Case Study

 

Course Objective for Assignment:

• Relate strategic management principles and decision logic to current complex health care management challenges and formulate effective solutions.

Continue working with the Case described in week 3. 

Review: 

Evidence-based Decision Making in Healthcare PPT

Apply the UMGC Library eBook:

Good Organizational Decisions: Ethical Decision-Making Toolkit for Leaders and Policy Makers

  Permalink to eBook:

http://ezproxy.umgc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=2655908&site=eds-live&scope=site

Apply your framework to evidence based decision making by completing the evidence based data collection and analysis chart included in the Assignment Link. 

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Evidence-Based Decision Making in Healthcare

What is evidence-based practice?
Good-quality decisions are based on a combination of critical thinking and the best available evidence (the quality of the evidence is at utmost importance)
According to Dawes and colleagues (2005):
Evidence-based practice is about making decisions through the conscientious, explicit, and judicious use of the best available evidence from multiple sources by
ASKING (translating a practical issue or problem into an answerable question)
ACQUIRING (systematically searching for and retrieving the evidence)
APPRAISING (critically judging the trustworthiness and relevance of the evidence)
AGGREGATING (weighting and pulling together the evidence)
APPLYING (incorporating the evidence into the decision-making process)
ASSESESING (evaluating the outcome of the decision taken) to increase the likelihood of a favorable outcome

What counts as evidence?
Evidence usually means information. It may be:
-based on numbers
-be qualitative
-be descriptive
Evidence usually comes from:
-scientific evidence
-organizational evidence
-experiential evidence
-stakeholder evidence
*Regardless of source, all evidence should be included if it is judged to be trustworthy and relevant.

Why do we need evidence-based practice?
Personal judgement alone is susceptible to systematic errors. Cognitive and information-processing limits make us prone to biases that have negative effect on the quality of decisions (Bazerman 2009; Clements 2002; Kahneman 2011; Simon 1997)
Benchmarking and “best practices” need to be critically evaluated before adaptation to a specific situation, organization, culture, time etc. Otherwise, use them only as a point of evidence and not as a deciding factor in decision making process.

Barriers to the evidence-based decision making practice
The managers need to be trained in the skills required to critically evaluate trustworthiness and relevance of information
Important organizational information may be difficult to access, the information available may be of poor quality or misleading.
Managers may not be aware of the current scientific evidence concerning the key issues in the field.

Why do barriers exist?
Practitioners pay little or no attention to scientific or organizational evidence, instead placing too much trust in personal judgement and experience, “best practices”, and the beliefs of corporate leaders. As a result, money is spent on management practices that are ineffective or harmful to organizations, their members or their clients.

Why do we have to critically appraise evidence?
Evidence is not perfect, may be overstated or misleading
Critical appraisal always follows the following pattern:
-Where and how is the evidence gathered?
-Is it the best available evidence?
-Is there enough evidence to reach a conclusion?
-Are there reasons that the evidence could be biased in a particular direction?

Why focus on best available evidence?
A fundamental principle of evidence-based practice is that the quality of our decisions is likely to improve when we make use of trustworthy evidence-in other words, the best available evidence.
Sometimes, the organizational or scientific evidence may be limited or unavailable. Even limited-quality evidence can lead to a better decision than otherwise as long as we are aware of its limitations and are ready to act on it.

Common misconceptions about evidence-based decision making (EBDM) practice
It ignores the practitioner’s professional experience: none of the four listed evidence sources is more superior than the others.
EBDM is all about numbers and statistics: none of the four listed evidence sources (including data processing and statistical information) is more superior than the other. Statistical reasoning may help assessing the evidence trustworthiness in regard of accuracy, reliability and validity.
Managers need to make decisions quickly and do not have time for EBDM: even split-second decisions require trustworthy evidence. The need to make an immediate decision is generally the exception rather than the rule. When important decisions need to be made quickly, an EBDM practitioner anticipated the kind of evidence that a good decision require (e.g. emergency evacuation)

Common misconceptions about evidence-based decision making (EBDM) practice
4. Each organization is unique, so the usefulness of scientific evidence is limited. Even though the organizations differ, they tend to face very similar issues, sometimes repeatedly, and they often respond to those issues in similar ways.
5. If one does not have high-quality evidence, one can do nothing. Limited evidence at hands should be supplemented through learning by doing on a small scale (e.g. pilot testing, prototyping). Critical reflection on such experimentation supplements limited evidence and improves the quality of such.
6. Good-quality evidence gives one the answer to a problem. Evidence need to be put in appropriate context and a critical mind-set. EBDM practitioners make decisions based on probabilities, indications, and tentative conclusions using available evidence along with other tools.

What is the evidence for evidence-based decision making?
Forecasts or risk assessments based on aggregated (averaged) professional experience are more accurate vs. based on a singular professional experience
Professional judgments based on data and statistical models are more accurate vs. based on an individual judgment
Knowledge derived from scientific evidence is more accurate vs. opinions of separate experts
A decision based on combination of critically appraised multiple types of evidence yields better outcomes vs. based on a singular piece of evidence
Evaluating the decision outcomes improves both organizational learning and performance, especially in novel and non-routine situations

Barriers to the use of EBDM and how to overcome them
1. Policy contexts: when the policies are not aligned with organizational capacity, managers have incentives to take shortcuts that might promote short-term efficiency at the expense of long-term performance.
**The managers should be advocating on all levels to support EBDM policies that can increase the effectiveness and efficiency of healthcare services.
2. Community and Market environments: strong social ties in closed close-knit communities and markets (while have multiple benefits) may restrict adoption of newer EBDM practices.
Competition for scares resources creates uncertainty and anxiety for managers. Those forces stress importance of power and politics in decision making within organizations and their communities (e.g. mergers). However, the evidence shows that mergers among hospitals do not result in improved efficiency or quality of care.

Barriers to the use of EBDM and how to overcome them
3. Organizational factors: culture, structure and resources (individually and collectively). Cultures that stifle open discussions and the expression of different views may produce disastrous decisions. Lack of psychological safety likely contributes to poor managerial decisions on a daily basis. Organizations promoting silos prevent managers from seeing the effects of their decisions. Any barriers to open communications create barriers to coordination of managerial work. They create divisions based on power and politics for individual agendas vs. the whole organizational benefit. Lack of organizational goals measurements promote divisions and silos and prevent meaningful and timely feedback. Incentive system promotes individual performance vs. individual contribution to the team or the whole organizational performance.

Barriers to the use of EBDM and how to overcome them
4. Individual managerial factors: well-documented limits of human decision making are reflected in multitude of biases, rigid or outdated beliefs and restricting personality traits.
**Continuous education, development of personal tool box and ability to recognize and overcome biases build capacity and confidence toward EBDM practice.

How to increase the use of EBDM practice in HC organizations
Organizational learning:
-frame the use of evidence and changes in decision making as learning
-foster a culture of psychological safety
-engage in learn-how and learn-why activities
-invest in infrastructure and time to support EBDM
-set realistic expectations. The performance may get worse before it gets getter
-use stable cross-functional teams as the building blocks for EBDM management
-emphasize supportive senior leadership

image1

Evidence-Based Decision Making in Healthcare

What is evidence-based practice?
Good-quality decisions are based on a combination of critical thinking and the best available evidence (the quality of the evidence is at utmost importance)
According to Dawes and colleagues (2005):
Evidence-based practice is about making decisions through the conscientious, explicit, and judicious use of the best available evidence from multiple sources by
ASKING (translating a practical issue or problem into an answerable question)
ACQUIRING (systematically searching for and retrieving the evidence)
APPRAISING (critically judging the trustworthiness and relevance of the evidence)
AGGREGATING (weighting and pulling together the evidence)
APPLYING (incorporating the evidence into the decision-making process)
ASSESESING (evaluating the outcome of the decision taken) to increase the likelihood of a favorable outcome

What counts as evidence?
Evidence usually means information. It may be:
-based on numbers
-be qualitative
-be descriptive
Evidence usually comes from:
-scientific evidence
-organizational evidence
-experiential evidence
-stakeholder evidence
*Regardless of source, all evidence should be included if it is judged to be trustworthy and relevant.

Why do we need evidence-based practice?
Personal judgement alone is susceptible to systematic errors. Cognitive and information-processing limits make us prone to biases that have negative effect on the quality of decisions (Bazerman 2009; Clements 2002; Kahneman 2011; Simon 1997)
Benchmarking and “best practices” need to be critically evaluated before adaptation to a specific situation, organization, culture, time etc. Otherwise, use them only as a point of evidence and not as a deciding factor in decision making process.

Barriers to the evidence-based decision making practice
The managers need to be trained in the skills required to critically evaluate trustworthiness and relevance of information
Important organizational information may be difficult to access, the information available may be of poor quality or misleading.
Managers may not be aware of the current scientific evidence concerning the key issues in the field.

Why do barriers exist?
Practitioners pay little or no attention to scientific or organizational evidence, instead placing too much trust in personal judgement and experience, “best practices”, and the beliefs of corporate leaders. As a result, money is spent on management practices that are ineffective or harmful to organizations, their members or their clients.

Why do we have to critically appraise evidence?
Evidence is not perfect, may be overstated or misleading
Critical appraisal always follows the following pattern:
-Where and how is the evidence gathered?
-Is it the best available evidence?
-Is there enough evidence to reach a conclusion?
-Are there reasons that the evidence could be biased in a particular direction?

Why focus on best available evidence?
A fundamental principle of evidence-based practice is that the quality of our decisions is likely to improve when we make use of trustworthy evidence-in other words, the best available evidence.
Sometimes, the organizational or scientific evidence may be limited or unavailable. Even limited-quality evidence can lead to a better decision than otherwise as long as we are aware of its limitations and are ready to act on it.

Common misconceptions about evidence-based decision making (EBDM) practice
It ignores the practitioner’s professional experience: none of the four listed evidence sources is more superior than the others.
EBDM is all about numbers and statistics: none of the four listed evidence sources (including data processing and statistical information) is more superior than the other. Statistical reasoning may help assessing the evidence trustworthiness in regard of accuracy, reliability and validity.
Managers need to make decisions quickly and do not have time for EBDM: even split-second decisions require trustworthy evidence. The need to make an immediate decision is generally the exception rather than the rule. When important decisions need to be made quickly, an EBDM practitioner anticipated the kind of evidence that a good decision require (e.g. emergency evacuation)

Common misconceptions about evidence-based decision making (EBDM) practice
4. Each organization is unique, so the usefulness of scientific evidence is limited. Even though the organizations differ, they tend to face very similar issues, sometimes repeatedly, and they often respond to those issues in similar ways.
5. If one does not have high-quality evidence, one can do nothing. Limited evidence at hands should be supplemented through learning by doing on a small scale (e.g. pilot testing, prototyping). Critical reflection on such experimentation supplements limited evidence and improves the quality of such.
6. Good-quality evidence gives one the answer to a problem. Evidence need to be put in appropriate context and a critical mind-set. EBDM practitioners make decisions based on probabilities, indications, and tentative conclusions using available evidence along with other tools.

What is the evidence for evidence-based decision making?
Forecasts or risk assessments based on aggregated (averaged) professional experience are more accurate vs. based on a singular professional experience
Professional judgments based on data and statistical models are more accurate vs. based on an individual judgment
Knowledge derived from scientific evidence is more accurate vs. opinions of separate experts
A decision based on combination of critically appraised multiple types of evidence yields better outcomes vs. based on a singular piece of evidence
Evaluating the decision outcomes improves both organizational learning and performance, especially in novel and non-routine situations

Barriers to the use of EBDM and how to overcome them
1. Policy contexts: when the policies are not aligned with organizational capacity, managers have incentives to take shortcuts that might promote short-term efficiency at the expense of long-term performance.
**The managers should be advocating on all levels to support EBDM policies that can increase the effectiveness and efficiency of healthcare services.
2. Community and Market environments: strong social ties in closed close-knit communities and markets (while have multiple benefits) may restrict adoption of newer EBDM practices.
Competition for scares resources creates uncertainty and anxiety for managers. Those forces stress importance of power and politics in decision making within organizations and their communities (e.g. mergers). However, the evidence shows that mergers among hospitals do not result in improved efficiency or quality of care.

Barriers to the use of EBDM and how to overcome them
3. Organizational factors: culture, structure and resources (individually and collectively). Cultures that stifle open discussions and the expression of different views may produce disastrous decisions. Lack of psychological safety likely contributes to poor managerial decisions on a daily basis. Organizations promoting silos prevent managers from seeing the effects of their decisions. Any barriers to open communications create barriers to coordination of managerial work. They create divisions based on power and politics for individual agendas vs. the whole organizational benefit. Lack of organizational goals measurements promote divisions and silos and prevent meaningful and timely feedback. Incentive system promotes individual performance vs. individual contribution to the team or the whole organizational performance.

Barriers to the use of EBDM and how to overcome them
4. Individual managerial factors: well-documented limits of human decision making are reflected in multitude of biases, rigid or outdated beliefs and restricting personality traits.
**Continuous education, development of personal tool box and ability to recognize and overcome biases build capacity and confidence toward EBDM practice.

How to increase the use of EBDM practice in HC organizations
Organizational learning:
-frame the use of evidence and changes in decision making as learning
-foster a culture of psychological safety
-engage in learn-how and learn-why activities
-invest in infrastructure and time to support EBDM
-set realistic expectations. The performance may get worse before it gets getter
-use stable cross-functional teams as the building blocks for EBDM management
-emphasize supportive senior leadership

image1

Correctional Health Care Assignment

Course Objective for Assignment:  

· Relate strategic management principles and decision logic to current complex health care management challenges and formulate effective solutions.

You applied and were accepted in an internship program of a state-level, Female Correctional Health Care Operation in the Southeastern United States and your primary responsibility is to work on 
the assigned projects related to the provision of inmate health care.

Case Study Associated Materials: 

***Correctional Health Care Delivery: Unimpeded Access to Care

 Section 2 and 4 are recommended for the main reference in working on this assignment. 

The Health and Health Care of US Prisoners: Results of a Nationwide Survey

Public Health Behind Bars

Sample Tool Control Policy

Inmate Sick Call Procedures-Corrections

Case Study Details: For the incarcerated population in the United States, health care is a constitutionally guaranteed right under the provisions of the eight amendments which is the prohibition against cruel and unusual punishment (
see Estelle v. Gamble). This particular prison can hold in excess of 1,728 offenders and routinely houses between 1,600 and 1,700 women on any given day. This institution incarcerates all custody classes to include minimum security, medium security, close custody, death row, and pretrial detainees. 

The health care operation provides the highest level of care for female offenders in the state. The health care facility is a 101 thousand square foot, 150 bed, three-story building that cost the taxpayers $50 million dollars to construct and is a hybrid of an ambulatory care center, long-term care center, and behavioral care center. The health care facility also houses an assisted living dorm.

The patient demographic includes women who have multiple co-morbidities including substance abuse, seriously persistent mental illnesses (SPMI), diabetes, cardiovascular disease, cancer, morbid obesity, HIV / AIDs, hepatitis, etc. On any given day there will also be 30 to 60 offenders who are pregnant, with 98% of those offenders having a history of substance abuse; all pregnant offenders are considered high-risk. The dental health of this patient population is exceptionally horrendous because of excessive drug abuse coupled with a sugary diet and poor oral hygiene practices. It is not uncommon for a 23-year-old to need all of her teeth extracted.

There are approximately 300 FTEs to include correctional staff that operate the facility and provide care to the offender population. The healthcare facility is comprised of the following directorates: (a) Medical, (b) Nursing, (c) Behavioral Health, (d) Pharmacy, (e) Dental, (f) Medical Records, (g) Health Service Support, and (h) Operations and Security.

Although the health care facility has a vast amount of capability, there limitations: (a) This facility does not have advanced cardiac life support capability (ACLS), (b) no surgical capability, (c) no ability to conduct telemetry, (d) no oral surgery beyond simple extractions, (e) no obstetrical capability beyond out-patient clinics, (f) MRI, (g) level 2 ultrasound, and the list goes on.

Those inmates who have medical needs that cannot be addressed by the health services staff at the correctional facility will need appointments with external health care providers who have a business relationship with the prisons in this area. On any given month, there will be approximately 300 offenders who will go to outside medical appointments, and making certain that these appointments take place is where the challenge lies. Similar to many health care operations, the prison Utilization Review / Case Management Department facilitates all external appointments and form the lynchpin between the correctional facility health care providers who refer offenders for specialty appointments, and the outside organization providing that appointment.  

Your assignment: You are the Case Coordinator. You have 300 patients that need to be scheduled for outside specialty appointments every month. You are tasked by the Administrator to develop a strategic plan organizing the out-of-the-facility appointments without impairing internal services.

***
Note: additional personal or financial resources are not available fortis case strategic plan. However, the question of the additional personnel or resources can be discussed in an Addendum. Specific justification must be presented and supported by evidence. 

As the first step, develop a Memorandum addressing:

1. Provide an overview of Estelle v. Gamble and how that 1976 Supreme Court ruling pertains to the provision of inmate health care.

2. Examine the challenges of providing health care in a correctional environment.

3. What are the challenges of providing health care to a female offender population that may not exist in a male prison?

4. What framework would you apply to strategic planning? Why? (

Strategic planning frameworks)

 

Make sure to cite in APA format when appropriate. Support your statements with credible evidence.