Clinical Management

As a health care provider, describe how income flows into the organization of your choice (e.g. Hospital, community or a private company).

As a health care provider, it is important to understand how money flows into the organization helps to determine whether the company is making growth or not (Hovakimian 2009, p161). Cash flow is the amount that arises from operations, investing, and financing. Organizations with ample income are in a better position to invest more into the business and generate more profit and cash. It is crucial to comprehend how income flows into the organization so that immediate actions can be implemented to prevent the organization from collapsing. This section will analyze the current setting of a hospital referred as St Mary Hospital, located in Madison, WI.

To fully understand St Mary Hospital’s cash flow, it is important to understand how the organization operates. Basically, this hospital is a surgical and medical hospital that provides the best medical care to patients. The hospital consists of 376 beds and various health care workers that include nurses, doctors, clinicians, physicians, pharmacists, and laboratory technicians just to name a few. St. Mary is a full service hospital that delivers outpatient and acute patient care. The majority of patients are those who require chemotherapy, blood transfusion, diabetes and endocrinology, and those with hematological disorders such as leukemia. The hospital is also known for its remarkable services in the emergency room where the hospital receives over 43, 000 visits annually (MedStar St. Mary’s Hospital 2013, p1).

Primarily, it is important to recognize how St Mary generates its income from the very top to the world level. In this case, the hospital generates its income from the consultation fees through which patients are obliged to pay. Additionally, the hospital generates its income from the medical procedures and surgical fees. With the recent innovation in technology, the hospital has provided quality and best medical care that attracts most patients to pay the intended cost. The hospital generates income from various services such as blood transfusion, blood taking, and giving injection. Pharmacies and laboratories are also available in the hospital, which helps in dispensing medicines and providing test services respectively. Patients do no not need to walk in miles searching for the prescribed medicines, rather they only need to pay the required cost and obtain the medicines. With the high number of patients visiting on daily basis, the hospital is more likely to generate more income flows from the pharmacies and laboratories.

Typically, the hospital generates part of its income from counselling services. Usually, patients are encouraged to participate in counselling services that is crucial in improving their well-being. Currently, counselling is mandatory during blood transfusion, HIV test, and other incidences such as early pregnancy. The hospital also offers spiritual counselling, which to some extent help patients to cope with their illness. The mentioned services are crucial as they generate extra income and augment quality health care (MedStar St. Mary’s Hospital 2013, p1). To operate effectively, the hospital has been privileged to have external donations and funding from other organization that donates and contribute part of the cash and income flow into the hospital (US News Health World Report 2013, p1). In brief, the hospital generates its revenue from different avenues such as donations and investment from other organizations, therapeutic procedures, surgical procedures, consultation fees, provision of various services such as blood transfusion, emergency services, and invasive diagnostic services.

Evaluate the steps you would take when reviewing the skill mix in the clinical setting of your choice. Discuss how you might balance the financial implications of your actions?

A research conducted by Gerrish & Lacey (2013, p10) stated that, the main challenge in the healthcare sector is to ensure that quality care is not comprised. With this, this research indicates that most organizations are using the Skill Mix (SM) to improve the organization effectiveness and quality care. SM is defined as the grouping of employed workers that play a crucial role in boosting quality care and organization performance. One of the main challenges faced by most health care organizations is achieving and determining the right mix of health care (Gerrish & Lacey 2013, p10).

As a health care provider, there are various principles I would put into consideration when reviewing the skill mix in the clinical setting of the St Mary hospital. First, I would evaluate the roles and responsibilities of registered nurses (RNs) and enrolled nurses (ENs). This question should first be answered prior to reviewing the skill mix in the mentioned clinical setting. To Marquis & Huston 2006 (12), RNs play various roles in St Mary hospital such as patient diagnosis, assessment, evaluation, and care planning. On the other hand, the ENs assists in feeding, ambulating, toileting, and bathing patients. After evaluating the roles and responsibilities of RNs and ENs, I would evaluate whether health care providers are performing their roles in boosting quality care and organization growth (Marquis & Huston 2006, p12).

Still, I would evaluate the current setting of St Mary hospital and determine whether the hospital have adequate staffing to boost quality care and organization growth. Currently, the main challenge affecting St Mary hospital is inadequate staffing, which is causing patients to be neglected. Thus, various steps must be taken to establish a recruitment plan and a plan that evaluates the number of staff that each department requires to promote effective health care. As a healthcare provider, I will evaluate the acuity of patients, staffs capabilities to perform the assigned duties, the complexity and challenges of nursing task, the administration and supervision an RN can provide in the hospital, and the available staffs allocated to accomplish the clinical tasks (Gerrish & Lacey 2013, p44).

As a manager, I would enhance team work in the organization. This would eradicate errors and disorders at the work place. To balance the financial implication of the mentioned actions, it is important to research the amount required to pay the recruited RNs and ENs. It is important to note that, RNs are paid more money than the ENs (Gerrish & Lacey 2013, p67). Thus, it is essential to assess the patient care required and evaluate who can perform the assigned duties effectively. Allocating duties effectively can assist in cost control as it enabled the organization to recruit the workforce required to perform a certain task. As mentioned earlier, it is cheaper to recruit ENs than RNs. With this, it would be preferable to recruit more ENs to do supportive care instead of having RNs to perform the task, which in turn would control the cost required.

Based on a research conducted by Marquis & Huston 2006 (p18), SM is liable for the consumption and distribution of resources. It is important for nurses to team up with the management team so that suitable decisions can be made to cut costs and promote safe and effective care to balance the financial implications of the organization (Marquis & Huston 2006, p30).

You are required to develop a system which would enable you to audit your staffing expenditure on a monthly basis. Offer detailed discussion of your rationale underpinning your system.

Table 1

Months (Staffing expenditure)	Staff Nurse (1 year experience	Staff Nurse (2 year experience	Staff Nurse (5 year Experience)	Enrolled Nurse (I year experience	EN (2 Year experience
Jan	$2, 000	$2, 200	$2, 800	$1, 000	$1, 500
Feb	$2, 100	$2,320	$2, 800	$1, 100	$1, 180
Mar	$2,400	$2, 500	$2, 890	$1, 300	$1, 450
April	$2, 000	$2, 300	$2, 700	$1, 400	$1, 550
May	$2, 600	$2, 780	$2, 800	$1, 600	$1, 700
June	$2, 500	$2, 800	$2, 900	$1, 500	$1, 900
July	$2, 560	$2, 600	$2, 800	$1, 600	$1, 800
August	$2, 100	$2, 300	$2, 890	$1, 650	$1, 900
Sep	$2, 400	$2, 700	$2, 990	$1, 800	$2, 000
Oct	$2, 500	$2, 700	$3, 000	$1, 900	$2, 200
Nov	$2, 700	$2, 900	$3, 100	$2, 000	$2, 400
Dec	$2, 500	$3, 000	$3, 500	$2, 100	$2, 300

Table 2

Job Assessment	Staff A	Staff B	Staff C
Late for work	0	1	15
On leave	1	0	1
Patient Compliments	0	1	0

A research conducted by Advisory Board Company (2004, p10) indicates that, staffing expenditure (SE) accounts for the amount of expenses linked with labours. It is worth to note that, health care services are labour intensive and therefore it is obliged that health care professionals receive both the salary and benefits packages. Besides what is listed in the table above, the SE is usually broken down into various categories such as staff benefits, basic salary, allowances, and annual increment. As indicated in Table 1, the amount of salary differs depending on the individual experience and the amount of input imposed on the organization. Looking at Table 1, the basic salary differs depending on the number of working hours and the staff performance. This table helps to keep records on the expenditure budgeting of individual staff based on their experiences and working hours.

As shown in Table 2, staff and work performance can be benchmarked by evaluating the number of medical leave, the number of compliments made by patients, and punctuality of staff members. The organization can benefit a lot from keeping records of work performed and the number of patients’ record. For instance, the organization can comprehend whether or not employees are working hard to achieve the intended goals and objectives. This system may help the organization to monitor staffs who fail to complete their assigned duties. Additionally, this may reduce instances of absenteeism and lateness. Still, it may encourage staff members to work hard to attain patients’ compliments. An organization is more likely to be productive when it records the number of patients’ compliments. It helps the organization to comprehend whether it is making positive actions that boost patients’ satisfaction. Evaluating the staff performance can boost work productivity and job satisfaction. The SM system ensures that expenses are well-budgeted, revenues are generated consistently, and necessary actions are conducted to improve patients’ satisfaction. In so doing, this improves the well-being of patients, increase job satisfaction, and augment growth in the organization (Gordon 2007, p20).

You are required to give a detailed discussion how you would audit non-staff expenditure on a monthly basis in a clinical setting of your choice. What reasonable cost effective strategy would you implement in order to maintain best practice?

Table 1

Months	Budget spent	Resources required (Strategies plan: Achieving quality and efficient care
January	$5, 000	Gauze Glove Syringes
February	$3, 000	Needles
March	$5, 000	Dressing set
April	$4, 500	Alcohol swab
May	$5, 500	Equipment Maintainers
June	$4, 000	Laundry

As argued by Guido (2010, p10), non-staff expenditure can be grouped into two categories, direct and indirect expenses. Direct expenses are resources associated with patients’ well-being such as surgical and medical supplies and drug while indirect expenses are expenses for various items such as maintenance, electricity, and laundry equipments just to name a few. The table 1 display the number of resources allocated on a monthly basis. Allocating these resources helps to access and monitor the amount required to enhance change and productivity. Still, allocating the number of resources required on a monthly basis may save resources and achieve cost-effectiveness (Advisory Board Company 2004, p20).

To maintain best practices, the following points will be considered. The organization will ensure that every supplied item is of good quality and bought at an affordable cost. In this case, the organization will discuss the cost and quality with other organization who have tried the modified products. This will reduce the cost wastage that emerges from purchasing redundant items. Typically, budget monitoring is conducted on a monthly basis to ensure that the generated revenue is consistent with the projected standards and productivity. Thus, staffs are usually urged to discuss the reinforcement of plans and strategies that augment productivity (Gerrish & Lacey 2013, p70).

To Marquis & Huston 2006 (22), it is important to monitor and evaluate budgets throughout the year so that improvement plan can be initiated earlier if deficiencies occur. Thus, it is vital to acquire knowledge of how an organization monitors its finances and participate in the development process. This boosts patients’ satisfaction and creates a favourable environment for healthcare providers to carry out their assigned duties effectively. When finances are managed effectively, an organization is more likely to achieve its intended goals and objectives. The organization is also in a better position to purchase many items that would promote growth and assist in operation process. With this, when the organization evaluates and monitors its budget, the organization will allocate the required resources to purchase medical facilities that in turn enhance productivity. When there are adequate medical facilities to perform medical practices, health care providers are more likely to be productive and have morale to perform their assigned duties effectively. In turn, this promotes a healthy working environment as health care providers work hard towards improving the well-being of patients. Still, this increases patients’ experiences in the hospital and improve their well-being emotionally, physically, and psychologically. It is pertinent to note that, when health care providers are content and satisfied they are more likely to perform their assigned duties effectively that those who are not. Still, an organization is likely to achieve its intended goals when there are adequate medical facilities to carry medical operations. The mentioned are strategies that would foster productivity, morale, and patients’ satisfaction (Marquis & Huston 2006, p22).

You are required to describe in detail essential information which would enable you to successfully manage your staff and non-staff budget. From your earlier information (Questions 1-4), what do you consider to be key issues in terms of successful management?

From the ongoing discussion, it is crucial to have a budget plan that would enhance effective health care and allocate resources to pay the required staffs. Effective planning can ensure that the hospital achieves its intended goal of quality services at an affordable cost. As Guido (2010, p33) puts it, budgeting is a crucial activity in, which expenses and revenues are managed properly to maintain quality care. Thus, it would be crucial to have a plan that would control and project all revenues and expenditures, so that cost-effective and excellent healthcare services can be achieved.

First, I would be committed to a strategic plan with well defined goals and objectives to successfully manage the non-staff and staff budget. According to Gordon (2007, p44), a budget should be designed in such a way that is outcome at all levels in the company relates to the company’s goals, achievements, and future goals. Having defined goals and objectives would create a strong path to understand the cost required to boost growth in the organization. Still, this would help to manage the staff and non-staff budget by eradicating any extra cost that may emerge (Gordon 2007, p55).

Secondly, having an effective organizational chart and structure would enable the organization to manage the staff and non-staff budgeting. This is because, an individual can only be held responsible if there is an organization structure that clearly defines the duties and responsibilities that must be accomplished (Marquis & Huston 2006, p18). Hence, the objectives and goals of the budget can be accomplished more easily if there is an organizational chart or structure that clearly defines the tasks for each member in the organization. For instance, the manager is accountable and responsible for managing the budget. With this, the manager can make all decisions that would help to adjust the budget to manage the program and control cost. These actions include removing or adding some programs, controlling and managing the program, and adjusting expenses and revenues in the nursing department (Marquis & Huston 2006, p88).

Thirdly, a budget reporting system may be required to facilitate and monitor the budget. This would ensure that the plan is periodically updated and there is a continuous evaluation of the organization’s progress. The most important aspect is ensuring that the projected budget is able to enhance progress and growth. Overall, the process of monitoring and setting budgets is an important part of planning and management cycle. When budgeting, one should allocate all resources packages such as non-clinical and clinical staff, building and equipment, and the amount required to meet the budget. It is also important to access the required resources to meet the intended goals and increase the productivity of the organization. Still, it is important to have a detailed and planned budget in place to foresee the outcomes of quality care in the organization. From the ongoing discussion, one can affirm that the key issues that enhance a successful management are allocating resources and the cost required, accessing the required resources to increase productivity and achieve the intended goals, and having a detailed budget to foresee the outcomes of quality care (Advisory Board Company 2004, p35).

Bibliography

Advisory Board Company, Managing staffing expenditures: the cfo’s role in containing labor costs and promoting productivity. Washington, D.C., 2004, Advisory Board Company.

Gerrish, Kate., & Lacey, Anne, The research process in nursing. Chichester, West Sussex, U.K., 2013, Wiley-Blackwell.

Gordon, Tracy, Fiscal realities: budget tradeoffs in California government. San Francisco, Calif, 2007, Public Policy Institute of California.

Guido, Ginny, Legal & Ethical Issues in Nursing, Boston, 2010, Pearson.

Hovakimian, Gayané, “Determinants Of Investment Cash Flow Sensitivity,” Financial Management (Blackwell Publishing Limited, Vol 38: Issue 1, 2009, 161-183.

Marquis, Bessie. L., & Huston, Jorgensen, Leadership roles and management functions in nursing: theory and application. Philadelphia, 2006, Lippincott Williams & Wilkin.

MedStar St. Mary’s Hospital, St Mary Hospital, 2013, Retrieved from http://www.stmaryshospitalmd.org/

US News Health World Report, St Mary’s Hospital, 2013, Retrieved from http://health.usnews.com/best-hospitals/area/wi/st.-mary’s-hospital-6450810