Introduction
The success of a given organization is based on their competence in handling and solving challenges and problems they face. As organizations grow, their challenges become complex and difficult to solve. Healthcare has been a challenge to both lower class and middle class families living in the United States. The healthcare department is a critical part of the society that faces its share of problems. This paper focuses on healthcare organizations challenges and some of the ways they can try to solve these problems. Organizational studies and researchers’ aim is to get a clear understanding of these issues, try to explain them, and seek for ways to predict, prevent and control them. Technology has been viewed as the ultimate solution to most of these challenges. It is a collective responsibility of all stakeholders to come up with logical solutions and implement them in healthcare organizations.
Transition from volume-based healthcare to value based healthcare challenge
This is one of the biggest challenges facing healthcare organizations. It has been difficult for healthcare organizations to adapt to the still new and evolving system. The earlier system that was used was called fee-for-service or volume-based system. This change has been brought by the need for increased patient care and catering for customer satisfaction. This moved has been aimed at improving the healthcare service quality and reduction in the cost of service. This has been focused on very carefully by these organizations because it has direct impact on costs thus revenue in healthcare organizations.
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There has been constant discussions on how to improve the healthcare system while decreasing its cost. The transition have been a collective agreement of various stakeholders to move from volume to value. There is a lot of work involved in making this transition a success. This mode of patient care involves prioritizing on quality of service delivery rather than the number of patients served in a given period of time ( Hillary, 2016 ). In order to keep the focus constant, the Institute of Healthcare Improvement came up with a guide to this system. The triple aim system. This focuses on improving patient healthcare experience by maintaining high quality serviced aimed at customer satisfaction. Keeping the population health at all times. Finally, maintaining a low per capita cost for healthcare services provided. Other frameworks have been incorporated to build up on this system such as quadruple aim.
Medicare and Medicaid have been on the forefront campaigning for this system and working around the clock to ensure adoption of the new system. These organizations make sure healthcare organizations maintain the standards set for this new system. If these organizations fall short of service, they may suffer fines and penalties from these oversight institutions. Keeping in mind that the hospitals might incur costs of treating a patient and not get paid and even get punished for it, the healthcare organizations are careful to follow the rules and regulations. However, those challenges that are unforeseen that lead to penalties increase the costs of operation of these organizations.
Under the new system, the healthcare organizations are responsible of finding the best talent possible in their organizations. For them to provide quality healthcare, there is need to look for professional and talented health workers who are patient oriented so that they can deliver the required patient care according to standards ( Turner, 2017 ). This does not only involve the clinical staff but also includes the non-clinical staff members. The search and availability of talent in healthcare has been a constant challenge that has persisted for ages and is evident that this is going to be a standing challenge. This shortage creates the challenge of costs due to increased costs of temporally help from the available staff. Due to these challenges, some organizations have to employ unprofessional or unqualified workers in efforts to fill the available gap. These organizations are at a constant risk catastrophic incidences and eventual penalties. All these events are happen concurrent with the efforts of the organization to maintain a competitive advantage and raising revenue.
In all these events, the organizations are also expected to come up with payment schemes for the talent workers. This scheme contains the basic salary, the compensation fee based on productivity of the worker and bonuses tied to the organization’s overall financial performance over a given time. Some of the workers go to great lengths in trying to increase the compensation fee based on production which may lead to unethical practices in efforts to increase the number of patients.
These organizations have also had problems in changing policies and practices to welcome the new model. A good example is the policies in purchase of devices. If a hospital buys devices from a given company and in its usage the patient does not get better or in some incidents get worse, the hospital is at a risk of facing charges. The organization does not get paid if the patient does not improve based on the new framework. The underlying problem is not the hospital mode of treatment. The manufacturers should cover the costs of the outcome so that they ensure production of quality devices. The policies need to evolve in order to exonerate the healthcare organizations in such incidences ( Caron, 2019 ). There is need for associated organizations and partners to take responsibility for their failures too. This strains the healthcare organizations in multiple ways.
Orienting health workers into the new system is costly and time consuming. Most of the health workers are used to measuring their work rate through the volume of patients attended to ( Sarwar, 2015 ). The organizations are responsible for helping these workers change this norm. It is critical to provide them with examples and models in efforts to effect the required change.
Information accuracy is another challenge in the journey of transition. The value-based system looks to use the big data technology. Large amounts of data have to be processed in determining quality and making decisions in terms of the patient records. The success of these transition is going to be based on the way these challenges are going to be handled by the health organizations and other interdependent organizations. It is only logical to proceed with a lot of caution in the transformation of the healthcare frameworks
Patient safety
It is a point of no contest that some patients leave hospital with infections they did not have when going in. These hazards prolong their stay in hospitals, inflict more harm or even in some cases lead to death of the patient. It has been clear that the success of treatment of a patient up to recovery is dependent on a range of factors and not the skillfulness or competence of the healthcare provider. Considering the multiple number of people a patient passes through in the hospital such as doctors, nurses, pharmacists, manual worker, other patients among others, it is not an easy task to ensure the security of the patient. Patients are regularly harmed in different ways by various factors in play such as miscommunication and delay in treatment. There is no accountability when these events happen and if anyone is held accountable is the las person to serve the patient. This is famously know as blame culture. It involves singling out anyone involved in during the occurrence of an incident and making them face the consequences of the outcome. Statistics have shown that these incidences increase proportionally to the size of the healthcare organization due to many variables coming into play.
The greatest threat is the digital transfer of data due to the transition to incorporate the new digital technologies. This transition has exposed confidential personal data to become compromised. Cyber security has risen in preference and priority by the management of health organizations. The fear of cyber-attacks has been roaming since the advancement of digital technologies ( Mehraeen, 2017 ). In recent times, these technologies have been adapted to the level of access on mobile phones and tablets. Doctors, patients and other healthcare workers use these devices to access wellness and health programs. It is also prone to internet-based attack since most of the data is store in the cloud. A good example is the catastrophic attack by a ransomware famously known as WannaCry in United Kingdom. It affected more than 16 healthcare organizations causing problems in various departments like operation sections.
The other security concern is abuse and beating of health workers. The medical staff is always at a risk of assault due to various reasons. Most of the reported cases of violence and abuse have been caused by the interactions with patients who cause harm through either hitting, kicking, and beating among others. This is sometime contributed by the unstable mental conditions of some patients, or escalation of an argument or a disagreement between the patient and the staff. These kind of security concerns mostly affect workers in psychiatric, pediatric and emergency departments.
Active assailant and terrorist attacks are also a great concern in the security of both patients and health workers. Health organizations are public places and with presence of people, it makes it an easier target by attackers with various agendas. This kind of attack can happen in multiple places such as emergency, patient room or even parking lots making it difficult to detect and dissolve these kind of attacks.
A good example is the active shooting in Dartmouth-Hitchcock Medical Center on September 13, 2017 . In this incident, a son shot his mother who was in the hospital intensive care unit to death. During the incident, after the shooter shot his mother, a ‘code silver’ was announced to all the staff in the hospital. Unfortunately, this was unheard to the staff and they neither knew what it meant nor how to respond to it. The operations of the hospital were brought to a stand while the authorities sought the shooter. The workers and patients were terrified during and after the incident. Even though the situation was contained and the shooter arrested with no more casualties, this was a wakeup call to all health organizations. The Lebanon police Cpt. Timothy Cohen describe the situation as invaluable. He continues to warn other health organizations saying, ‘ Unfortunately, it’s a necessity in today’s society. Not just in Lebanon, but anywhere. ... Nobody is necessarily exempt from this. ’ (Tim, 2017).
Another security concern in healthcare organizations is infant abductions. This is the most common form of abduction in these organizations. Most of these incidences happen in the mothers’ rooms with some even having mothers assaulted during the abduction. With the large number of personnel and patients the abductors are able snick in the hospitals without being suspected. A large number of the abductors pose as doctors or nurses.
Another disturbing security concern is property and supplies theft in healthcare organizations. Healthcare facilities are faced with losses from theft of items ranging from drugs, medical equipment and food supplies among other items. Culprit may be patients, visitors and even staff. A recent example is arraigning of a former employee of Riverside Community Hospital California in February this year. The accused was charged with seven accounts of theft of surgical equipment. When the hospital conducted an audit, the report indicated a huge sum of $2.9 million worth of equipment was missing (Ayla, 2019). This is a very high cost the hospital had incurred over a period of three years. These thefts lead to an unnecessary overhead and are a clear indications of a security vulnerability in healthcare institutions.
The pressure of cutting down costs is also a challenge in security. Most health facilities do not want to hire security staff in efforts to cut costs of running the facilities. According Lowers & Associates, (2018), almost half of the hospitals reported a rise in crime incidences between 2016 and 2017. A substantial 23 percent of these institutions had cut down their security budgets in the same period. This is a clear indication that cutting down on this department adversely affect the situation in these organizations.
Information and service integration challenge
The new technological advancements have been critical in healthcare improvements in recent times. The larges of them is the adoption of big data technology that helps set up non-relational databases useful in information processing and sharing. There is only a small portion of the healthcare providers who have been able to integrate these services in their institutions. Most of them are the big and financially stable organizations that benefited from this technology.
Cost issue has been the main challenge in implementation of the Health Information System in most healthcare organizations. The implementation of these changes has turned out to be very expensive and will keep recurring every now and then in customization, upgrading, training users among others. It is not cheap to set up interfaces and connecting to other systems. Other costs that are hidden, running costs and future expenditures make this integration difficult for small and unstable organizations. The high initial costs and the perceived return being low has led to rejection of this change.
Another concern in these technology is the security and confidentiality of data (Rajkomar, 2018). Even though this technology is helpful, most of the patients are not willing to share their data with third parties such as drug manufacturers. There are laws and regulations prohibiting healthcare providers from sharing patient data to third parties without their consent. The third parting have to undergo the costs of research and development due to limited access to patient information. These costs are later passed on to the consumers in the purchase of their products.
Cloud environment consideration and connectivity requirements also hinder the adoption of these system. Healthcare providers in remote area are not able to integrate these systems due to extra requirements and unprecedented costs of making it happen. Most of the organizations also do not understand the cloud technology and are unwilling to adopt these changes on grounds of trust issues and fear of the unknown. Those that accept it only connect to a few other systems limiting the advantage of the system. Access control is also a challenge in this information system. With access to this system possible remotely on a variety of devices, it is a concern how to control who sees what in the system. Unauthorized access can have fatal consequences due to bleach of confidentiality ( Saha, 2019 ).
Medical rationality is also a reason for the negative response in integrating this system. Most of the organizations are only prepared to invest in something that has direct effect on the patient. The medical personnel do not see the technology in the perspective of the information technology people and those in management. The medical persons do not also want to take the initiative in learning the new technology or even investing in training other workers. The competitive advantage in these institutions play a part in the reluctant acceptance of this system. Most of the healthcare providers think they will lose customer if they share their information with other institutions and therefore are not willing to integrate this system in their organizations. The coordinated patient care takes away business thus lowering their profits and income revenues. Different organizations also have variant regulations on data sharing. These differences limit them in the number of other instructions they agree to integrate their systems.
Some of the small organizations and those in rural areas are not able to see through this process. The integration of this system requires specialists and knowledgeable personnel to install, sustain in the long term and handling the system challenges. The acquiring and sustaining these professional is costly and not a priority in the small hospitals and those in the rural areas. The reduced financial support from the government has also fueled the reluctance to invest their limited funds in this kind of project.
Solutions
Some of the solutions to transition problem from volume-based system to value-based system is continuous financing and gradual transition. The healthcare organizations should not look to have an abrupt transition due to the cost issues. Moving one step at a time will be easier than waiting to have enough resources for a one time transition. This way, they can cut on the cost pressures. It is also advisable for these organizations to source finances from other activities other than their revenue income. Grants and fund raising would be a good way to raise revenues to cater for these expenses. The small institutions should collaborate with other institutions through formal and informal alliances in efforts to pool resources to finance these projects. These pools help them by enhancing bargaining power and staff sharing among them. Collaborating with bigger organizations may also help due to reduced pricing on products and services.
Encouraging focus on analytics of revenue cycles and change of management techniques by administrators in a universal manner to everybody can be a good way to solve the problem of transition (Next Step Solution, 2019). Most of the workers get frustrated when there revenue income is moved from fee for service model to the value based system. A frustrated workforce can only reflect negatively on the service they render to their customer so it is important to help them have a smooth transition.
Coming up with a universal or common policy on the consequences of failed equipment or medical devices will help reduce the chances of the organizations being in loggerhead with third party organizations. These policies should be developed in collaboration of all the affected stakeholders to ensure acceptance by all.
Actively engaging all stakeholders in this transition is also a big plus. Engaging all the workers in integration assures them that their needs remain a priority. It is important to call meetings and planning sessions while allowing them to participate in the discussion thus ensuring widespread support. Engaging them in every step helps sharing the vision of the organization while ensuring the workers are focused on a similar goal.
On patient safety, there are multiple ways to improve the security and solve some of the underlying issues. Network access control is one of the ways to ensure data confidentiality and reduce the risks of bleach ( Esmaeilzadeh, 2019 ). This method employs a method in which each user device and its user is identified while at the same time able to identify vulnerable devices especially those that have outdated protection spywares. It also limits the amount of data and information a given user can access rather than depend on the integrity of the user. In case of bleaches, the system is able to identify the vulnerabilities and offer solutions to try and mitigate or remedy the situation. Auditing staff members’ devices can also prevent intentional leakages. The organizations can also invest in data loss prevention software in efforts to prevent data exfiltration.
Training on safety precaution techniques in hospitals can help in educating staff on the emergency response techniques. Improving on communication is also vital. For example in the shooting scenario described above, it would have been helpful if the staff knew what ‘code silver’ meant in order for them to respond appropriately. These precautions may help prevent or contain a situation. Ensuring safety and emergency response learning materials are readily available would be useful to those who want to learn in their own personal time. Investing in security officers and relevant equipment would also help scare away attacker as they attack where there are weaknesses ( Peker, 2019 ).
One of the ways to prevent child abduction in hospitals is limiting access to infant holding units. In previous events, the abductors first familiarize themselves with the vicinity by visiting several times. Keeping the units secure may create obstacles to such criminals. It would also help if patients involved are educated on safety precautions to prevent these abductions.
Laying down policies and requirement regulations on hospitals to prioritize in on incident prediction and prevention would also help in preventing cost cuts on the security department. The government should also help by offering security services to small and less financed healthcare organizations. These institutions should also integrate the new technologies in their institutions such as surveillance cameras to ensure the safety of their staff and patients.
Some of the solutions on information and service integration problems include educating patients on the importance of information sharing. Free flow of information and access to health records help in developing better patient care methods promote development in medical advancement and new drugs. Regulated access to patient records can also help drug manufacturers which cuts on production costs subsequently reducing cost of drugs.
It is also relevant to educate the healthcare organizations on the importance of integrating the information and service system by showing them the benefits of the new system. Most of the small institutions feel they will have minimal benefits from the system. Encouraging them to keep up with the trend in digital advancement and presenting to them the underlying returns of these systems boosts their trust in the new system.
In conclusion, healthcare problems have to be solved for the organizations and patients to leap full benefits of their investments. These problems are solved through the cooperation by organizations’ leadership, health workers, the patients, and the government among other stakeholders. While this article enumerates just a few of the problem in healthcare organizations it is crucial to continually come up with possible solutions to these and other challenges in order to maintain a high standard of service delivery. Technological innovations have been on the frontline in inventing new ways to improve healthcare services and ease the delivery of service to patients. It is the main objective of any healthcare organization to provide sufficient, valuable, competent and affordable healthcare to all patients.
References
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