Introduction
People use health care facilities for various reasons including curing illness and complications of health care problems among others; all this is done to improve the quality of life. By studying the national trends, policy and regulations on community health facilities in the US, it becomes possible to facilitate the identification of spotlight areas that need in-depth investigations in the future. These spotlights could be future care needs, health expenditures, and improving organization competency (Zhang et al., 2009).
Over the past decade, public and private health facilities have made great strides in identifying disease causatives, disease treatments, and cures. Additionally, much has been done to educate citizens on how to reduce the incidences and prevalence of the major diseases. Clinical guidelines have been developed and disseminated to influence the providers in order to recommend evidence based practices.
Another transformation in the health facilities is the integration of the care payments mechanisms provided by the insurers and other payers as a method of controlling health care costs i.e. Medicare and Medicaid, use of electronic health records amongst others. These emerging trends have made the government to establish legislation policies to control how the health care facilities deliver their services. It is therefore important for hospitals to incorporate these national trends and policies in determining the appropriate path to select their service lines (Principe et al., 2012).
This paper will use Trinity Community Hospital to develop a service line development case study. The research paper commences with a brief background description of Trinity Community Hospital. Then, national trends, policy and legislation will be explored in order to summarize the impact it has on Trinity Community Hospital service lines of orthopedic center, cardiovascular center and cancer center. Additionally, the possible legislation that may result from the trends explored will be pinpointed.
Trinity Community Hospital
Community hospitals are accountable for health needs of the locals in the regions they are situated. According to America Hospital and Association (AHA), community hospitals perform up to seven types of activities in addressing community health needs. They have the highest degree of community orientation. However, these community health facilities continue to lag significantly behind in collection, tracking, and communication of relevant health information. It is important to understand that they form an integral part of the community they are located in because they address their needs (Principe et al., 2012).
Trinity Community Hospital is 150-bed facility located in the Southeast United States. It offers a variety of medical services including pulmonary medicine, gastroenterology, urology, thoracic surgery, gynecology, and neurology. The hospital’s excellence is attributed to its competent and dedicated staff in offering an outstanding patient care. The facility offers cardiovascular, orthopedic and oncology services. However, these services are not well managed.
Despite the efforts of the board of trustee’s efforts to make Trinity the centre of cardiovascular in the region, their efforts are often futile. This is due to the financial constraints to support medical practitioners’ coordination for quality services. The physician staff is inadequate and so are the health equipment and facilities. Additionally, the preventive interventions and management programs are lacking making it even harder for the practitioners (Anon, 2010a).
Oncology Service Line of Delivery
Currently, Trinity Community Hospital caters for 3,200 cancer patients. The hospital lacks a cancer specialist. Additionally, the oncology services are poorly coordinated with not cancer prevention and management program. Currently, this department has staff totaling to ten – two radiation oncologists and eight oncologists. This team is working hard to set up a cancer management program in this center. According to statistics, 50% of men and 33% of women are expected to develop cancer complications at one point in their lifetime.
This implies that there could be a possibility of rising cancer cases by 34% by 2015. Therefore, in response to these estimates, the board of trustees has strategies to make Trinity Community Hospital the centre of oncology services in the region. They plan to do so by offering clinical programs and services such as offering a disease focused clinics such as breast, GI , prostrate and lung. In addition, the board of trustees will ensure that comprehensive medical, surgical and support services are offered to the patient. Cancer prevention and control programs will be established in order to educate communities on the importance of living healthy lifestyle as well as conducting regular community screening in order to identify an early onset of the disease (Kathiek, 2010).
Orthopedic Service Line of Delivery
The Community Premier Orthopedic groups are located in competing facilities. This is a heavy blow to the community hospital as it only has occasional orthopedic surgery. However, recent statistics indicate that the hospital handles 11,800 orthopedic services. The orthopedic cases (inpatient joint and spine) are expected to increase by 46% by 2015. However, the existing facilities are inadequate to handle this number. For example, currently, the hospital only possesses two scanners, one MRI scanners, nuclear medicine, and ultrasound devices.
The centre has a mobile PET scanner, which is underutilized. To make it a leading orthopedic center in the region, the Centre is required to offer distinctive clinical programs and services such as spine, total joint, and hand. Additionally, they are required to offer rehab and support programs and other best practices required. The centers are also required to emphasize the prevention strategies through community education, coordination of services and fast track scheduling (Knight, 2010b).
Cardiovascular Service Line of Delivery
There are increased demands for cardiovascular services. Currently, the service caters for 54,000 coronary artery complications, 10.800 diagnostic catch procedures, and 4,000 angioplasties. These estimates are expected to increase by 22% in 2015. The key concern regards government and board of trustee’s efforts to handle the growing demand of cardiovascular services in the region.
To start with, the board of trustees aims at making the Trinity Community Hospital the centre of cardiovascular diseases by offering distinctive clinical programs and services such as cardiology for women, evidence based treatments and electrophysiology of periphery artery diseases and heart failure. Additionally, prevention interventions will be emphasized through community education, conducting regular community screening, and offering of coordination services in order to outreach services to the underprivileged communities.
Recently, the board of trustees set up a five-year strategic plan to facilitate quality health care delivery in this community based hospital. The strategic plan is outlined into four objectives including
- Improved quality and safety: through recruiting adequate staff and purchasing of medical equipments. Additionally, use of computerized MD and EHRs will ensure that Medical practitioners can have access to the patient’s full medical history at any point of care in order to deliver health care effectively and efficiently. Such like systems will ensure that patients have access to their medical records readily. Additionally, the systems are supported by tools that support physicians in reaching clinical decisions and other routine practices such as the reminders for preventive measures and e-prescribing. Investigation reveals that this health technology transforms the health care making it safer, effective, and efficient because of the adherence to clinical guidelines thereby enhancing service providers with the ability for disease surveillance reducing medication errors. Medical services that have implemented EHRs systems are reported to have reduced transcription services, decreased labor, and supply costs
- Service excellence: this objective is interrelated with the first objective.
- Staff achievement: this focuses mainly on the staff satisfaction in order to reduce turnover rate thereby offering quality service delivery
- Growth and profitability: this can be achieved through the first three objectives, and further enhances the health quality of life (Knight, 2010c).
The goals are further split into three strategies namely
- Strategy A: Offering distinctive clinical programs in the respective line of service delivery i.e. orthopedic, cardiovascular and oncology
- Strategy B: Emphasized prevention and control interventions in respective service line of delivery through community education, regular community screening and risk assessment, and
- Strategy C: Enhance services access through fast track scheduling and patient navigation.
The board of trustees has allocated several targets at allocating $8,625,000 to cater for cardiovascular services, a further $3,500,000 to develop orthopedic centre and $8,700,000 to cater for oncology services (Anon, 2010b).
The role of National trends, policy, and legislation in service delivery
According to the national trends, policy and legislation, it is the duty of every community health care facility to ensure that it offers/delivers total care to the patient for quick recovery. The health centers should have a quality, patient-centered care. An ideal care facility is one, which ensures that the patient’s information is clinically relevant and is available whenever required. This trend is achieved with electronic health records systems. Secondly, the patient care should be synchronized amongst the several care providers to ensure efficiency in management. Lastly, the health care system should be perpetually improved to ensure that the care that patients are given are of high quality (Zhang et al., 2010).
Medical practitioners should have access to a patient’s full medical history at any point of care in order to deliver health care effectively and efficiently. To readily have the information, the most feasible approach is the implementation of electronic health record system (EHR systems). EHR systems will ensure that patients have access to their medical records readily.
Additionally, the EHRs have tools that support providers in making clinical decisions and other routine practices such as the reminders for preventive measures and e-prescribing. Investigation reveals that this health technology will transform the health care by making it not only safer but also effective and efficient because of the adherence to clinical guidelines thereby enhancing service providers with the ability for disease surveillance reducing medication errors. Medical services that have implemented EHR systems are reported to have reduced transcription services, decreased labor, and supply costs (Principe et al., 2012).
In addition, patient care should be synchronized among several medical providers to ensure efficiency in management. Patients visiting any community health facility see multiple providers e.g. primary or specialized physicians, social workers, psychologists, and physical therapists. Therefore, it is important to ensure that their care is coordinated across the transitions.
Without proper coordination and management, patients are bound to suffer from erroneous medical information and unnecessary delays to receive their treatment. An ideal health facility should work together across the setting in order to deliver high quality and valued care. At the system level, there should be accountability and shared commitment by the health practitioner to offer quality care. For example, the medical practitioners can conduct a peer-reviewed procedures and process in order to share practices and monitoring of the system performance (Zhang et al. 2010).
Possible legislations on Trinity Community service delivery
In order to obtain the qualities of an ideal healthcare facility, key attributes of health care identified include effective organization structure stimulated by policy interventions. The policies identified covers provider payment reform, patient incentives, regulatory changes, accreditation, government infrastructure support, provider training, and promotion of health information technology.
According to national trends, policy and legislation, financial incentives are the most powerful lever to transform the service provider conduct. The introduction of diagnosis related group prospective payment system resulted to decreased length of hospital stay. Existing financial incentives are inadequately rewarding care coordination, efficiency and the high valued care.
In addition, the incentives are so limited and therefore, discourage patients to choose high performing organized health facilities. Regulatory changes are two faced. They can either act as a barrier to certain types of delivery system organization or facilitate them. The current regulatory environment however, impedes hospital- physician integration. Accreditation programs have been shown to stimulate growth of the organized delivery systems improving their performance.
They should be highly emphasized. Government infrastructure support is so limited to support any financial incentives within the clinical setup. This is especially so in the rural areas and other regions where the small independent health practices dominate. Therefore, in such areas, the government should facilitate the creation of shared and organized financial support in order to improve community health facility performances, their activities and coordination of networks (Zhang et al., 2010).
Conclusion
Evidently, national trends, policies, and legislation have a great role in shaping quality service delivery in healthcare. The Broad of Trustees which consists of Mr. John Printer (chairperson), Mrs. Cathy Promo (Developing market manager), Mrs. Maria Lopez (Marketer), Mr. Robert Holland (accountant), Dr. David Joint (orthopedic surgeon), and Dr. Randy Sharp is giving all it can to ensure that the hospital delivers quality care. The board is ensuring that it pays attention to health and legislative environment in planning processes of transforming Trinity Community Care into the centre of orthopedic, cardiovascular and oncology diseases. The major concern and growth-inhibiting factor in Trinity Community Hospital is the thin and declining medical financial incentives provided by the government.
There is also a need for the Government infrastructure to support any financial incentives within the clinical setup. This should be especially in the rural community hospitals such as Trinity Community Hospital. The government should facilitate the creation of shared and organized financial support in order to improve community health facility performances through activities such coordination of networks and integration of advanced information technology. Community based hospitals are very significant due to their close touch with the community and thus they can easily aid to ensuring that the community develops healthy.
References
Anon. (2010a). Trinity community Hospital- Board profile. Jasper, FL: Trinity Community Hospital.
Anon. (2010b). Five- Year program plan. Jasper, FL: Trinity Community Hospital.
Kathiek, A. (2010). Trinity Community Hospital: A patient centered facility. Jasper, FL: Trinity Community Hospital.
Knight, J. (2010b). Position overview- CEO Trinity community Hospital. Jasper, FL: Trinity Community Hospital.
Knight, J. (2010c). Trinity community hospital fact sheet. Jasper, FL: Trinity Community Hospital.
Principe et al. (2012). The impact of the individual mandate and internal revenue service form 990 Schedule H and community Benefits from Nonprofit Hospitals. American Journal of Public Health, 12(2), 229-37.
Zhang et al. (2009). Do rural hospitals lag behind urban hospitals in addressing community health need? An analysis of recent trends in US community hospitals. Australian Journal of Rural Health, 17(1), 183-188.