I. Introduction
a. Purpose of consultation
Nearly all medicals service providers in the United States aim to safeguard the wellbeing of patients. Despite the efforts of these providers, there are many that are unable to shield their patients against harm. For example, it is understood that there are some facilities which engage in patient dumping (Pruitt & Langland-Orban, 2016). This practice is a serious violation of healthcare standards and compromises the wellbeing of patients. In an effort to understand the measures that medical facilities undertake to ensure patient wellbeing, a consultation was carried out. The consultation sought to serve a number of important purposes. One, the consultation was aimed at understanding the role that nurse leaders play in enhancing patient welfare. Nurses and their leaders have a critical function in ensuring that all systems and processes contribute towards promoting patient wellbeing. Two, the consultation sought to establish the impact of organizational dynamics on the delivery of medical services to a diverse patient population. The dynamics range from the number of employees to the evidence-based practices that a healthcare provider has adopted. Three, through the consultation, it was hoped that an understanding of the factors that derail the effective delivery of medical services will be gained. The consultation allowed for insights about the hardships that facilities face when they deliver care to be obtained. These insights were then to be used to develop recommendations.
b. Overview of the consultation process
For any consultation to deliver helpful insights, it must be based on an elaborate plan. The planning stage of the consultation process involved such tasks as identifying the organization on which to focus and the nurse leader to consult. With this step carried out, the plan proceeded to outline the logistical aspects of the consultation process. The meeting venue and time are the main logistical issues that the plan addressed. It was determined that the consultation would take place at the Oakland Medical Center. This is one of the dozens of facilities that are under Kaiser Permanente. This facility was selected for a number of different reasons. For example, the Oakland Medical Center was the first facility that Kaiser Permanente set up. Therefore, it is fair to expect that this facility reflects the original values, heritage and mission of Kaiser Permanente. That Oakland Medical Center leads other facilities under the Kaiser Permanente umbrella in innovation and the adoption of evidence-based practice is another reason for its selection. The consultation revealed that the Oakland Medical Center is always on the cutting edge of medical innovation and research. It invests huge amounts every year in upgrading facilities and medical research. With the venue identified, the next step was to move on to the actual interview. At this step, a wide range of questions were posed. The questions addressed such issues as the history and routine operations of the Oakland Medical Center. The role of the nurse leader and the challenges that she faces as she executes her mandate are other issues that the interview explored.
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II. Organizational Analysis
Description of organization
The structure, processes and operations of the Oakland Medical facility are some of the issues covered in the interview. Below is a discussion of some of these issues.
• Type and location of organization
Oakland Medical Center is a general hospital that offers a wide range of services. As already stated, the facility is one of the many that are under the Kaiser Permanente umbrella. As is the case with the other facilities, the Oakland Medical Center shares the values, principles and philosophies that govern the operations of Kaiser Permanente. This facility is located at 3600 Broadway, Oakland, CA. This location is ideal as it enables the facility to deliver medical services in a convenient fashion. The Oakland Medical Center keeps its doors open for 24 hours, every day of the week for emergency services.
• Number of employees and patient encounters (approximate)
For any medical facility to effectively deliver care, it must be adequately staffed. Many facilities in the US struggle to deliver care because their employees are overwhelmed as they are required to attend to many patients. The Oakland Medical Center understands the need to ensure that the number of employees matches the patient population. During the consultation, the nurse leader shared that the number of employees at the facility is privileged information that should not be released to private individuals. From the total number of employees that Kaiser Permanente employs, it is possible to estimate the size of the staff at the Oakland Medical Center. Today, Kaiser Permanente has employed over 200,000 employees. This figure includes hundreds of physicians, pharmacists and nurses. Since it is the oldest and most important facility under the Kaiser Permanente umbrella, it must be that the Oakland Medical Center accounts for a significant proportion of the employees. Moreover, this facility operates dozens of departments and divisions. To effectively run these units, the facility requires massive employee input. An approximate figure of 200 employees was arrived at after considering the operations of the Oakland Medical Center. This figure only represents the medical personnel such as physicians and nurses and excludes such support staff as janitors and drivers. The nurse leader consulted was cagey about the population of the patients that the facility serves. However, from the number of departments that the facility operates, it is possible to estimate the patient population. The number of patients who visit the facility on any given day is clearly in the hundreds.
• Departmental map, organizational chart, or leadership structure
The nurse leader made it clear that the facility has a policy that prohibits its employees against sharing sensitive and privileged information with outsiders. She was therefore unable to provide any information that can be used to determine the leadership structure or departmental chart of the facility. However, details of the general leadership structure of Kaiser Permanente are available online. The following is the leadership structure of the California division of Kaiser Permanente:
• Service area (e.g., size, age, demographics)
The Oakland Medical Center focuses most of its operations on the Oakland area. It attends to the health needs of the residents of this area. However, it also receives patients from other parts of California and the nation. The demographic profile of the patient population is varied. It treats children, young adults and the elderly. However, individuals in the 22-45 age bracket constitute a bulk of the patients that the facility treats.
• Services provided
The services that patients can find at the Oakland Medical Center are varied and numerous. These services include emergency care, pharmacy services, chemical dependency recovery, dermatology, HIV testing, hospice care, laboratory services and nutrition. Other services are pediatric care, psychiatry and urgent care. The wide range of services available at this facility indicates that it aims to be a provider of holistic care.
Primary needs of population served by this organization
The effectiveness of the services that a healthcare facility depends largely on how the facility attends to the needs of its patients (Sines, Saunders & Forbes-Burford, 2013). The services should be a direct response to the needs. For example, a facility that attends to a community of addicts should prioritize rehabilitation. Thanks to the consultation with the nurse leader at Oakland Medical Center, it was established that this facility gears its services towards attending to the health needs of the Oakland community. One of the serious challenges that this community grapples with is inadequate housing (Swan, 2016). The high rents that members of the community are required to pay have been blamed for a wide range of health conditions. For example, a link between such ailments as asthma and hypertension and the Oakland housing crisis has been established (Swan, 2016). As the members of the Oakland community are evicted from their homes and forced to pay higher rents, their health suffers. The Oakland Medical Center has sought to alleviate the suffering of the community. The nurse leader confirmed that the facility receives many patients who are concerned that they will lose their homes. This facility has set up special units to deal with such illnesses as hypertension. The facility’s response is clear indication that it shares Kaiser Permanente’s dedication to insulating communities against harm.
The Oakland community has taken steps to shield its members against health risks. However, as the nurse leader shared, the efforts of the community have not been entirely successful because there are hundreds of patients who are diagnosed with illnesses stemming from risks in the community. Today, the US is facing a crisis of lifestyle. Millions of Americans have adopted lifestyles that expose them to a greater risk of developing infections and disorders. For example, a worrying increase in the rates of obesity has been observed (Skinner et al., 2018). Oakland is among the areas in the US where lifestyle diseases pose a serious challenge. The Oakland Medical Center has joined the many healthcare providers who are committed to tackling such conditions as Diabetes and obesity. This facility encourages its practitioners to work with the patients with the goal of promoting healthier lifestyles such as physical activity and nutritious diets. It is evident that the Oakland Medical Center is committed to community health.
One of the factors that hamper access to medicals services is poverty. Millions of Americans endure hardship as they seek quality healthcare (Shi & Stevens, 2005). The nurse leader shared that poverty is a serious problem for many of the patients that the Oakland Medical Center treats. Some of the patients present with illnesses that are the result of poverty. For example, there are some whose children are so malnourished that they are unable to attend school. There are also others who require treatment for injuries sustained as a result of the high crime levels to which they are exposed. The nurse leader confessed that Oakland Medical Center is unable to address the social issues that the patients face. However, she proudly stated that the hospital has made provisions through which it serves poor patients. For example, through the Kaiser Foundation, the Oakland Medical Center offers subsidized and even free care to poor patients. What is clear from the consultation is that the Oakland Medical Center is responding to the plight of underprivileged members of the community.
III. Nurse Leader Interview Summary
Nurse leader role
Before discussing her role at the Oakland Medical Center, the nurse leader lamented that oftentimes, the impact that nurse leaders have on the performance of healthcare organizations go unappreciated. Her title at the facility is nurse supervisor. As this title suggests, her main mandate is overseeing other nurses. However, her responsibilities extend beyond this mandate. She is also required to manage individual cases. For example, the Oakland Medical Center usually assigns her cases of patients who require special care and attention. Patients who are unable to afford services are among those whose cases she oversees. As part of the oversight, she works with such partners as sponsors to ensure that the patients receive care. While the nurse supervisor’s role mainly concerns the delivery of care, she is also involved in a number of administrative functions. For example, she is part of the recruitment and employee training team. Through this role, she is able to ensure that the facility hires competent nurses who understand the need to focus on patient health. The nurse supervisor also monitors the nurses closely so as to ensure strict adherence to the policies of Oakland Medical Center and Kaiser Permanente.
Overall, the roles of the nurse supervisor are in line with the fundamentals of master’s education in nursing. One of the pillars of nursing education is quality improvement and safety (“The Essentials of Master’s”, 2011). The education that nurses receive is intended to equip them with the insights and competencies that they need to lead change with the aim of improving quality and safety. The nurse supervisor is involved in routine tasks which enhance patient safety and the quality of services. For example, she closely scrutinizes nurses to ensure that the care they deliver is of high quality and in line with the standards of the Oakland Medical Center. Another pillar of nursing education is patient advocacy. Nurses are expected to lead the charge in defending patients (Sundqvist et al., 2014). The nurse leader works tirelessly to ensure that patients are provided with adequate and quality care. As already noted, she works with such patients as those who are too poor to afford care. For the most part, the nurse leader performs her duties without hindrance. However, she opened up about some of the challenges that she encounters when executing her mandate. Being undermined by the top leadership is one of these challenges. She shared that there have been numerous instances when the top management instructed her to withdraw from certain initiatives. For example, recently, a patient filed a lawsuit over negligence on the part of the facility. In an effort to ensure an amicable resolution, the nurse supervisor initiated arbitration. She received instructions from her superiors to pull out from the case. She complained that interference from top leaders is frustrating and hinders her efforts to perform her duties.
b. Characteristics of organization
• Strengths
The effective delivery of medical services hinges on how a healthcare provider is able to leverage its strengths. If they truly wish to enhance service delivery, facilities need to exploit such strengths as resource endowment and practitioner competence. The Kaiser Permanente is consistently ranked as among the best providers of health services in the United States (“Twenty Kaiser Permanente”, 2015). This is one of the strengths that Oakland Medical Center shares. As a result of the positive image that it has established, this facility has become the preferred provider of services in the Oakland area. It is worth noting that patients come from other parts of California and the United States for treatment at this facility. The adoption of evidence-based practice is yet another feature that continues to fuel the success and operations of the Oakland Medical Center. Evidence-based practice plays a critical role in enabling a facility to employ the latest insights, technologies and interventions in the treatment of patients. The Oakland Medical Center challenges all of its employees to provide patients with care of the best possible quality. The wide range of services that Oakland Medical Center is yet another strength responsible for its success. This facility is able to attend to patients with different conditions. Essentially, it has become a one-stop provider of quality care. Investment in infrastructure and technology also boosts the operations of the Oakland Medical Center. The nurse supervisor pointed out that this facility is continually identifying ways to improve its facilities. For example, it is setting up buildings with greater bed capacities for the purpose of attending to more patients. The facility also invests in practitioner competence. It delivers regular training to its physicians, nurses, pharmacists and other practitioners. The training is offered in a bid to enhance the skills and knowledge base of the practitioners. Another strength which has allowed Oakland Medical Center to rise to the top of the healthcare industry is the focus that it places on preventive medicine. Prevention presents such advantages as lower costs and improved patient outcomes.
• Weaknesses
The US healthcare system is in a crisis (Ruston, 2009). Medical service providers appear unable to fully meet the health needs of the nation. This inability can be blamed on a number of weaknesses which hamper the efforts of the providers. The Oakland Medical Center strives to provide quality care. However, such weaknesses as poor treatment of patients hold it back. A few years ago, the facility was embroiled in a damaging scandal involving patient dumping. The nurse supervisor said that she had raised the alarm about patient dumping and other violations of medical standards and ethics. However, the facility failed to take action. As a result, its image suffered. The nurse supervisor added that while the facility has addressed patient dumping, there are other violations that still occur. The violations include overcharging patients and providing patients with treatments which only offer temporary solutions. These violations have caused the Oakland Medical Center to lose its reputation as a facility whose primary priority is delivering quality care. Low staff morale and productivity is another weakness that Oakland Medical Center grapples with. The facility endeavors to incentivize its practitioners in a bid to promote morale. Despite the facility’s efforts, such issues as absenteeism and low productivity are still being witnessed. The patients have borne the brunt of this challenge.
• Evidence-based practice activities
Evidence-based practice is the key to enhancing the delivery of care. Basically, this practice is concerned with relying on the latest evidence and insights to inform decision making as regards treatment (Houser & Oman, 2010). Today, an increasing number of facilities in the US and across the globe are embracing evidence-based practice. The Oakland Medical Center is among these facilities. Research is one of the activities that this facility undertakes as part of its evidence-based practice. The nurse supervisor offered a tour of the research division of the Oakland Medical Center. This division is made up of researchers who work tirelessly to provide practitioners with the latest insights which are then integrated into interventions. Another activity that constitutes evidence-based practice at the hospital is constantly examining patient needs and values. If a healthcare provider is to effectively integrate evidence-based practice into its operations, it needs to ensure that the practice meets patient needs while being in line with the values of the patients. The main patient value that drives evidence-based practice at the Oakland Medical Center is the desire for quality care. Consequently, this facility’s practitioners strive to ensure that their operations facilitate the delivery of quality care.
• Quality improvement projects
Continuous improvement is one of the hallmarks of effective delivery of quality care (McLaughlin, Johnson & Sollecito, 2011). Medical facilities should not be complacent. Instead, they should explore ways to improve the quality of care that they offer. Research offers the facilities an avenue to gather insights for quality improvement. The Oakland Medical Center has undertaken a number of projects whose primary purpose is quality improvement. The construction of buildings to boost bed capacity is one of the projects. In the United States, medical facilities are unable to adequately attend to the needs of patients due to limited capacity (Andrulis & Duchon, 2007). In response to this challenge, the Oakland Medical Center continues to invest in infrastructure projects. The hospital also delivers regular training to all of its practitioners. It holds seminars and conferences which seek to introduce the practitioners to the latest trends and developments in the healthcare industry. The practitioners proceed to incorporate the insights into their roles. Negligence is one of the issues that erode the quality of care that facilities in the US offer (Patel & Rushefsky, 2014). As noted earlier, the Oakland Medical Center’s employees demonstrate low levels of morale and productivity. As a result, the facility has registered a spike in cases of negligence in recent years. In response to this issue, this hospital has developed an accountability framework. Through the framework, it has achieved higher levels of productivity while minimizing the cases of negligence. The framework is clearly one of the projects that the hospital has initiated to promote continuous quality improvement.
IV. Recommendation for Organization Change
Recommendation
The Oakland Medical Facility faces various challenges that require urgent solutions. Most of these challenges are the result of internal weaknesses that can easily be rectified. It is recommended that this facility should adopt a clearer and stricter code of ethics and conduct. The implementation of this recommendation will undoubtedly go a long way in addressing the weaknesses while enhancing the welfare of the community that the hospital serves. In the following discussion, a detailed analysis of the rationale for this recommendation is offered.
Rationale
Medical facilities are involved in the sensitive business of preserving human life. Therefore, before they adopt any proposal, the facilities need to critically scrutinize the proposal. The proposal should only be adopted after it has been established that it will improve patient outcomes. As it develops a better code of ethics and conduct, the Oakland Medical Center will be poised to enjoy a number of benefits. The code will challenge the practitioners to exhaust all resources and measures in safeguarding patient wellbeing. Thanks to the code, the facility will effectively tackle such violations as patient dumping. It is understood that codes of conduct and ethics which spell out standards and requirements clearly inspire practitioners to pursue excellence. The code of conduct and ethics will also reinforce the image of the Oakland Medical Center as a facility that is dedicated to quality care. The nurse supervisor stated that the scandals surrounding patient dumping damaged the reputation of the facility. Through the code of conduct, the facility will remind the public and other stakeholders that it remains committed to quality and excellence. One of the weaknesses identified in an earlier discussion is low productivity and morale. This weakness can be blamed on the lack of a proper code of conduct and ethics. The Oakland Medical Center needs to update its code so that it reflects the need for commitment, hardwork and a passionate desire to treat communities. While the new code of ethics and conduct will enhance the image and operations of the facility, it will also go a long way in improving patient outcomes. Therefore, the Oakland Medical Center should move with speed and write up a new and improve code of ethics and conduct.
Measurement of effectiveness
As they implement proposals with the goal of improving service delivery, medical facilities should use benchmarks to measure their performance (Smith, Mossialos & Papanicolas, 2008). The benchmarks allow them to determine if their implementation of the proposals meet set standards and expectations. In the US, there are numerous standards that medical facilities can use to evaluate their performance. The Accreditation Association for Ambulatory Health Care (AAAHC) has developed a framework that the Oakland Medical Center can use to measure the effectiveness of the implementation of the proposed change. One element of the framework is how a facility honors the rights of patients. The impact of the implemented change on governance and administration is another element of the AAAHC framework (“16 Accreditation Handbook”, 2016). This framework also challenges medical facilities to assess how their operations affect the quality of care, information management, infection control and patient safety.
It is advised that the Oakland Medical Center should use the AAAHC framework to determine if the adoption of a better code of ethics and conduct improves operations and patient outcomes. All the stakeholders need to examine how adherence to the code affects service delivery. For example, if it is determined that fewer patients develop complications and that most patients make a full recovery, this is basis to conclude that the change has been implemented successfully. The stakeholders should also investigate the impact of the change on hospital finances. For instance, should it be established that the cost of compensating patients who have suffered harm has dropped, the hospital can conclude that the change has been successful. In general, an overall improvement in service delivery and patient experience should be taken as evidence of the effectiveness of the new code of ethics and conduct.
V. Conclusion
The Oakland Medical Center is the flagship facility of Kaiser Permanente. It has been in operation for decades and continues to deliver quality care today. This facility provides a wide range of critical medical services. While it welcomes patients from across the nation, most of its patients are residents of Oakland, CA. The facility responds directly to some of the health risks in this area. The risks include lifestyle illnesses, poverty and social challenges. The massive investment in infrastructure, competent personnel and a commitment to enhancing patient wellbeing are some of the strengths that have enabled Oakland Medical Center to command the respect and admiration of many. However, numerous weaknesses erode the effectiveness of this facility. To address these weaknesses, it is recommended that the facility should rewrite its code of conduct. As it does this, it will inspire its employees to work tirelessly to ensure that all the needs of the patients are met satisfactorily.
References
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