Healthcare is a complicated system that is affected by the interplay of many factors, including regulatory requirements and issues related to quality. Consequently, as much as the industry could be interpreted in corporate terms, the complexity of factors that underpin its existence, especially in the US, makes healthcare a unique industry. The objective of this paper is to assess the effects of regulation, reimbursement, and business strategies on the provision of patient-centered care. The paper uses evidence from BayCare™, which is a non-profit system of hospitals most of which operate in Central Florida. To attain the stated objective, the author applies the Patient-and Family-Centered Care Organizational Self-Assessment Tool (PFCC) to collect data on the organization that would be used to understand the unique leadership concepts in the healthcare industry. Further connections between the collected data and the leadership concepts are made according to the ideals of the systems and transformational leadership theories. The author finds that business models, regulatory mechanisms in the industry, and the systems of reimbursement for health care services significantly influence the provision and accessibility of patient-centered care in the chosen organization.
The Effects of Business Strategies, Regulatory Practices, and Reimbursement Models on Patient-Centered Care in BayCare
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Business Strategies
The existence of private investors in the healthcare industry makes it similar to the rest of the corporate sector. Specifically, the players in the industry, as do the rest of the businesses, should balance their interests with those of their clients. For BayCare, although it is a non-profit organization, two models of corporate strategy can be used to analyze the effects of business practices on the provision and accessibility of patient-centered care. The two practices underscore the need for health care providers the world over to provide their services in a caring and passionate way because of its implication on reputation and the regulatory framework. First, the organization strives to provide the highest quality of services to the patients because of the element of patient satisfaction that is similar to customer satisfaction in business terms. In literature, patient satisfaction emerged in the 50s, and it has evolved to its current state as one of the factors that contribute to the patient-centered model (Torres, 2017). For example, at BayCare, the staff understands that it must always care for the patients in ways that would increase their likelihood of recommendation to others (About BayCare, 2018). The clinical settings are dotted with state-of-the-art technologies and qualified personnel, which ensures that the patients remain happy with the quality of care that they receive. Patient satisfaction requirements have further contributed to the expansion of the service portfolio at BayCare, which is another significant factor that indicates the connection between business strategies and patient-centered care. The organization strives to reach to as many persons in the target community as possible. Consequently, the fifteen hospitals that the organization operates are distributed around Central Florida and Tampa Bay, and they are equipped with multi-disciplinary teams that provide a range of services to the populace (About BayCare, 2018).
Another corporate strategy observable at BayCare Group is that of social responsibility. According to the premise of corporate social responsibility, organizations are supposed to balance their profitability objective with that of improving the wellbeing of the communities in which they operate (Schwartz, 2017). Apart from being a non-profit organization, Baycare engages in a series of programs that target to improve the wellbeing of the communities in which it runs. Among the most notable engagements of the organization is patient and public education that seeks to improve public health awareness (About BayCare, 2018). In the context of patient-centered care, it should be noted that patient education helps in bolstering patients’ understanding of their conditions, including the best personal management practices that could be undertaken to deal with both chronic and mild conditions (Barry & Edgman-Levitan, 2012). The group’s management considers that it is critical for patients to learn how to manage their conditions, which is an extension of the nursing program that is adopted by the organization to improve its approval by the public.
As much as this analysis does not identify management as a strategy, it is imperative noting the crucial role that the management of the Group plays in ensuring the success of the two business strategies. At BayCare, the management team has the role of directing the attainment of the mission and vision statements, which are both centered on patient-centered care (About BayCare, 2018). Frequent meetings with employees, for example, help the management to assess the performance of the organization in terms of its mission and vision. One notes, therefore, that the management has an important role to play in ensuring the success of strategies regardless of whether a corporation is for-profit or not-for-profit.
Regulatory Practices
Patient-centered care has been among the six aims of the health care of the US since 2001 after the Institute of Medicine identified a list of factors that define it (Millenson, 2014). The significance of the report in shaping the healthcare system of the nation is the fact that patient-centered care was adopted into the regulatory framework of healthcare. While there are many ways of interpreting this system in the context of the BayCare Group, analyzing the organization’s code of ethics would be the most useful. Therefore, at the organization, the management and the rest of the team in charge of patient care comprehend the implications of an ethical conduct in their interactions with the patients. Patient-centered care is a ‘relationship’ model of care that requires the healthcare professionals to build proper bonds with their patients. After realizing the challenges that could come with relationship-building, the management of the organization developed a detailed code of ethics that guide the relationship between staff and the patients, and professionalism, autonomy, privacy and confidentiality, and informed consent are among the leading regulatory elements that this analysis identifies.
The staff at the Baycare Group is supposed to maintain the highest professional standards possible in their interactions with the patients. According to the organization’s website, professionalism is the primary factor contributing to honesty and integrity (About BayCare, 2018). For instance, as the website further reports, the code of ethics spells that the caregivers should be open and sincere in their communications with the patients, and that they should always do so in ways that foster healthy future relationships. In addition, the era of information technologies has made it a requirement that healthcare providers in the US and elsewhere manage patient information properly, which explains the significance of privacy and confidentiality, autonomy, and informed consent clauses in codes of ethics of health care organizations.
Since healthy relationships are the core of patient-centered care, health care providers often collect sensitive information from the patients, which they must handle appropriately. The BayCare Group has prioritized privacy and confidentiality of personal information (About BayCare, 2018). Any disclosures of such information are only made according to the provisions of the 1996 Health Insurance Portability and Accountability Act (HIPAA). In line with adherence to the requirements of the HIPAA, the management has spelled out in the code of ethics the need to promote patient autonomy. The interplay of the regulatory and corporate issues described so far suggests the prioritization of patient-centered care at the hospital.
Reimbursement and Patient-Centered Care
The emergence of patient-centered care has transformed the models of reimbursement for health care services in the US. Currently, policy is moving health care providers away from the conventional pay-for-service models towards a value-based system of paying for services received (Gruessner, 2016). In realization of the changes that have taken place in the recent few years, the BayCare Group has now adopted the value-based reimbursement model. Consistent with the essentials of patient-centered care, the value-based reimbursement approach that the Group has adopted places the quality of services delivered to the patient first, and it is important noting the quality of the services are self-reported (Gruessner, 2016). The essentials of value-based system of reimbursement, therefore, are in line with the business practices of the organization that rely on patient satisfaction. Altogether, it implies that an evolution in the models of reimbursement for health care around the country has contributed significantly to the promotion of patient-centered care by the staff and management of the BayCare Group of hospitals.
Completion of the PFCC Tool and the Accompanying Analyses
A Description of the Healthcare Setting
Founded in 1997, BayCare is among the leading non-profit healthcare organizations that seeks to connect persons and families to a wide service portfolio. The services that the Group offers are available in fifteen hospitals as well as hundreds of other locations that are conveniently located for patient accessibility throughout the Central Florida and Tampa Bay regions. The hospital system provides outpatient and inpatient services, including home care and wellness, behavioral health, laboratory, imaging, primary, and acute care (About BayCare, 2018). The mission of the healthcare organization is to better the health of each of the individuals that it serves through the provision of community-based health care services that define the standard for compassionate and high-quality care.
The group adopted several core values that guide in the realization of the mission, and they include dignity, excellence, responsibility, respect, and trust that are a reflection of the organization’s responsibility to attain excellence in the communities that they serve (About BayCare, 2018). Currently, the Group has an approximated 27600 employees, a bed capacity of 3459, 5240 physicians and medical professionals, fifteen hospitals, thirteen imaging facilities, fifteen urgent care centers, and four surgery centers. Collectively, the staff and facilities that the organization owns has allowed it to manage 63165 outpatient surgeries, 176,228 discharges, 675,645 ER visits, and 875,576 home health visits so far that have seen the community value rise to $319 million (About BayCare, 2018). The corporate website of the hospital indicates that it complies with the directives of the Civil Rights Law that bars discriminatory practices in the delivery of care on the basis of religion, sex, disability, age, national origin, color, or race (About BayCare, 2018). Therefore, it is notable that the number of patients indicated have diverse backgrounds because of the commitment to avoid discrimination.
*The Completed PFCC has been attached separately
2. Strengths and Weaknesses of the Organization According to the PFCC Domains
Table 1 summarizes the strengths and weaknesses of the organization according to the different domains assesses. Any score below 3 was considered a weakness, while that that between 3 and 5 was strength.
|
Domain |
Strengths |
Weaknesses |
| Leadership/Operations |
Statement of commitment to patient and family-centered care Inclusion in policy Explicit explanation and assessment of patient-centered care |
Not applicable |
| Mission, Vision, and Values |
The vision, mission, and value statements reflect patient-centered care Bill of Rights reflects patient-centered care |
Not applicable |
| Advisors | Not applicable |
Patients and their families are not properly represented on the hospital committees The patients and their families participate sparingly in safety and quality rounds The patient and family advisory councils are not well established |
| Quality improvement |
The patients and families inform strategic goal development The patients and their families are active in task forces The patients and families participate in safety and risk meetings The patients and their families attend the NPSF, IHI and other meetings |
Not applicable |
| Personnel | ||
|
There is expectation for collaboration between staff and patients in the development of job description policies The patients and their families engage in interview teams The staff is prepared to enhance patient-centered care |
The patients and their families do not welcome new staff at new staff members | |
| Environment and Design | The clinical environment supports family presence and interdisciplinary collaboration | The patients and their families do not participate fully in clinical design projects |
| Information and education |
Web portals are useful Clinical emails at the facility are robust Patients and their families help in education Patients and their families are encouraged to use the resource rooms |
Not applicable |
| Diversity and Disparities |
Careful selection and assessment of diversity language The patients and their families have a timely accessibility to interperimeter services There are navigator plans for the underserved and minority patients Education material suit the literacy levels of the patients |
Not applicable |
| Charting and Documentation |
The patients can access electronic and paper records The patients and family members are able to chart |
Not applicable |
| Care support |
Families are not restricted to visit Families can engage in rounds and change shifts The patients and their families find support, disclosure and support Family presence is allowed The families are allowed to initiate rapid response systems Family presence is allowed during rescue events The patients access updated medical histories at each visit |
Not applicable |
| Care |
The patients and their families collaborate with clinicians The patients and their families are listened to and treated well The staff involves patients and families in planning for transitions care Pain is managed respectably in a collaborative approach |
Not applicable |
Table 1 : the strengths and weaknesses of the BayCare Group of hospitals according to the different domains of the PFCC
Identification of an Area of Improvement
The data presented from the PFCC analysis suggests that the hospital group has not done well in the advisory domain. Consequently, the domain is the primary area that is in need of improvement.
Strategy to Improve Patient Centeredness
The idea and fundamental principles of patient-centered care revolve around the levels of attention that caregivers give to the patient’s needs. The PFCC assesses the levels to which an organization inclines to an inclusive approach to care, which is why any effective strategy should be founded on a similar principle. The primary issue identified in the operations of BayCare concerns the inclusion of patients and their families on the hospital advisory committee. Consequently, the best approach to mitigating the problem would be to adopt an inclusive approach that would underpin the importance of collaboration between employees, patients, and their families. The Sharma, Angel, and Bui (2015) model would be the most useful in addressing the issue.
According to the model advanced by Sharma and colleagues, a successful prototype would have five domains each with different projects. The first domain is that of engaging the clinic leadership to ensure that they are committed to supporting the inclusion of patients in the advisory committee and respecting their contributions to success of the boards. The second domain entails the need for diverse recruitment of the patients to the advisory board. One of the approaches to doing this is to ask the staff and providers for nominations and to notify the patients of such opportunities through recruitment letters and emails (Sharma, Angel, & Bui, 2015). The third domain entails a careful inclusion criterion, especially one that would ensure that the recruited patients would cooperate with other members in ensuring the success of the board at strategizing. The fourth domain, as the authors suggest, is that of the need for adequate funding that would ensure a smooth running of the board. In line with the vision and mission of the advisory board, the fifth domain is the need for the committee to devise a mission and vision statement that would foster the attainment of the objective of patient-centered care.
Application of the Systems Theory to the Strategy
Before detailing the application of systems theory to strategy, it is imperative noting the components of the model. According to Kast and Rosenzweig (2013), the systems model has six components, which are sub-system, synergy, open and closed systems, system boundary, flow, and feedback. The sub-system component of the theory argues that parts of a whole system make the whole system. Applying this idea to the execution of the strategy means that different departments of the organization would be involved, including those concerned with communications, patient education and wellbeing, and others. The synergy component of the model suggests the need for the different systems to work together to attain the set objective. Therefore, it would be useful to appoint a team that would be charged with the execution of the strategy through ensuring proper interdepartmental coordination.
The systems theory suggests that all organizations are open systems because of the way in which they interact with the environment. The team in charge of executing the strategy would inquire from others not included in the team about the best practices that should be applied. The fourth component, which is the system boundary, directs the need for the team in charge of the program to respect the autonomy of the different departments involved. Coordination would be handy in avoiding any confusion that might arise during the process. The flow component suggests that the process should be in constant movement, and for the case of the strategy, the members appointed should remain active in their engagement with others. The last part is feedback, and it suggests the need to assess the efficacy of the chosen strategy.
Financial Implications
The proposed strategy would have financial implications because of the need to develop educational material, undertake the necessary adjustments to the clinical settings, and to train the team involved in execution. Nevertheless, the implications would not be immense considering that the proposed method does not necessitate significant changes to the organizational structure and infrastructure.
Method of Evaluating the Efficacy of the Strategy
Since the proposed strategy is part of a patient-centered model of care, self-reporting would be the most suitable method of evaluating the efficacy of the proposed solution. The approach to assessing the effectiveness of the strategy would include a patient and family survey on their perceived inclusion levels that would be done after one month upon the implementation of the strategy.
Multi-Disciplinary Team
Potential Members and their Roles
Table 2 indicates the potential members and the roles that they would play in the execution of the strategy
|
Members |
Role |
| Physicians, nurses, and family members | Those that involve directly in caring for the patients |
| Patient representative | To represent the interests of the patients and coordinate the interaction of the patients and the rest of the team |
| A representative from the management of the hospital | Operational management and coordination of the core functions involved in patient care |
| Social worker | Supporting services that help in the facilitation of patient care |
| Subordinate hospital staff | The performance of indirect and task-specific services that would lead to the provision of an environment that fosters patient support. |
| A representative from the State Department of Health | To articulate the Federal Policy on diversity and inclusion of people on teams. |
Table 2 : the team and personnel in charge of strategy execution
The Significance of Cultural Diversity in the Team
The team developed to deal with the inclusion of patients on the hospital advisory board should be culturally diverse. The reason for this idea is the fact that patient-centered care is designed to provide care to the patients at individual levels. Consequently, cultural diversity would be useful in understanding the implications of care to the patients, including their perceptions and beliefs concerning healthcare, their likes and dislikes, and other aspects (Campinha-Bacote, 2011). Altogether, culturally diversity would help in avoid generalized care, which might not meet the requirements of some of the patients and their families.
Leadership Style
Transformational leadership as described in literature is one of the most preferred styles of management across different fields, especially healthcare. The significance of the style of leadership in the development of the team in charge of executing the strategy is the idea that it strives to create autonomy among the members (Gabel, 2013). When the leaders in charge of the teams apply this approach to management, they inspire the rest of members to strive to lead the way in attaining the set objectives. In relation the case study of BayCare, transformational leadership would contribute significantly to the attainment of the four fundamental process that are necessary for team success, which are coordination, affective, motivational, and cognitive (Gabel, 2013).
How the Team Would Work Together
The team listed in table two is multidisciplinary, and it has a leader who coordinates at the group level. In line with the constructs of the systems theory, the administration of the hospital would coordinate the overall activities of the rest, which would ensure a smooth flow of activities. For example, the leadership of the team would lead the rest in setting the vision and mission statements that would inform the specific objectives that would be met. The rest of the task of the leadership would be to inspire the rest using the transformational leadership style to realize the set goals and to evaluate the success of the team on each success metric.
Approach to Communication and the Intended Outcome of the Strategy
Meetings would be the most appropriate method of communicating the objectives of the strategy. It would be important for the team holds meetings frequently to assess the milestones realized towards the attainment of the objective of the inclusion of patients and their families on the hospital board. At the organizational level, meetings with the healthcare staff would be necessary to communicate the objectives of the team at first, but subsequent communications may involve structure emails and flyers that would also be issued to the patients and their families at regular intervals of say one month.
Tools for the Assessment of Self-Assessment Skills
Because of its prior use in this paper, the PFCC tool would be applied in assessing the efficacy of the proposed strategy. Furthermore, the TEAM (Team Evaluation and Assessment Measure) tool proposed by the National Center for Inter-professional Practice and Education (NCIPE) would be used to access the efficiency of team development and performance (Taylor et al., 2016).
References
About BayCare. (2018) . baycare.org . Retrieved 25 October 2018 from https://baycare.org/
Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making—the pinnacle of patient-centered care. New England Journal of Medicine, 366 (9), 780-781.
Campinha-Bacote, J. (2011). Delivering patient-centered care in the midst of a cultural conflict: The role of cultural competence. The Online Journal of Issues in Nursing, 16 (2).
Gabel, S. (2013). Transformational leadership and healthcare. Medical Science Educator, 23 (1), 55-60.
Gruessner, V. (2016). Patient-centric strategy key for value-based care reimbursement . Retrieved 25 October 2018, from https://revcycleintelligence.com/news/patient-centric-strategy-key-for-value-based-care-reimbursement
Kast, F. E., & Rosenzweig, J. E. (2013). General systems theory: Applications for organization and management. Academy of Management Journal, 15 (4), 447-465.
Millenson, M. L. (2014). New roles and rules for patient-centered care. Journal of General Internal Medicine, 29 (7), 979-980.
Schwartz, M. S. (2017). Corporate social responsibility . Routledge.
Sharma, A., Angel, L., & Bui, Q. (2015). Patient advisory councils: giving patients a seat at the table. Family Practice Management, 22 (4), 22-27.
Taylor, C., Brown, K., Lamb, B., Harris, J., Sevdalis, N., & Green, J.S.A (2016). Team Evaluation and Assessment Measure (TEAM) . Nexusipe.org . Retrieved 2 November 2018, from https://nexusipe.org/advancing/assessment-evaluation/team-evaluation-and-assessment-measure-team
Torres, A. (2017). The business of healthcare: how patient satisfaction plays . acoep-rso.org. Retrieved 25 October 2018, from https://www.acoep-rso.org/the-fast-track/the-business-of-healthcare-how-patient-satisfaction-plays-a-role/
