what impacts the bottom line. The issue is often the impact is greater than just making a decision. It is crucial to look at the big picture and have all the facts before making decisions.
It is also not effective to make to make reactive decisions; rather make decisions that will impact the long term gain of the organization well maintaining the mission, values and goals. References Rundall, T. G. , Martelli, P. F. , Arroyo, L. , McCurdy, R. , Graetz, I. , Neuwirth, E. B. , Curtis, P. , Schmittdiel, J. , Gibson, M. , & Hsu, J. (2007). The Informed Decisions Toolbox: Tools for Knowledge Transfer and Performance Improvement. Journal of Healthcare Management, 52(5), 325-342. Liebler, J. G. & McConnell, C. R. (2008) Management Principles for Health Professional (5th ed) Sudbury, MA: Jones 7 Bartlett