Introduction
The Cooper Green Mercy Hospital and Community Care plan is a self-governing non-profit organization which had the highest standards in communal 24 hour 7 days a week medical care provision. Led by Doctor Hullett the hospital is devoted to the provision of a complete range of high-quality inpatient and outpatient healthcare services for the community. A chief executive nurse in the hospital was designated to be directly answerable to the CEO and the county governing body. This structure was set to bring about superior nursing care. “The hospital provides care for newborn, pediatric, adolescent, adult and geriatric patients with critical, acute and chronic conditions including, but not limited to: General-Medicine, Surgery, and Palliative Care, Neurological, Orthopedic, Trauma, Obstetrical, Gynecology and Critical Care, Inpatient and Outpatient Surgery” (Swayne, 2007).
Overview statement
The current Mercy Hospital which was formerly the Cooper Green Hospital (CGH) was built in the year 1972 by the Alabama state in conjuction with Hill-Burton funding. The sole reason why it was built was to serve the impoverished citizens of Jeffersons’ county with quality services irrespective of their ability to meet their hospital bills. Because of its tolerances in treatment costs, it did experience an influx in both inpatients and out- patients. As aresult, the staff became overwhellemed in terms of provision of services, the facilities too became overstreched. The hospital tried to curb this problem by setting up community care clinics. However, the hospital is facing challenges; one of it being the lack of awareness among the citizens and the second one is the diminishing of the funds allotted for the Community Care Plan (CCP) program.
In the center of this dilemma is the current CEO, who is faced by the challenges of development of the program, retaining the present clinics or the terminating the program all in all. The predicament that is currently being expirienced is that the hospital is about to be sold due to the loses being encountered by the county.
Background statement
The former Cooper Green House hospital is working under the tutelage of a CEO Dr Michael who was formerly chief of staff of the same. Dr Michael assumed office in the year 1992 after a promotion. Dr Michael has for the recent past experienced unabated headache over the growing numbers of inpatients and out-patients in the hospital. He is also faced with overstretched facilities coupled with understaffed personnel.
The hospital has been under pressure for a long time to deliver quality services to the inflating population of the locals and this leads to increase in costs of operations. This forced the hospital to effect cost reduction strategies which included retrenching of staff among others. One day while on duty; Dr Michael met a patient diagnosed with respiratory tract infection which had become severe due to laxity by the patient to receive treatment. Upon scrutinizing the patient, Dr Michael realized that the patient lacks knowledge of the functions of the existing community care clinics. Otherwise, the treatment would have been sought long before at its early stage. It then dawned to Dr Michael that patients’ awareness of the functions of the existing Community Care Plan (CCP) was essential.
Dr Michael initiated the revolution of Cooper Green Hospital to Jefferson Health System (JHS) which executed its roles under two plans. Health first and Community Care Plan (CCP) with the former established on the basis of financial strength of the locals, and the later addressing the need for affordable and accessible medication under prepaid membership plan. Dr Michael wanted to make CGH the hospital of the choice in terms of quality services and cost effectiveness.
Community Care Plan is a program launched under a five-year funding program to put to rest the problems haunting Dr Michael. The Community Care Plan did set up clinics within the vicinity so as to enhance an easy access to medical care and treatment. What a patient ought to do is to register with the CCP at a fee which is paid on quarterly basis. Upon submission of a quarter registration fee, a patient is liable to receive regular medical care at the Community Care Plan clinics. The CCP offered services at the patients’ disposal thereby minimizing time wastage and fatigue with respect to the patient. The Community Care Plan program funding was however limited to half a decade and the period was elapsing. This added to Dr Michael’s long list of predicaments and he was consequently torn between expanding this program and terminating the same.
Role identification
Taking the role of a consultant I will try to seize this situation outright by advising Dr Michael.
Major problem and secondary issues
According to the CEO Dr Michael, his core problem lies on the lack of funding coupled with the skyrocketing operational costs. Dr Michael who was at the helm of the administration felt the weight of swelling population of the Jefferson’s county locals. He felt his staff was overburdened by this surge in patients and again he could not meet their needs in terms of medication. Dr Michael goes a head to score in his own net by retrenching his personell among other cost cutting strategies in an effort arrest a hike in operational costs.
Dr Michael envisioned a CCP program that would be self-sustained by the end of the funding program. He was expecting to generate revenue by the virture of the high turn-out of registered members in the CCP program to enhance the program to run autonomously. Unfortunately, due to the high number of 1000 members per CCP clinic his anticipation was not achieved by the end of the funding proogram in most CCP clinics. On inquiring the reasons behind this low turn-out, it explicitly dawned on him that enrollment to health care programs’ is not the residents priority since they are faced with a lot of challenges. Dr Michael realized that the community encounters insecurity issues, housing problems among others which are on top of their priority list.
Another predicament that has been faced by the hospital for a long time is that commisioners at the hospital were used to employing friends and relatives without any accountable process. This was again responsible for the provision of poor services and mismanagement of funds.
Organisations strength and weaknesses
Cooper Green Hospital was formed to address health issues of the poor Jefferson county community. CGH had this in mind: provision of affordable and accessible medical care as well as quality services especially to the poor individuals. CGH wanted to be a hospital of ‘last resort’ according to the CEO, Dr Michael. Irrespective of the patient’s ability to meet his /her medical bills, he/she is liable to quality medication. This made the hospital to be one of a kind and attracted many patients culminating to high operational costs.
CGH under the management of Dr Micheal boasts a great deal of resources. Behind Dr Micheal there was a dedicated team of a of a few physicians, “assistant physicians, certified nurse midwives, nurse anesthetists and clinical nurse specialists” (Ginter, 2007). The CGH hospital also enjoys benefits from the policies set by the federal government e.g. Medicaid which funds the state run programs. There is also the ‘Balanced budget act’ which compensates for the medical care for patients’ who are under the age of 19 years. CGH hospital enjoys medicare established under ‘Social Security Act’. “The medicare was established in 1965 to ensure medical coverage for the aged and disabled” (Jills, 2004). The Alabama environs is also greatly diversified in terms of economy. It was “once known as centre of the steel-making industry, Jerfferson County, Alabama, boasted a diversifiied economy by the 1990s” (Duncans, 2007).
Cooper Green Hospital sits on a gold mine environment since it has a rich vicinity in terms of economy. The few affluent citizens of the county can help boost the funding of the program which is on the threshold of collapse. The poppulation of the Jefferson County is a big incentive to the CCP program which can enhance it run independendly. However, these opportunities cannot be realised if the issues of insecurity and housing cannot be delt with absolutely. Most Alabama residents lacked health insurance cover and when inquired, “the low-income residents overwhemingly listed crime, violence,and drugs as their priority issues” (Dubay, 2000). If these issues are not tackled with haste, then probablythe hospitall will have no choice but to shut down the entire program and the whole system will be rendered a sham. It will fail to meet it’s expectations and hence collapse.
Alternative course of action
The hospital is in a crossroad. It is supposed to ensure an easy access to cheap medical care for the growing number of the Jefferson County residents. Under the ‘Managed Care Policy’ watchdog, Dr Micheal must “cut down health care cost” (Baker, 2007). This reduction in health care costs has a negative effect on the program since the poppulation is rising. Dr Micheal has an option of maintaining the existing CCP clinics but then he must bear in mind the poppulation growth index.
The method that I would use to evaluate the best option to be applied by the CEO will therefore be ethical analysis. As stated by Moberg, “the current management focusses on the value of outcome rather than on the value of the means chosen” (Moberg, 2001). Therefore, it follows what is essential to focuss on the results. I will bias my analysis towards utiliterian theory model of approach. In a nut shell, this theory “holds that actions and plans should be judged by their consequences” (Sidgwick, 2004). According to Sidgwick again, decision architects should weigh their options and find the best way to satisfy the majority. I also believe the utiliterian theory option is the best suited for this situation because it “encorages entrepreneurship, innovation and productivity” (Moberg, 2001). Just like a perfect competition, in utiliterian theory, the final decision is a compound of individual decisions. According to Moberg, utiliterian theory “facilitates calculative shortcuts” (Moberg, 2001). These advantages makes utiliterian option the best option for this scenario. As shown by Moberg, the main obstacle of the utiliterian theory is that: “it can result to unjust allocation of resources’ and is virtually impossible to assess the effects of a PBA” (Moberg, 2001).The other options at Dr Micheal’s disposal are; ‘Theory of rights’, which is not convenient with respect to this situation because it is based on the legal issues. However, the advantage of this theory is that “it specifies minimal level of satisfaction” ( Beck, 2006). Another option is ‘Theory of justice’ which is basically based on justice and hence irrelevant in this case.
Another cause of action is the provision of accountable management that would block commisioners in influencing unethical decisions at the hospital. The hospital books should again be provided to the public so that there can be proper accountability. This is so since the hospital runs partially on public funds.
Plan of action
According to utiliterian theory, the course of action to be taken should be such that it simplifies the difficulty of the process. It should first of all “adopt some ideological system that reduces ellaborate calculations of intrest to a series of utiliterian rules” (Mill, 2003). The second course of action to be taken by the CEO is that he should fomulate a framework of assessing the parties involved. The final action is for the CEO to “make bounderies on the utiliterian calculations” (Lyons, 2003). Under these guidelines the CEO will come up with a concreate decision since this option will enable him weigh the consequences of his actions in an appropriate way.
Evaluation
For the hospital to assess the reliability of its methods it should therefore carry out statisics on the impact of the program to the residents of Jeffersons county. The Ceo should assess the plan of action relative to it’s consequences and hence make a viable verdict.
Conclusion
Currently the hospital is about to be sold. It is said that the county does not need a county-owned-hospital, but instead it needs health care for the indegent. It is true that the hospital has been providing cheap health care for poor patients for a long time, but due to unaccountable management the hospital is down on its knees. Therefore the many clinics that are branched from this hospital cannot be run effectivily due to the problem of inavailability of resources. Although incentives have been put in place to inject public funds in an attempt to revive the clinics and the hospital’s entire programs, lack of accountability has made patients pay twice as much for medical care. In a synopsis the hospital cannot easily recover from the its predicaments that are lack of stocks, being understaffed and a swarming outpatient clinic.
Refferences
Baker, L. (2007). Managed Care, Health Expenditures, and Medical Technology. Journal for Health Research and Policy Research 23 (3), 62-69.
Beck, G. (2006). Immanuel Kant’s Theory of Rights. London: Oxford University press.
Dubay, L. (2000). The uninsured and the affordability of health insurance cover. A journal for Health Affairs 15 (4), 254-293.
Duncans, J. (2007). Strategic management of health care management. New York, NY: Oxford university press.
Ginter, P. (2007). Health care management. London: McGraw Hill.
Jills, Q. (2004). The Color of Welfare: How racism undermined the war on poverty. New York, NY: Oxford University Press.
Lyons, D. (2003). The forms and the limits of utiliterianism. London: Oxford Clarendon Press, 1965.
Mill, J. (2003). Utiliterianism. New York, NY: Prentice hall.
Moberg, D. (2001) The Ethics of Organisational Politics. New York, NY: Oxford University Press.
Sedgwick’s, H. (2004). Methods of health Ethics. Journal of health ethics, 19 (2) 62-87.
Swayne, L. (2007). Cooper Green Hospital and Community Care plan. London: McGraw Hill.