Process Evaluation Approaches

Morton Plant Hospital, which is in Clearwater, is one of the best-known hospitals in Florida with the best customer experiences. It is a 687-bed hospital with more than 300 services in fifty specialty areas. Since its conception, the hospital has been outstanding, but people can understand more about its performance by analyzing the facility's data from the customers’ viewpoint. Therefore, analyzing the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, can provide a glimpse of how the customers rate the Morton Plant Hospital ( Liang, Cako, Urquhart, Straus, Wodchis, Baker, & Gagliardi, 2018). Also, the analysis allows comparison in customers’ rating between the hospital, states, and public performance. The data on customer ratings can also help the hospital improve to match other top-performing hospitals in Florida, such as Mayo Clinic. 

HCAHPS Scores for a Hospital 

Morton Plant Hospital’s HCAHPS score is impressive as people rate the facility as four stars, and this means that the provision of its services is of a good standard. The hospital scores 80% for p atients who report that their nurses "always" communicate well, and 78% for doctors who communicate well ( Fulop & Ramsay, 2019). Besides, 66% of the patients say that they "always" receive help immediately when they visit the facility. The hospital scores 65% for clients who claim that they get a proper explanation of their prescription ( Otim, 2019).  

Furthermore, 73% of patients accept that the hospital’s rooms and bathrooms are clean. Only 56% of patients assert that their rooms are quiet at night. The data also show that 89% of patients get an explanation of what to do during recovery, while 56% of patients understand their medication (Galgali, Fong, Bissell, Armstrong & Humphrey, 2018). Also, 79% of the clients rate the hospital nine out of ten, while 84% could recommend the hospital. 

The Hospital HCAHPS' Score Analysis 

It is essential to understand how Morton Plant Hospital is performing at the state and national levels. Comparing the HCAHPS data at the national and state level could draw a line of comparison. The hospital scores 80% for patients who report that their nurses "always" communicate well, which is above the state (76%) but below the National tally (81%) ( Lazar, Rappaport, & Sharif, 2018). The facility scores 78% for doctors whose patients report that they "always" communicate well is also above the states' score (76%) but lower than the national average (81%). At the hospital, 66% of the patients report that they “always" receive help from physicians while in the facility. The data is lower than the average at the national (70%) but higher at the state level (64%) ( Otim, 2019).  The hospital scores 65% for the patients who claim that they get an explanation, which is higher than the state average (62%), but lower than the national average (66%) ( Fulop & Ramsay, 2019). 

Furthermore, 73% of patients accept that the hospital has clean rooms. The score is higher at the state level (70%) but lower compared to the national average (75%). Also, the claim that the hospital's rooms are quiet at night from 56% of patients is lower than both state (89%) and national level (62%). About 89% of patients claim that they got an explanation of what to do during recovery ( Galgali et al., 2018). The score is better than the state (85%) and national (87%) averages. About 56% of patients claim that they understand their medication after leaving the hospital, and this is better than both national and state levels. Also, 79% of clients rate the hospital 9 out of ten, while 84% would recommend the hospital. Such scores are better than both national and state levels. 

The table below compares the Mayo clinic to other health facilities and shows that it is above the Morton Plant regarding customer ratings in many aspects of HCAHPS. However, Morton Plant outperforms the Holy cross in most of the HCAHPS elements, as the table shows ("Medicare.gov | Hospital Compare"). According to Fulop & Ramsay (2019), from the table, it is evident that patients rate the Mayo clinic higher than either Holy Cross or Morton Plant. 

	Mayo clinic hospital	Holy cross		Morton plant
Patients who reported that their nurses "Always" communicated well	84%	73%		80%
Patients who reported that their doctors "Always" communicated well	85%	80%	78%
Patients who said that they "Always" received help as soon as they wanted	73%	59%	66%
Patients who reported that staff "Always" explained about medicines before giving it to them	68%	59%	65%
Patients who said that their room and bathroom were "Always" clean	77%	65%	73%
Patients who said that the area around their room was "Always" quiet at night	63%	49%	56%
Patients who said that YES, they got information about what to do during their recovery at home	88%	84%	89%
Patients who "Strongly Agree" they understood their care when they left the hospital	63%	50%	56%
Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)	85%	68%	79%
Patients who reported YES, they would recommend the hospital	88%	73%	84%

Another notable difference between the hospitals that could also have a significant say on the HCAHPS scores is the survey response rate. A look at the return rate for Holy Cross and Morton plant is higher than the Mayo clinic. They score 67% and 65% for Morton Plant and Holy cross, respectively, while Mayo Clinic is at 59% ("Medicare.gov | Hospital Compare"). The total number of the target participants for the Morton Plant was 2350, which was fifty more than the Holy Cross hospital that had a target of 2300 ("Medicare.gov | Hospital Compare"). Out of the 2350 surveys sent, 67% were returned at Morton Plant while 65% at Holycross. Morton Plant, more female 56%, returned the surveys than the male with the same results at the Holy Cross ("Medicare.gov | Hospital Compare"). At Mayo clinic, however, there were a total of 3090 participants with a total of 59% returning their Liang et al. (2018) argue that the percentage of survey returned could have an impact on the HCAHPS scores for each of the hospitals. 

Morton Plant Hospital serves a vast demographic population in the United States and the world. The hospital's demographic profile by age ranges from newborn to older people. Mostly, there is about 25% of the patients with an age range of one month to 19 years old ("Medicare.gov | Hospital Compare"). These are mostly children and teens that seek different treatments, for instance, maternity health and children healthcare ( Lazar, Rappaport, & Sharif, 2018). Furthermore, both males and females received the same treatment in the hospital; however, female reports more than males in the hospital. Married people take about 45% of the population served by the hospital, with most people being professionals in different fields. Business people also take a good percentage of patients at this hospital. The hospital serves mostly the middle class with stable annual income and tertiary educational level ( Lazar, Rappaport, & Sharif, 2018). Young mothers and fathers also benefit from different educational health programs such as women healthcare care, family education, and maternity education ( Otim, 2019).  The cancer patients are also considerable in numbers. Patients suffering from different heart disease also benefit from cardiology services in the hospital. Other services, such as research, bariatrics, are also found in the hospital ("Medicare.gov | Hospital Compare"). Geographically, Morton plant patients come from Florida that accounts for 54% of the total patients within the hospital. However, there are also patients from different states that account for about 20%. The hospital also extends its services to global patients ( Clancy, Povey, & Rodham, 2018). Economically, the hospital serves both the middle class and the upper class at a premium cost. Unfortunately, the prices are high for clients in the lower class. According to Galgali et al. (2018), t he institution's services also target both male and female — however, the hospital prioritizes children with a number of its services targeting kids. The hospital focuses on oncology, pediatrics, gynecology, and children health being part of the services packages that the hospital values more ( Otim, 2019).  These are the services that make the hospital rank best at the state and national levels. 

Like any other hospital that operates in a diversely populated country, such as the United States of America, Morton plant also faces many challenges. The problem stems from different factors that reshape the provision of its services, which have a positive or negative impact on its HCAHPS score. Cultural dynamics is one of the critical factors that the hospital face as it provides the services to the clients. For instance, some consumers do not like services like immunizations for their children ( Clancy et al., 2018). When the hospital emphasizes issues to do with vaccinations, its rating falls, and this harms the facility's HCAHPS score. Culture problems, such as drugs, different medical and health programs could influence the society to have either a positive or negative impact on the score. Clancy et al. (2018) add that the effect may reflect on the hospital's final percentile score. 

Education is also another factor that could change the facility's HCAHPS score. The educated population understands the healthcare issues, and thus understand when the hospital does a review. Therefore, when a hospital operates in an area with a highly educated population, its score reflects the true nature of services than when it works in regions with less educated people. The Socio-economic dynamics can also affect the facility's rate of HCAHPS scores ( Galgali et al., 2018). For instance, when a hospital charges high prices in areas with low-income individuals, they will rate it poorly. However, when the facility provides services for those who are capable of paying such costs without any difficulty, it will get a good rating. Therefore, the socio-economic stability of a population influences how they will rate the hospital, and this impacts the general HCAHPS score (Lazar, Rappaport, & Sharif, 2018) 

Finance is essential for both non-profitable and profitable companies. Therefore, a hospital requires funds for proper operation. For instance, the hospital should pay its staff to avoid absenteeism and low morale ( Galgali et al., 2018). Worst still, inadequate funds may lead to more staff leaving the hospital than when it has enough funding. Also, a hospital cannot be in a position to provide quality services and acquire a skilled team when it operates below its financial expectations. Chevalier, Watson, Barras, Cottrell & Angus (2018) discuss that the resulting impact is a lack of expansion and low-quality services caused by lacking qualified staff that can provide better and quality services to the patients. It is because, for quality services, the hospital needs skilled personnel, proper equipment, and a pleasant environment. Therefore, the hospital should properly sort out both short term and long term issues towards getting their best settings for the staff to achieve the best quality ( Galgali et al., 2018). 

The Potential Causes of the HCAHPS Score 

The primary cause of the HCAHPS score is the quality services provision. From its profile and rating, Morton Plant rates as one of the best, with its customer rating hitting 84%. The Quality services provision is what makes customers rate a hospital positively. Therefore, due to the facility's quality services provision, it can be easy for the customer to rank it high ( Lazar, Rappaport, & Sharif, 2018). Another potential cause of the rating is the staff’s satisfaction as they sell the organization's image. Hence, when the hospital's workforce is satisfied with the nature of services they provide to the customers, they rate the premises positively. The same is true for a hospital that creates an excellent working environment for its staff. It is because when employees feel positive about the facility, they influence the public and client, and this may increase the HCAHPS score ( Liang et al., 2018). Another potential cause of the score can be the prices and promotion. These are marketing strategies that work to create a positive impression and positioning in the mind of the clients. Galgali et al. (2018) assert that when correctly done, pricing and promotion strategy can create a good impression on customers, and this can increase the hospital's HCAHPS rating. 

Organizational Strategic Plan to Improve HCAHPS Scores 

Morton Plant Hospital is doing well, as its HCAHPS rating reflects. However, the hospital can implement changes that can improve its operations to hit more than 84% score. For instance, the hospital can improve its score by focusing on areas it had a lower rating. In this case, the change should focus on two areas to improve the score in this hospital. The first area is physicians explaining the medication properly to the patients so that they get their prescriptions right while out of the premises ( Chevalier et al., 2018) . The hospital's score in this area was 65%, while Mayo Clinic was rated 69%. Another area where the hospital can change is improving the interaction between the staff and the patients so that when the clients leave the facility, they acknowledge the services ( Galgali et al., 2018). The hospital has a poor score in this area standing at 56%, and Mayo Clinic scores 64%. Therefore, Morton Plant hospital should implement a proper strategy to improve these two areas and maintain its performance in other areas ( Galgali et al., 2018). If the institution succeeds with the approach, it will only need a small percentage margin to outscore Mayo Clinic. 

Therefore, the hospital's plan is enhancing communication and interaction between the staff and the patients within the hospital. The approach ensures there is proper communication between the patients and the team on how best to use the drugs. Another aim is making physicians explain the diagnosis and treatments plan effectively to the patients for them to understand both the care plan and the medication for the sake of their recovery. Therefore, the idea has two objectives ( Galgali et al., 2018). The first objective is increasing the interaction between the customers and the staff. The second goal is ensuring that there is excellent communication between the team and the clients. Together, these objectives will create a pleasant and interactive environment where patients are free to ask the staff questions concerning their medications and treatments ( Clancy et al., 2018). The plan will also focus on creating an environment where the staff is encouraged to interact with the patients' questions and try to answer them in the simplest way possible. The action will make clients understand their treatment plans and medications. Therefore, the framework enhances training for the staff, which will make them understand the importance of interaction ( Lazar et al., 2018). Also, the plan ensures employees understand better means of interacting with the customers and communicating with them to enhance their understanding of the treatment procedures ( Lazar et al., 2018). 

The process has several simple steps of training the staff. The first step is carrying out the need assessment, mostly in areas where the change is necessary. The transition should directly target the nursing department, the pharmacy department, the laboratory department, and other line departments with direct interaction between the patients and staff. The next step is selecting a team that will be in charge of the project. Lazar et al. (2018) discuss that the group should incorporate the training and development team that understands the scope of the change needed and the best way to facilitate it within the hospital. Another step is formulating training topics, organize meetings and conferences for training the staff, and to sensitize them on the importance of having an interactive environment with the clients. The final step is implementing an evaluation plan for the success of the strategy. Thus, creating a customer satisfaction survey question is a good idea ( Lazar, Rappaport, & Sharif, 2018). The questions should target the interactive nature between the staff and patients, the environmental quality, and how the team addresses the clients' questions and concerns. The outcome will enhance a better and interactive environment with mutual interaction between the patients and staff. 

In the healthcare industry, there is a rapid rise in the need to incorporate evidence-based care operations. Therefore, the hospital's staff should rely more on evidence-based care to increase the interaction between the employees and patients. In this case, the facility should use survey questions as it is the best way to find evidence that the hospital’s strategy is producing a positive change ( Otim, 2019).  Another way to incorporate evidence-based practices is by enhancing research-based decision making in the organization. Evidence-based practices will be critical to this case because if the hospital includes them in its operations, it will engage differently with the patients. Therefore, the staff will be encouraging clients to share their thoughts and suggest solutions through interacting with them. Otim (2019) argues that b y delegating such roles to the staff, there will be shared governance in the hospital, and this will be critical to the patients and the team in general. 

There is a need for a hospital to have in place approaches to ensure that shared accountability among the patients, payers, medical providers, and personnel ( Chevalier et al., 2018). For the patients, the best method is an improved communication system. Having in place a communication system that allows the patients to voice their concerns, provide feedback after treatment, and also suggest recommendations on treatment could be the right approach of enhancing shared accountability among them. For the providers, evidence-based medical services provision could be the best approach to strengthen accountability. Focusing on evidence-based services provision ensures that medical providers and personnel are accountable for the quality of services they provide to the patients (Fulop & Ramsay, 2019). For the payers, the best approach to enhance accountability is to come up with a reimbursement model that suits them and the hospitals in general. It will entail shifting away from the traditional reimbursement approach to modern approaches such as bundled pricing, that create shared financial incentives that encourage providers to improve collaboration, integration, and accountability across the healthcare continuum ( Otim, 2019).  For other healthcare personnel, establishing quality and outcome metrics and also creating team works could be the best method to improve shared accountability. 

Telehealth is an example of a technology that can best serve the patients in this case. The hospital can use the technology to follow up and enhance interaction between the patients and the staff. Smartphone use in the hospital can also be encouraged because the patient can interact with the team through the use of such a platform. Finally, enhancing health records and data storage is also the best way to use technology. According to Chevalier et al. (2018), i t is because the facility can use data to trace the patients' information and send them as survey questions to understand their opinion on the services provided. Besides, hiring the best training team can be the best way of improving quality. Reducing cost means diversifying a portfolio of services, and also having different branches in the country will enhance the hospital's performance ( Otim, 2019). 

Additionally, encouraging patient interaction is the best way to create a patient-centered healthcare service delivery. Furthermore, the hospital can improve its financial stability by having more services and providing quality services to attract more clients. Also, the hospital should build more branches in different states, other than Florida, as this will make it operate at a national level. Such operations are likely to increase financial stability. 

Implementation 

The change managers will lead the transition in the organization and their role in ensuring that all the strategies are in line with the hospital's needs. The training team will also ensure that they formulate the goals for training and implement a time frame for the training process. The staff's critical role in the change is ensuring they attend the training and also influence other employees positively to adopt any transition in the hospital ( Otim, 2019).  The best way to ensure that both staff and stakeholders are involved in facilitating the change is by creating goals and targets for each of them as they will work to achieve the objective. Also, parties will cooperate because they have accountability for the success or the failure of their personal goals ( Galgali et al., 2018). By striving to achieve personal goals and targets, the staff will fully involve in the change process. Galgali et al. (2018) assert that the team will need communication training to facilitate the change. The one-month training will include interpersonal training and communication skills to ensure that staff is well equipped to enhance change. 

Before the implementation starts, there will be checkpoint questionnaires or surveys that will have short questions targeting the implementing team to ensure that they meet all requirements. Also, the development plan will allow for a smooth implementation ( Liao et al., 2019). The implementation will take three months, and its framework will be the three C's framework. The first step or C will be communication that will take about a month. It will entail coming up with an excellent way to communicate the new changes to the hospital shareholders. Emails, posters, meetings, and also blogs will be developed within a month and shared. It will also entail getting feedbacks from the targeted people. Feedback checkpoints will be critical to knowing the level of understanding ( Galgali et al., 2018). The second C, which is the commitment, will take another one month. It will be a commitment to ensure that all staff understand their new roles and are committed to the course to oversee the change. According to Fulop & Ramsay (2019), it will entail a commitment to finding change agents, supporters, and also have them enforce changes in different departments affected. There will be checkpoint surveys to understand whether there is change resistance. The last C will be the control where there will be a checkpoint survey to understand the achievement, the need to change any process to reinforce the proper implementation. The control will take one month. The table below is a breakdown of the time frame that the implementing team will use to ensure an effective implementation process for the program. 

Implementation stages	Activities	Time Frame
Stage One: Communication	Training a team that will be communicating to the target stakeholders(change agents)  Drafting a communication plan  Drafting different communication templates (posters, emails, and blogs)  Organizing and holding meetings with stakeholders. There will be different meetings with each department involved, and each meeting will last for three to five hours.  Distributing the poster to target areas where they are accessible to target people, Interaction, answering a question, collecting, and analyzing feedback.	Three days  Four days  One week  One week  Five days
Communication feedback checkpoint	Analyzing the feedback from the communication stage  Defining whether feedbacks are positive  Correcting areas where there are complaining at the communication stage  Revisiting the strategy for the next stage of the implementation process	Two days
Stage two: Commitment	Finding the change agents at each department  Training the change agents  Division of labor at every department  Drafting surveys and distributing them to the target individuals  Procurements of necessary resources for the change implementation at each department  Allocating the staffs at each department to aid in change management and getting the job done by assigning new roles	2-5 days  One week  Four days  Six days  Two weeks
Survey Response checkpoint	Collecting the survey responses  Content analysis of surveys and comparison  Aligning feedbacks from the survey with the success of the second stage  Making changes where necessary and holding meetings to discuss the outcome of the stage  Revisiting the strategy for the next stage	One day
The third stage: control	Holding meetings to review the objectives of the change, and compare them with the results from the change  Planning for the measures to evaluate the outcome of the program  Data collection from each department concerned  Data analysis  Discussion to find the solution for correcting the mistakes and ensuring that there is a path for the program.	2-4 days  One day  Two weeks  One week

Evaluation process 

In this case, the best evaluation process will be the process evaluation approach. It will entail evaluating the success of each process and interpreting the implications of the process successes ( Galgali et al., 2018). The method of measurement will be interviews, feedback forms, and checklists. These will be studied, analyzed, and compared to understand the process and define whether they meet the objectives. The timeline will take two months, within which the implementation process will be taking place. Content analysis will be critical as it will allow for comparison, to understand whether the operation was successful in defining whether there is a positive or negative result from the process ( Fulop & Ramsay, 2019). The process evaluation will target both the team and the patients. By using content analysis to understand the feedback, the change team will conclude to know whether the process has achieved a positive result. After getting the input, there will be a selection of every key stakeholder to participate in the content analysis process. After that, the change team will request the stakeholders to provide suggestions and recommendations based on the progress of the change ( Galgali et al., 2018). It will also involve understanding their views on the evaluation's results and how to implement the change. Otim (2019) discusses that  the hospital's change team will use Emails to communicate the result to the outside stakeholders. However, the team will use internal memos, posters, emails, and other communication techniques, such as meetings, to communicate the results to the domestic staff. 

References 

Chevalier, B. A., Watson, B. M., Barras, M. A., Cottrell, W. N., & Angus, D. J. (2018). Using discursis to enhance the qualitative analysis of hospital pharmacist-patient interactions.  PloS one ,  13 (5), e0197288. Retrieved from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197288 

Clancy, L., Povey, R., & Rodham, K. (2018). "Living in a foreign country": experiences of staff-patient communication in inpatient stroke settings for people with post-stroke aphasia and those supporting them. Disability and rehabilitation , 1-11.Retrieved from: https://www.tandfonline.com/doi/abs/10.1080/09638288.2018.1497716 

Fulop, N. J., & Ramsay, A. I. (2019). How organizations contribute to improving the quality of healthcare. BMJ ,  365 , l1773. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK279133/ 

Galgali, G., Fong, K., Bissell, K., Armstrong, D., & Humphrey, G. (2018). Improving the quality of clinical coding of post-partum hemorrhage: the process and its effects on reported incidence rates in a New Zealand hospital maternity service.  The New Zealand medical journal ,  131 (1479), 64-71. Retrieved from: http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2018/vol-131-no-147927-july-2018/7646 

Lazar, A., Rappaport, D., & Sharif, I. (2018). Improving medication pickup after hospital discharge: A Quality Improvement Initiative. Pediatrics ,  141  (1 MeetingAbstract)  412;  DOI: https://doi.org/10.1542/peds.141.1_MeetingAbstract.412 . Retrieved from: https://pediatrics.aappublications.org/content/141/1_MeetingAbstract/412 

Liang, L., Cako, A., Urquhart, R., Straus, S. E., Wodchis, W. P., Baker, G. R., &vGagliardi, A. R. (2018). Patient engagement in hospital health service planning and improvement: a scoping review.  BMJ Open ,  8 (1), e018263. Retrieved from: http://dx.doi.org/10.1136/bmjopen-2017-018263 

Liao, E., Eisenberg, N., Kaushal, A., Montbriand, J., Tan, K. T., & Roche-Nagle, G. (2019). The utility of the Vascular Quality Initiative in improving the quality of care in Canadian patients undergoing vascular surgery. Canadian Journal of Surgery ,  62 (1), 66. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351256/ 

Medicare.gov | Hospital Compare. Retrieved from https://www.medicare.gov/hospitalcompare/search.html?# 

Otim, M. (2019).  Improving estimation of the proportion of readmissions among patients with liver cirrhosis and associated complications in the gastroenterology ward, Mulago hospital  (Doctoral dissertation, Makerere University). Retrieved from: http://hdl.handle.net/10570/7475