Assignment - Reading Rehabilitation Hospital: Implementing Patient- Focused

Care

Group 5

Kaberi Malakar

Krishnapriya Baby

Manvendra Singh

Nimisha Verma

Pratik Rungta

Question1.

Who are RRH’s stakeholders? What do they want from RRH? How do they define
quality?

Answer 1.

The various stakeholders of RRH are:

· Patients - They want quality treatment. Quality includes proper care and services
and good cost-effective treatment.

· Therapists – They want perks and salaries and good work environment. They
determine quality by their work satisfaction.

· Nurses - They want perks and salaries and good work environment. They
determine quality by their work satisfaction.
· Other staf - They want perks and salaries and good work environment. They
determine quality by their work satisfaction.

· Insurance Companies – They want good business prospects. They determine

quality by the revenues generated.

· Other acute care hospitals - They want reduced competition.

· Corporations and federal government- Medicare and Medicaid. They make

policies regarding licences and bill payment under schemes.

Other stakeholders include trauma centres, nursing homes, social workers,

Seventh Day Adventist churches etc.

Question 2.

What are the benefits of the new system in which care delivery is organised
around diagnosed or “service line” in comparison with the old system where
patient care was organized by function?What are the drawbacks?

Answer 2.

Benefits -

· Reduced time in stay of patients at the hospital and no post posting of their
discharge

· Costs burden reduced on patient’s shoulders due to reduced time in

treatment

· More emphasis on patient’s need and convenience rather than caregivers

· Diversification of services started being offered

· ‘Patient-focused care’ approach due to which the entire service line was
located on the same floor
Drawbacks-

· RRH fall short of its therapist utilization target

· Less time spent on team conferences, patient evaluation and patient

documentation

· Significant variation in the average earnings of the hospital

· The therapists were now involved with only one kind of patient and thus it
difficult to fill their name

· Variability in patients visits due to which it created problem in staff

positioning

· They were eventually losing efficiency in the treatment of patients

Question 3.

At 116 therapists is RRH overstaffed? How many therapists would you hire?

Answer3.

By referring to Exhibit 3, we can note that the RRH was performing well and
good as compared to the national benchmark. Patient’s felt happy and satisfied
after being treated at RRH. But, the service line showed underutilisation on
part of therapists, nurses and other hospital services. They cannot reduce the
number of therapists as the number of patients varied a lot on a daily basis and
require proper attention. What the hospital could do instead was more
utilisation of their staff capacity and less manipulation of staff time. RRH
should stop limiting just 19 beds to be the skilled nursing unit for less acute
patients but should change as per demand.

Question 4.
Should RRH keep service line, or return to the earlier way of organizing care
around functions?

Answer 4.

As the demand for service in RRH was totally upon referrals by physicians and
acute care hospitals. RRH could not predict the number of patients per service line
or the length of a patient stay until they received the referral, RRH had to keep
excess staff on duty, which kept RRH’s operational costs the same even when the
demand for service was low. Nursing staff was managed in a cost efficient manner
by part time contracting and they were sent home when the patient census was
low, because the supply of nurses was plentiful in the area at the time.
Manipulating the nursing labour hours was the only method RRH had for short-
term cost reduction. On the other hand, occupational and physical therapists were
in short supply in the labour market, making it impossible for RRH to manage
them on an as needed basis. The opportunity cost for sending therapists home
during periods of low census was too high, thus therapists were left idle about
50% of the time. As a result, RRH was feeling the pain of costly uncertainty. In this
specific case, RRH management was constrained by the unknown supply of
patients and the perceived power of the therapists to resist management efforts
to reduce their hours when the patient supply was low.

However, his initiative to change the company strategy was incomplete. It lacked a
cost benefit analysis. He did not calculate that the efficiency of the patient
focused care would bring shortened lengths of stay, and thus a decrease in
revenue. Patient focused care at RRH was working out well for the patients and to
the satisfaction of therapists, but the initiative was losing money for RRH.

So they should return to their traditional way because the new infrastructure
made was not up to the mark as they were losing a lot of revenue in running their
RRH.

Suggestions
 Case manager
 Clinical pathways
 Creating service lines that have enough volume for intergrity and demand stability
 Marge multiple service lines
 Flexible hrs for therapists