NHS FPX 6008 Assessment 3 Developing an Implementation Plan

Developing an Implementation Plan for an Economic Initiative

Separate diabetes unit in Raulerson Hospital

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

Raulerson Hospital is a large medical institution, which is aiming to provide high quality care by including a diabetes care unit in the campus by adopting a feasible budget and economic model that addresses economic initiatives and dynamic environmental forces (Saeedi et al., 2019). The purpose of this paper is to create a five-year budget for the expected costs, earnings, and funding to establish a separate diabetes unit and develop an implementation plan, analyze its impact, and explain strategies to make the initiative an asset to the organization by addressing dynamic environmental forces. 

Budget estimation

Based on the previous analysis of new economic opportunity for the Raulson Hospital, it is evident that the unit does not require a budget for the plot of land as it was proposed to use the existing land in the campus to construct the diabetes unit. Further, the costs of equipment, staff, materials, capital costs, and other costs will be considered by using statistical projection of costs in the future, possible adjustments, existing issues and resources, short-term and long-term goals and investments, federal regulations, and ever-changing health care costs for diabetes (Lyford & Lash, 2019). 

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

The budget related to earnings and revenue will be calculated by using projected care costs, number patients per year, performance or revenue in the current and previous year, prevalence of diabetes in the community (Koch-Weser et al., 2019), and reputation of the hospital in the community as it was highlighted in the previous paper that, “Raulerson Hospital is located in Okeechobee, which has a population of 5,724 according to the 2019 census. In 2019, the total prevalence of diabetes worldwide was seen to be 9.3% (Saeedi et al., 2019). Going by that rate, it can be seen that around 530 people are diabetic in a city with a population of 5,724 people.” 

The diabetes prevalence rate highlights that revenue will increase each year as patient count is increasing. This creates a need for increased staffing and material procurement (Shakya & Plemmons, 2020). Thus, projected health care staffing cost along with probable salary hike and staffing requirement will be considered along with training costs for novice nurses and paid leaves including education sponsor for health care professionals (Chattopadhyay & Zangaro, 2019).    

Budget for expected costs and earnings over the first five years

FY 2022YEAR 1 (Thousands)FY 2023YEAR 2 (Thousands)FY 2024 YEAR 3 (Thousands)FY2025 YEAR (Thousands)FY2026YEAR 5 (Thousands)TOTAL (Thousands)
Opening Cash Balance500.0018753542.45283.87013.8
Fund Received225
Loan225
Operating Receipts
Patient Service Receipts(UCC)3250348036543764392018068
Total Receipts3250348036543764395218068
Operating Payments
Staff Salaries102512501375150015006650
Basic Utilities6062656665348
Insurance151517181868
Other Operating Payments3753804004004001595
Total Operating Payments147517071857198419839006
Operating Surplus/Deficit177517731797178019699062
Nonoperating Payments
Annual Loan Repayment55.655.655.65050266.8
Total NonoperatingExpenses55.655.655.65050266.8
Investments
Construction, Furniture,and Equipment40050
Cash Surplus/Deficit13751667.41741.4173019198932.8
Closing Cash Balance18753542.45283.87013.88932.88932.8

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

The above budget was created to exhibit projected revenue, expenses, and economic growth of the organization over five years from 2022 to 2025. The diabetes care unit was constructed on the organization owned land, but the building and equipment cost was $400 thousand. It was expected that it is difficult to exactly predict the cost and varying equipment cost (IQVIA, 2021). Hence, 5% increase in equipment cost and 3% possible losses due to delayed construction or increased pay or expenditure to finish the process within the time limit of one year was considered (Haque et al., 2021). As a result, $50000 was added as equipment costs in FY 2023. The unit is expected to finish by the beginning of FY 2022 and all equipment was procured within the first quarter. As it is expected that 1st year might not include high patient count, the revenue was limited to $3250 thousands considering 3 to 5% increase in health care costs from 2021 considering $100 as fees. It is also expected that the unit will be fully functional from the third quarter of FY 2022. 

Further, by considering diabetes prevalence rate, 5 to 10% increase in patient count and health care cost is considered (Sathe et al., 2016). Thus, the revenue increased in subsequent years. When it comes to the expenses, basic utilities are considered to vary slightly initially and use of energy efficient and sustainability systems will reduce the cost in the future. Thus, in FY 2025, the cost was $65000. The other operating expenses included marketing, sponsorship, and public awareness programs along with administrative expenses. The cost increased considerably from FY 2022 to 2024 as it is a new unit. However, a better reputation reduces operating cost, thus, the value stays the same at $400 thousands from 2024. 

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

The insurance and staffing cost correlate as they both change with the number of patients and nurse staffing needed. Based on report by U.S. Bureau of Labor Statistics, indeed, Medscape, Glassdoor, Payscale, and other portals, the average salaries for full-time physician, nurse practitioner, medical assistant, receptionist, EHR nurse, and nurse specialist are $294,000, $124,000, $39,000, $35,000, $44,000, and $79,000 respectively (U.S. Bureau of Labor Statistics, 2021). The total salaries were calculated by considering nurse to patient ratio and 1.5% to 10% hike every year based on experience, performance, and salary growth rate (Moucheraud et al., 2019; NurseJournal, 2021). As the number of patients are expected to increase by 2024, more nurses will be recruited, which increases the cost. 

The loan repayment of $55.6 thousands is considered for the first three years to set the loan repayment of $50 thousands from 2024 onwards to reduce interest amount on loan from 2024. Thus, loan repayment value reduced significantly after three years. Based on all of the calculations, the unit showed excellent growth with an expected cash surplus of $8932.8 thousand after five years. 

Implementation plan rollout, stakeholders involved and ethical and cultural consideration

    The timeline or rollout starts from implementing the planning and communicating phase, which will take one month from June 2021 to July 2021. The management will approve the project and an audit will be conducted from July to September to allocate funds and consider mitigation plans. The construction will take 6 months and the unit starts to function from April 2022 with limited functionality and resources. By the end of June 2022, the unit will be fully functional. To reduce administrative hassles, a bi-weekly discussion and progress analysis will be conducted for the first two months where involvement of administration, nurses, physicians, pharmacists, medical equipment suppliers, and lab managers will be included. Both internal and external collaborators will be included in the shared decision-making process (Clapper, 2018). This will aid in responsibility sharing and outcome analysis, which is critical in providing timely reports to all the stakeholders to increase sustainability (Norris et al., 2017). 

Stakeholders such as patients and nurses are the central part of the implementation process. Thus, all the objectives, vision, planning, progress, and goals will be communicated to everyone to achieve sustainability. Further, cultural and ethical considerations such as using the funds efficiently, following the federal regulations, staying loyal to the community by integrating culture-based and culture sensitive care, timely and quick care, ease of access to all irrespective of race, religion, gender, sex, age, color, disability, culture, and other characteristics to create an inclusive Raulson diabetes care unit (Koskenvuori et al., 2017). Further, it is aimed to provide cost-effective care with high-quality services to follow ethical practice models. On top of that, all health care professionals will be treated respectively with better work to life balance, safe space, better salary, insurance, and other incentives to support sustainability and empower stakeholders involved (Hashish, 2015). 

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

An audit system will be implemented to efficiently use spending, pay loan in time, and use funds to extend the services if required. The services might include adding facilities, testing centers and labs, specialist nurses, training and teaching programs, and hiring more nurses to provide care for high in-flow of patients by maintaining good nurse to patient ratio and reducing burnout in nurses (Blouin & Podjasek, 2019).   

Analysis of the impact of your proposed initiative

By implementing the diabetes care unit, overall reputation and service offered by the organization increases as patients can access different facilities on the same campus. For example, diabetes testing will be necessary in most units including cardiovascular care, end of life care, pediatric units, and other units (Koch-Weser et al., 2019). This reduces difficulty in accessing services and thus increases patient satisfaction. The revenue from the unit positively impacts other units and their expansion. It is also expected that negative impacts such as increased work burden on nurses to order and interpret test, burden on pharmacist and other health care professionals to coordinate between different units, and staffing issues such as staff borrowing, rescheduling, and increased in-flow of patients in particular unit affects the outcome negatively (Blouin & Podjasek, 2019). Further, it becomes critical for the healthcare organization to provide better guidance as older and disabled patients might find it difficult to commute between different units to get tests done and get treatment. These negative effects need to be addressed. 

The strategy to reduce work burden and burnout in nurses is to increase nurse to patient ratio and include flexible scheduling to prevent any borrowing. This further addresses the issue of handling high in-flow of patients (Blouin & Podjasek, 2019). It is important to recruit more nurses including assistant nurses in units where workload and burnout is high (Hashish, 2015). Further, the community might find it difficult to find and access different units. Thus, call support or hotline along with GPS-based unit location, pamphlet and direction marking on buildings will increase ease of access. The issue of commuting between units for elderly and disabled can be solved by ward boys who coordinate between units and assist patients in getting tests and reports done.  

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

Strategies to address dynamic environmental forces

There are different environmental risks that might affect the proposed initiative. The very first issue is maintaining the demand and supply chain as at times suppliers might not provide required materials and equipment in time. The second risk is the need for IT systems and community management to manage the increased patient counts as the community prefers to opt for health care, which offers all the needed services (Lenz & Reichert, 2017). The third risk factor is related to pandemic where risk of infection spread increases due to crowding (Lodhi, 2020). The fourth risk factor is availability of other diabetes care units within the vicinity of the organization, which might affect the patient in-flow and revenue. 

Even though the risk of supply chain management is there, efficient stocking and resource management prevents shortage of supply for a long time as it uses dynamic stocking to reduce the gap between supply and demand. The issue of supply and demand can be solved by implementing a resource management unit, which communicates with suppliers to keep steady flow of supply. The aspect of large health care networks, HIPPA compliance, and community education aid in addressing IT systems as the revenue helps in investing the share in deploying IT units to increase patient support (Chen & Benusa, 2017; Lenz & Reichert, 2017). This strategy overpowers other diabetes care units that cannot integrate IT framework in their setting. The aspect of pandemic can be addressed by using large campuses to maintain safer distancing, masks, sanitization, vaccination, and spreading awareness (Lodhi, 2020). However, social distancing is not viable for other competitors as they lack space to accommodate patients. The aspect of affordable care, availability of different services, and reputation has an edge over other diabetes facilities within the vicinity. 

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

References

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Chattopadhyay, S., & Zangaro, G. (2019). The economic cost and impacts of scope of practice restrictions on nurse practitioners.

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Clapper, T. (2018). TeamSTEPPS® is an effective tool to level the hierarchy in healthcare communication by empowering all stakeholders. Journal Of Communication In Healthcare11(4), 241-244. https://doi.org/10.1080/17538068.2018.1561806

Haque, W., Demidowich, A., Sidhaye, A., Golden, S., & Zilbermint, M. (2021). The financial impact of an inpatient diabetes management service. Current Diabetes Reports21(2). https://doi.org/10.1007/s11892-020-01374-0

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

Hashish, E. (2015). Relationship between ethical work climate and nurses’ perception of organizational support, commitment, job satisfaction and turnover intent. Nursing Ethics24(2), 151-166. https://doi.org/10.1177/0969733015594667

IQVIA. (2021). Diabetes costs and affordability in the United States. Iqvia.com. Retrieved 3 July 2021, from https://www.iqvia.com/insights/the-iqvia-institute/reports/diabetes-costs-and-affordability-in-the-united-states.

Koch-Weser, S., Chui, K., Hijaz, S., Lischko, A., & Auerbach, D. (2019). Investigating consumer hospital choice: Demand and supply-side levers could address health care costs. Healthcare7(3), 100353. https://doi.org/10.1016/j.hjdsi.2019.01.001

Koskenvuori, J., Numminen, O., & Suhonen, R. (2017). Ethical climate in nursing environment: A scoping review. Nursing Ethics26(2), 327-345. https://doi.org/10.1177/0969733017712081

Lenz, R., & Reichert, M. (2017). IT support for healthcare processes – premises, challenges, perspectives. Data & Knowledge Engineering61(1), 39-58. https://doi.org/10.1016/j.datak.2006.04.007

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Norris, J., White, D., Nowell, L., Mrklas, K., & Stelfox, H. (2017). How do stakeholders from multiple hierarchical levels of a large provincial health system define engagement? A qualitative study. Implementation Science12(1). https://doi.org/10.1186/s13012-017-0625-5

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

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