Scenario Healthcare management professionals should not take lightly the intrica

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Scenario Healthcare management professionals should not take lightly the intricacies involved in delivering healthcare services. Regulations, third-party payer requisites, licensing, and accreditation standards contribute to these intricacies. The use of official policies and standardized procedures can mitigate the complexity by promoting workplace safety, regulatory compliance, and the delivery of safe, high-quality patient care. (Irving, 2014) In this scenario, you are a new program administrator of an outpatient chronic wound care center. You have held your role for a little over one year, and you manage a staff of 14 that consists of front office personnel, billing personnel, medical assistants, nurses, and several physicians. The wound center uses formalized, written policies and procedures that fulfill a number of important purposes such as: • Facilitate adherence with recognized professional practices. • Promote compliance with regulations, statutes, and accreditation requirements, including HIPAA, EMTALA, CMS Conditions of Participation, and the Joint Commission. • Reduce practice variation. • Standardize practices across multiple wound clinics within a single wound care management company. • Serve as a resource for staff, particularly new personnel. • Reduce reliance on memory, which, when strained, has been shown to be a major source of human errors or oversights. (Irving, 2014) Recently you have been approached by staff members who have expressed concerns about one of the wound center physicians. The medical assistant mentioned that several patients have complained to her that the physician seems in a hurry and does not listen to their concerns. One of your nurses also stated that several patients have complained of increased pain after treatment and that their wounds appeared worse. Your clinical nurse leader has expressed that the physician is not documenting his clinic procedures daily. In fact, sometimes several days pass before he completes his notes in the patient’s medical record. Additionally, the billing associate has complained that the physician has not been filling out the procedures and diagnosis codes on the Superbill for each patient visit for reimbursement. In the last month you also have received several phone calls from the hospital’s outpatient billing department notifying you of payment denials on several wound center patient accounts. You decide to review the physician’s healing outcomes in the center’s clinical database and discover that his healing rates and quality indicator scores are far below the standardized expectations. Many of the physician’s entries in the patients’ charts are incomplete. As you review the physician’s documentation further, you see that his poor outcomes have been an ongoing trend intermittently over the last several years, and that he was counseled twice in two years by the former wound center administrator. After being counseled, the physician showed a slight improvement in outcomes and quality indicators each time. Subsequently, within several months after each counsel, a downward trend in quality measures reoccurred. Patient volumes are at an all time high in the clinic and the physician seems stressed. Patient satisfaction scores are declining. The purpose of developing this portfolio project is for you to demonstrate your leadership skills and knowledge as a health care administrator/manager in the areas of: trends and challenges that exist in health care management; the basic management techniques utilized in health care organizations; the role that communication plays in a health care organization; and the financial responsibility and budgetary process in health care. Your project will discuss issues and solutions in the scenario relating to: • Delivery of evidence-based health care treatment • Quality improvement processes • Financial improvement/costs reduction • Effective communication • Formalized written policies and procedures The intended audience is your wound clinic physician, the clinical nurse leader, and the hospital executive team that includes the hospital’s President or Chief Executive Officer (CEO), Chief Nursing Officer (CNO), Medical Officer, Chief Financial Officer (CFO), and any other senior management team members you deem necessary. Scenario reference citation: Irving, Anne. (2014, October 13). Policies and Procedures for Healthcare Organizations: Risk Management Perspective. Patient Safety & Quality Healthcare (PSQH). https://www.psqh.com/analysis/policies-and-procedures-for-healthcare-organizations-a-risk-management-perspective/ Directions Applying the information shared in the scenario above, each week you will analyze and critically evaluate the wound care center in written format to eventually provide a cohesive report that addresses actions, recommendations, the role of communication, finance, patient safety, quality of care, and policies and procedures. It will be important to support your findings with scholarly resources pursuant to each required deliver . Points to include as you write your report: • Identify the problem(s) • Provide immediate and long-term actions to address issues • Outline basic management techniques you would use in addressing the issues in the scenario • Technology and resources you used to evaluate the information needed to address the problem Write a 250-word report to the physician, nurse clinical leader, and hospital executive team that describes the role of communication in addressing the issues described. Use at least one scholarly reference in your report to support your assertions. Points to include as you write your report: • Communication methods used with physician, nurse, and hospital executives • Listening skills used o Hint – think about “Soft Skills” which are a combination of people skills, social skills, personality traits, attitudes, and social and emotional intelligence that help individuals navigate their environment, work well with others, perform well, and achieve their goals • Managing patient complaints, concerns, and patient satisfaction o Hint – Healthcare organizations have processes for addressing patient complaints and grievances to follow federal regulations and accreditation standards, as well as to protect patients and reduce liability. Current trends in healthcare such as patient-centered care and patient satisfaction data make seeking and responding to patient feedback increasingly important components of risk management and patient safety programs. For example, patient complaints are associated with both clinical complications and increased risk of malpractice litigation.

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