Strategic leadership is critical for all organizations including healthcare institutions. The use of strategic leadership ensures that healthcare institutions provide high-quality services amidst the complexities that result from globalization. Strategic leadership involves the policy formation and implementation that meet both short term and long terms goals of the organization. Thus, there is a need to understand the shortcomings of an institution to formulate effective polices that will ensure success in the long run. The focus of this paper is Johns Hopkins where its performance will be examined based on the results from HCAHPS. Examination of HCAHPS shows that Johns Hopkins hospital is performing poorly from the perspective of patients with a two star rating compared to other hospitals. Further examination helps in understanding critical leadership strategies that will facilitate improved quality care and service that meets the patient’s expectations.
HCAHPS
HCAHPS measure the scores of a hospital based on the perspective of the patients concerning the care they received. HCAHPS gives up to five-star rating for the patient’s perception of the hospital. Medicare government websites provide a hospital compare where one can view the rating of all hospitals that add their details on HCAHPS. The ratings make it easier for consumers to spot institutions that provide excellently and quality services From Medicare; Johns Hopkins has a HCAHPS rating of 2; thus the hospital has an overall 40% HCAHPS score. The HCAHPS score was based on patient experiences on recent stays, perception on timely and effective care, and complications or any deaths experiences. Additionally, the score also measure the perception of patients on unplanned medical imaging, payment and value of care, and unplanned hospital visits. The rating is below average implying that most patients have not had good experiences while seeking services from the healthcare institution.
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Analysis of HCAHPS score for Johns Hopkins Hospital
Compare with nation averages: Medicare provides both national and state averages of the HCAHPS rating. The overall national ratings provided combined the results from 4,579 hospitals. Out of the 4,579 hospitals, 337 (36%) had five star, 1155 (25.22%) had a four-star, 1187 (25.92%) had a three star, 753 (16.44%) had a two star, 260, (5.68%) had a one star, and 887 (19.37) were not rated. From the results, 58.5% hospital had a rating of 3 and above. Considering the 19.37% of the hospital did not provide their HCAHPS, and then Johns Hopkins performed poorly. Out of the total number of hospitals, less than a thousand, including the Johns Hopkins had ratings below three.
Compare with state averages: There are 51 hospitals in Maryland. Most of the hospital in Baltimore had a rating of three (60%) and above. From Medicare data, four hospitals had a five-star (100%), ten hospitals had a four-star (80%), and seventeen hospitals had a three star (60%). Only fourteen hospitals had star rating lower than 60% with nine having as two stars (40%) and five having a one start (20%). Johns Hopkins Hospital has a 40% HCAHPS score. The 40% score is low compared majority of the hospital in Maryland; therefore, the hospital is performing poorly in terms of service and quality care.
Compare to two other hospitals: To better understand the performance of Johns Hopkins, it will be critical to compare performances with a hospital that is close. First, there is Mercy Medical center that is 1.4 miles away and has a four star (80%) HCAHPS score. Second is the University of MD Medical Center Midtown Campus that is 1.9 miles and with a two star, (40%) HCAHPS score, thus, its performance equally as Johns Hopkins.
Survey response rate : The survey response rate is reflected by the star ratings. Johns Hopkins Hospital and University of MD Medical Center Midtown Campus have a star rating of two which implies that 2 out of five people are willing to participate in the survey (Medicare). At mercy medical center, four out five patients are willing to participate in the satisfaction survey; thus, it has a higher survey response rate compared to the other two hospitals.
Demographics and services: Johns Hopkins is an Acute Care Hospital that is 0.1 Miles and has emergency services. The acute beds in the hospitals are 1,131 (MHCC, 2018) and the number of inpatients admitted is 47,403 (JHM). 0.6% of the patients are insured, 29.9% receive Medicaid benefits, and 28.3% receive Medicare benefits. According to Johns Hopkins database, the annual patient visits is more than 900,000 and 158 patients come from central Maryland. 58% of the patients are white, 25% are African Americans, 8% make up other races, 2% of the patients come from unknown races, 4% are Asians and 1% makes up the American Indian, Alaskan Native, Native Hawaiian, Pacific Islander, Hispanic, Latino, or Spanish Origin.
Cultural Dynamics: Usually, cultural dynamics such s religion, ethnicity, and race influence the HCAHPS score. Cultural diversity negatively affects operations within the organization for instance through communication barriers. Additionally, cultural diversity may increase inequality in service provision. Therefore, cultural diversity, if not managed well may contribute to the low HCAHPS score in healthcare institutions. When patients feel that there is favoritism in how they are treated just because of communication barriers, they will rate services lowly affecting the overall HCAHPS score.
Education dynamics: Difference in the level of education affects the level of HCAHPS. Individuals that are well educated will understand the importance of taking insurance that would cover their care. Also, educated individuals will be more will to participate in the surveys as opposed to the uneducated individuals. Education rate reduces the number of individuals that are willing to participate in the surveys, thus, there will be incomprehensive precipitation that may not give true scores of patient perceptions. Education barriers create a possible of many satisfied patients not participating in the survey.
Social, economic dynamics : Higher social, economic individuals are highly likely to afford medical care as opposed to patients with lower socioeconomic patients. With high income, patients can request for premium service and thus give a positive rating for the care. Additionally, high income provides health care with finances to cater for the quality services required by the patients.
Financial Impact : Johns Hopkins is a nonprofit health care institution; therefore, its short term and long terms goal are to provide high-quality performance and support strategic entities with minimum finances from the patients. The goals of Johns Hopkins Hospital include supporting funding and resources for medicine, clinical care, education, and research. Its long-term goals are to transform the health and advance medical education. Usually, quality care is depended on the availability of funds. Thus, when the institution demands minimum pay from the patients and yet lack external funding for its services, then it may not be possible for the hospital to service its equipment and pay its staff sufficiently to ensure quality care. As a result, there will be a low rating from the patient's perception due to low-quality services. The ratings will negatively affect the company in the short run and long run. However, with sufficient funds, there is a high probability for healthcare to provide high-quality services that will reflect positive score both in the short run and in the long run.
Potential causes of Hopkins low HCAHPS score
Baltimore, MD has a low score on the diversity index as evaluated from the different ethnic groups (Yeip, 2015). There is, therefore, a possibility that cultural diversity was not managed well in the institution. When healthcare providers given unequal treatment to patients due to their ethnicities, they will feel it and they will give negative feedback on the survey of patients’ experiences. The negative feedback may therefore have contributed to the low HCAHPS score at Johns Hopkins Hospital.
According to Berube & McDearman (2015), the level of poverty and inequality in Baltimore Maryland is high. With low income, the hospital will not be able to give timely and effective care, medical imaging will not be efficient, and delay because complications and even death. When feedback is collected, patients that receive unsatisfactory experiences will reflect the same in the surveys which contributes to poor HCAHPS rating. Therefore, it is possible that social, economic diversity caused the low HCAHPS rating.
There is a high disparity in Baltimore which causes disparity even in education. When all members of society have access to equal education, then many will afford higher living standards. Thus, education dynamics may have contributed to the low HCAHPS rating in the hospital.
Organizational Strategic Plan
Organizational Change: First, it is important to note that cultural disparity is the highly probable cause of lower HCAHPS in the healthcare institution. Other causes of lower HCAHPS like education and finances draw from the cultural diversity. Therefore, the company needs a change in the leadership which will, in turn, facilitate the provision of high-quality care and services to its patients. Elements critical to employed strategic leadership should first understand the priorities of the organization as well as being able to develop visions that adds value to the hospital ( Rashid et al. 2015) . Secondly, each member of the team should be able to contribute positively towards success of the organization. Thus, personal process will facilitate strategic thinking at personal and team level ( Rashid et al. 2015). Finally, there is a need to have responsible members of the team both in leadership and subordinates.
The patients need to develop confidence in the ability of the patient to provide reliable evidenced-based practice, access reliable healthcare providers, effective care coordination, interactive appoints, nurses that are dedicated to nurse-to-patient time, and short wait times. Good strategic leadership will ensure that Johns Hopkins provide high-quality service that satisfies the patients which will, in turn, leads to an improvement in HCAHPS score. Strategic leadership will analyze the experiences of patients, define the patient experiences, and then involve patients and family in designing and improving care delivery. Good strategic leadership will also ensure to hire the right staff, improve employee engagement, provide regular training to inform staff how to care for patients and discuss the patient experience score with staff.
Structure: The structure of the strategic plan is focused on understanding the fundamental roles of all stakeholders involved in the hospital. The functions of services providers will then be defined in line with the vision, mission, and perception of the patients. Following a need for a new definition of roles, there will be leadership and overall structural reforms in the hospital. There will be the promotion of good governance that ensures performance in service delivery.
Processes: The actions that the structural reform will work on are ensuring patient-centered care, safe care, and ensure all standards of care are met. The hospital CEO will oversee the attainment of the objectives, and the management committee will monitor the objectives regularly.
Outcome: The structure and process involved will ensure patient satisfaction. In particular, the patients will be willing to participate in the survey; most patients will recommend the hospital to other, appreciate the hospital for the services provided, and rate the hospital 4 or five stars.
Improving organizational quality: Blending the concepts of evidence-based practices (EBP) with governs helps in cultivating quality in the dynamic institutions. EBP will be promoted by encouraging staff to further their education to enhance their practice and invest in the institution more. Shared governance will be incorporated by giving more individuals in subordinate levels to take up manageable leadership roles especially the nurses who will then advocate for increased use of EBP. Importantly, high-quality EBP is critical in ensuring delivery of quality care. The blending of shared governance and EBP supports continuous improvement in the quality of services provided to patients as well as promotes accountability among staff. Shared governance, when blended with evidence-based practice is vital in healthcare since it entails involving all members of staff in the improvement of healthcare. This creates a sense of responsibility among nurses and other subordinate staff since they are all aware that it is also their prerogative to ensure patient satisfaction.
Shared Accountability: Shared accountability is critical to patient satisfaction as it ensures all stakeholders perform their duties as required. To ensure the concepts of shared accountability are incorporated well at Johns Hopkins Hospital, some strategies will be used. First, all the stakeholders will be required to understand and meet the conditions of participation. For instance, Medicare requires that suppliers meet the standards in CoPs and thus help in establishing expected standards (Berenson & Rice, 2015). The participation requirement will also ensure that all professionals have board certification which proves the ability to provide quality care. The second strategy will involve the use of performance measures that will lead to termination of stakeholders who underperform. The institution will also seek authorization from Medicaid and Medicare on lessons learned from the highly priced intervention programs. The patients will be made accountable by educating them on critical health matters. For instance, patients can be encouraged to participate in the surveys. Also, patients can be taught on the strategies they need to manage their conditions. Payers of medical bills such as Medicaid, Medicare, employers, and private institutions need to make prompt payment to ensure fund are available to help in successful treatment and quality care of patients.s
Technology trends: Technology has also become part of healthcare, and it is vital for any strategic leader to ensure that technology is part of their strategy to ensure organizational success. Technology, in healthcare, is used for record-keeping purposes and monitoring of the patient’s medical progress. The use of technology has also enabled healthcare delivery for chronic diseases to become easier since some of the machines have diagnostic capabilities. Technology trends will improve efficiency, enhance talents by providers, and improve the healing process among other factors that promote patient satisfaction. The technology trends that will be incorporated at Johns Hopkins include the use of an enhanced database management system that integrates the use of portable devices and with back up stored in the cloud. The centralized database management system will improve the decision-making system and facilitate continuous monitoring of patients (Wager, Lee, & Glaser, 2017). The supply of medical equipment and all other supplies will be digitalized to improve operations management.
Improve Care Delivery System: Improving the care delivery at Johns Hopkins is the only way that can lead to improvement in HCAHPS ratings. Improved care delivery results in high patients’ satisfaction. Importantly, the greater public awareness has increased the demand for high-quality patient care (Cherry & Jacob, 2016). For this particular hospital, quality in the care delivery can be improved by ensuring efficiency in operational systems, competency among personnel, quality training of nurses, and using high-quality infrastructure and tools. The cost will be managed by reducing wasteful use of resources, improving performance, tracking quality measures automatically, streamline operations, and educating all stakeholders on the cost structure. Access to medical care will be made efficient by changing the structure and scope where highly trained professionals like doctors and physician assistants can delegate some reasonable duties to juniors. The intense use of technology and telehealth can also facilitate access to care delivery. Additionally, the use of shared appointments can reduce the number of patients on the wait list and facilitate access to medical practitioners. Leaders will facilitate patient-centered care by making sure that all staff understands their duties and responsibilities, setting goals, rewarding individuals that perform well, setting clear guidelines, and working closely with the patient advocates.
Improve Financial Stability: Financial stability in healthcare can be improved by ensuring that there is complete transparency between the management and the stakeholders. This creates an environment of accountability and openness in day to day running of the hospital operations. The management should also ensure that they follow up on projects to ensure that other projects do not consume funds allocated for other plans. This ensures financial accountability and improves on service delivery in the healthcare industry. To ensure financial stability, the leaders will ensure that employers are satisfied with how they are treated and that they are happy. As a result, there will be operation efficiency characterized by employees earning true value of their work. Demoralized employers turnover will be high which affects costs negatively (Skiba, Saini, & Friend, 2016). Secondly, high-quality performance will reduce costs and wastes. The leaders will also ensure to hire high-quality staff and train the present ones to maximize production.
Implementation of a strategic plan and timeline
Stakeholder Roles and Responsibilities: The stakeholders that determine the successful implementation of the strategic plan include patients, employees, partners, insurance companies, suppliers, and government. The leaders should thus ensure that roles and responsibilities of the stakeholders are well defined. The patients and families will provide suggestion on the best strategies that will make then satisfied with the services provided by the institution. The patients and family will be encouraged to participate in the surveys as it will help the hospital to understand the progress it has made in healthcare. The insurance companies will provide leverage for the price negotiations and allow for a reduction in prices with the increase in some insured patients. The most affected individuals in the implementation of the strategic plan are the members of staff. Therefore, the smooth running implementation process will be facilitated when the roles of each employee are identified. The nurses will be expected to provide services high-quality services to the patients while reporting to managers. The project manager will ensure all tasks are performed, reported and recorded regularly. Additionally, the project manager will keep the partners and sponsors informed of the progress made with the project.
Stakeholder Accountability: Stakeholder accountability is critical in the implementation process. To ensure accountability, the all stakeholders need to be extensively involved in the process. One way to promote accountability is by listening to the concerns of stakeholders and addressing them (Camden et al. 2015). The implementation team should be able to identify all issues that hamper the completion of the project and address them; this way, stakeholders will feel appreciated and work to attain the goals of the project. Accountability can also be increased by managing the expectation of the stakeholders by clearly defining the roles in the attainment of the goal. If expectations are not met, stakeholders may be frustrated or angered and have negative attitudes towards new projects in future.
Training: Some of the activities that will ensure patient satisfaction include safe care, centered patient care, and meeting all standards of care. These processes will directly involve nurses. Importantly, these activities are always known to most all accredited nursing professionals. However, ignorance and negligence contribute to poor performance and eventual low HCAHPS ratings. For this reason, training will be needed to remind the employees of what is expected of them (Holmes & Noel, 2015). Additionally, protocols, structure, and policies will be changed to meet the patient satisfaction needs; thus, training will be crucial to inform the employees of the changes, new roles, and importance of their full participation in the implementation process. The training sessions will also provide project managers to clarify what the employees do not understand about the new project. Importantly, employees will be taught about performance measurement and the rewards that will be achieved with their corporations. Training ensures the creation of an environment conducive to implementation as well as ensures staff is motivated towards the success of the project.
Plan Implementation: The implementation of the plan will take at least 13 months. In the first month, consultation with the planning team will be made the strategic plan process will be introduced to the leadership team. Discussions and reviews will help in the development of work plan. In the next three months, information concerning the quality of service and available resources will be collected from all departments. Additionally, self-assessment will be conducted to determine the competency of nurses and results will be shared with the planning team.
The following three to six months will involve the development of the strategic goals where vision, objectives will be articulated in detail. These goals and the mission will ensure that the stakeholder focuses on patient satisfaction strategies. Also, there will be a review of the goals and the vision to ensure only the project will be fruitful. Once the goals are set, they will be shared extensively with the staff and other necessary stakeholders. Afterward, development of internal and external communication plan will be employed, and staff will be trained on the new projects. The internal and external communication is critical to sharing the new strategic plan to the workforce and other concerned external stakeholders including patients and family. Finally, three months will be used to ensure that all stakeholders perform their roles and responsibilities as defined by the strategic plan.
Importantly, mid-point checkpoints will be held two years after the implementation of the strategic plan. The checkpoints will offer a platform to share progress updates, identify new tools and partners, and amending the plan to ensure the patient satisfaction in the long run and over the years is achieved.
Evaluation of the Strategic Plan’s Success
Method: First, the HCAHPS provides a critical tool for measure the outcome of the strategic plan. Improved ratings score will show imply that the strategic plan is a success. For this particular strategic plan, an internal survey will be used to measure patient satisfaction. The survey will be filled voluntarily by patients and family. The surveys will collect demographic data, they will include open-ended questions, and they will be distributed to the largest groups of patients through the mail (Wolf & Floyd, 2017). As such, sufficient data for accurate evaluation will be attained. First, a pretest will be done on the survey to ascertain whether or not the questions are problematic to the patients. Here, conventional interviews will be used to get understanding of what patients think about the surveys. Any problems can the be sought through educational programs. Cross reference analysis can then be used to evaluate the results of the surveys to ensure that different patients understand the purpose of the survey. Cross reference analysis will prevent the use of misleading results.
Evaluation of the Timeline: One year after the implementation, the hospital should have moved from a two star to a three star. Additionally, the company should move to a four-star HCAHPS score at the end of the second year. Failure to attain the goal will mean that the company’s strategic project will be a success.
Method of Analysis: Once the implementation plan has been completed surveys will be used to collect data from the patients. Analysis of the first year after implementation will be done in the second year while analysis of the second year will be done in the third year. Here, sample size, the average score for each question, the confidence interval of 95%, and distribution of questions, response rate, and level of satisfaction will be measured. High response rate, good distribution rate, and high satisfaction rate will show that the company is performing attaining the goals of the strategic plan.
Involvement of stakeholder: Some ways can be used to implement stakeholders in the evaluation process. First, there is a need to provide stakeholders like partners to offer reality checks and feasibility of the survey (Peter da Costa, 2012). Others like community representatives will help in offering insights of the impacts of populations to the results obtained. The stakeholders can also be given the opportunity to comment on the results of the evaluation results which will in turn help in identifying areas of improvements. In particular, the stakeholders will participate in giving feedbacks and recommendations.
Communication of Results: Communication of results is critical for all stakeholders involved as it provides them a means to understand the progress they have made by participating in the strategic plan (Peter da Costa, 2012). First, a written overview will be prepared with a detailed and summary of the evaluation which can then be posted on the company’s website for stakeholders involved to access. Second, a PowerPoint representation will be prepared based on the overview and used to communicate and allow for discussion with employees in the planned forum. The written overview can be distributed to key stakeholders through email.
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