Congestive heart failure (CHF) is an intricate clinical syndrome characterized by the reduced ability of the heart to pump or fill with blood. Physiologically, CHF can be defined as an inadequate cardiac output to meet metabolic demands or insufficient cardiac output secondary to compensatory neurohormonal activation (Tan et al., 2010). CHF affects people of all ages, with an approximation of 550,000 new cases being diagnosed in the U.S. each year. This estimate to nearly 5 million Americans living with CHF and 1.4 million of them are persons under 60 years of age. According to Woodruff Health Sciences Centre (2018), CHF is responsible for 11 million physician visits each year and more hospitalizations than all forms of cancer combined. More than 50% of those who develop CHF die within five years of diagnosis (Woodruff Health Sciences Centre, 2018). CHF costs the American government an estimated $30.7 billion each year. In Dallas County, Texas state, an estimated prevalence of 600 per 100,000 adults aged 35 years and above suffers from CHF. The aggravating risk factors for CHF include diabetes, hypertension, and coronary heart diseases. CHF treatment usually involves taking medications, reducing sodium in the diet and getting daily physical activity. The CHF patients also track their symptoms each day so they can discuss them with their healthcare team (CDC, 2016). The report will discuss surveillance as a way of mitigating re-hospitalization of CHF patients in Dallas County.
Surveillance is the continuous, systematic collection, analysis, and interpretation of health-related data needed for the planning, implementation, and evaluation of health practice (World Health Organization, 2017). This form of the strategic plan will benefit the area by managing those who are predisposed to re-hospitalization for the condition. The principal objective will be to prevent recurring incidences of patients being hospitalized due to CHF. The surveillance strategy will also deliver systems that enable users within the health sector of Dallas County and other partner organizations to get the latest information and plan for actions in response to an adverse trend among the CHF diagnosed patients. The data obtained from the surveillance will be integrated into other health care systems within the county and adopt new technologies to improve the outcomes of the system ( Public Health England Transition Team, 2012). Moreover, the information obtained will also support the development of policies based on the conclusions from the data collected from the surveillance. Surveillance encompasses the processes of data collection, analysis, interpretation and dissemination that are undertaken on an ongoing basis, provide measures of population health status against defined levels for action and there is an agreed and explicit set of activities that will be initiated by the outputs.
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For active surveillance to take place, an external analysis has to be carried out. External analysis has five processes for its undertaking. Organizing the external study gives the implementors a rough idea of what to expect on the ground and the core variables that are useful in creating an issue map. It is at this stage when the issue map template is formulated. After the organization is done, scanning of the trends in CHF related issues across Dallas County will follow. This will give the organization the current and emerging trends in regards to the development and control of CHF. The data will be collected from the people in the area and also secondary sources such as publications in the area will also be utilized. The critical areas of concern are demographic characteristics of the population information, cultural attributes of the people, the technological advancements in the field, the economic status of the people and the political situation in the area. The information collected will then be organized, categorized, analyzed and evaluated to define the trends of CHF in the county clearly.
Monitoring will be done to enable the acquisition of a database around the CHF related issues in Dallas County. This will involve the assessment of the sources of information to ensure their credibility, identify other organizations in the area that are also creating change as far as congestive heart failure is concerned and finally, define the variables that will be used to report changes in the county. Hospitals such as Hamilton Heart and Vascular Hospital and Baylor Scott & White heart and vascular hospital, located in the Metropolitan area of Dallas and Fort Worth, will provide the vital information to predict the CHF trends and impacts. The next step after monitoring is forecasting. With the information gotten, the organization will be able to identify and predict the possible outcomes in regards to the CHF trends. The predictions will provide the organization with vital data that shall be used to assess the most significant impact points in the patterns. The assessment of the environmental changes will be done based on the perceptions, values, past experiences and context of the situation in hand, to foster strategic thinking. The issues will be grouped in a 2×2 matrix based on the degree of their probabilities and impacts. With all these processes complete, an issue map can be drawn which will guide the practice of the organization.
Among the tools and techniques involved in environmental analysis, the organization shall adopt the Delphi method as the primary technique to carry out the ecological study. Despite the process having a probability of taking a long time to complete, the method eliminates management biases and uses field experts hence the data obtained is more likely to be credible and informed decisions can be made. The experts will be distributed across Dallas county hospitals that specialize in cardiac diseases, research centers for heart diseases and public libraries. Dialect inquiry will be marginally utilized to complement the Delphi method regarding forecasting and assessing as the method helps to surface many sub-issues and factors.
An analysis of the service area competitors will be undertaken to provide a forum for leaders to review and evaluate their assumptions about the organization’s capabilities, market position, and competition. The analysis will also identify market niches hence contribute to the successful implementation of the surveillance strategy. Porter’ five forces of structural analysis were used to carry out the review. The existing organizations in the area include the Hamilton Heart and Vascular Hospital and Baylor Scott & White heart and vascular hospital. The two organizations have established themselves in Dallas County as the number 1 go-to hospitals for cardiac diseases. However, the hospitals lack a comprehensive surveillance program to prevent re-admission of the patients.
The two hospitals are equally balanced regarding the quality of service, and they highly value patient success. The Hamilton Hospital is the regional cardiac surgical center, regional electrophysiology program, and regional heart investigation unit. Hamilton has specialized in the holistic care of cardiac anomalies. In an emergency situation, the first medical assistance Hamilton offers is the emergency medical technician (EMT). The EMTs make it their goal to identify if a person is experiencing a heart attack as quickly as possible. They also work closely with the nurses and physicians at the medical center so that immediate treatments are ordered and preparations made in anticipation of the patient’s arrival (Hamilton Health Sciences, 2018). The hospital has a staff capacity of 42 beds with an average patient discharge of 865. The average revenue from the patients is around $70, 121 (American Hospital Directory, 2017).
The organization will also conduct an internal analysis and determine some of the competitive advantages it has over other similar organizations. The data obtained from the Environmental analysis will serve as the baseline for the internal review. The data will provide the prevalence of the CHF issues and identify the potential clients the organization will have. With a population of 2, 485,003, Dallas County offers an excellent place to carry out surveillance (HRSA, 2017). The high prevalence of CHF at 0.6% makes the free institutions unable to cater to the patients’ needs effectively.
The organization will focus on surveillance of CHF diagnosed patients, something that the other hospitals in the area are missing. This together with the high prevalence gives our organization a chance to establish and promote its services. The organization has state of the art surveillance equipment coupled with the strong management team ensures efficient flow of information in the organization, hence effective service delivery. The organization will also be sensitive to the people’s cultural background, making it less likely to be resisted by the people of Dallas. The organization puts the people first. The main weakness of the organization is its lack of reputation. The company is not well known in Dallas as compared to the other organizations in the area. This will require a firm footing and advertisements to try and establish a customer base.
However, the competitors lack the surveillance program that is aimed at preventing readmission of the patients with CHF. This makes the surveillance system an innovation that gives the organization an edge when compared to its competitors. The competitors also have established networks with other significant stakeholders; hence chances of sourcing out investors are quite high as compared to our organization. All the major competitors have a holistic approach to CHF, making them more attractive to potential clients. With time, our organization will establish itself and manage to enjoy the same competitive advantages the other organizations have, with an added benefit of the surveillance system that prevents the readmission of clinically diagnosed patients with CHF.
References
American Hospital Directory, (2017). Individual hospital statistics for Texas . Retrieved from https://www.ahd.com/states/hospital_TX.html
CDC. (2016). Heart failure fact sheet . Retrieved from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm
Hamilton Health Sciences. (2018). Cardiac & vascular. Retrieved from http://www.hamiltonhealthsciences.ca/body.cfm?id=2391&fr=true/
HRSA, (2017). HRSA Fact Sheets. Retrieved from https://data.hrsa.gov/data/fact-sheets
Public Health England Transition Team, (2012). Towards a public health surveillance strategy for England. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_ data/file/213339/Towards-a-Public-Health-Surveillance-Strategy.pdf
Tan, L. B., Williams, S. G., Tan, D. K., & Cohen-Solal, A. (2010). So many definitions of heart failure: are they all universally valid? A critical appraisal. Expert review of cardiovascular therapy , 8 (2), 217-228.
Woodruff Health Sciences Centre, (2018). Heart & vascular: Conditions & treatments . Retrieved from http://www.emoryhealthcare.org/heart-vascular/wellness/heart-failure- statistics.html
World Health Organization, (2017). Public health surveillance. Retrieved from http://www.who.int/topics/public_health_surveillance/en
