Application of Strategic Leadership

Effective leadership is required to drive change in the rapidly evolving healthcare system to meet the demands of patients. Strategic leadership involves setting and working towards fundamental goals such as reducing the cost of healthcare, sustaining development, and improving the quality of health services (Kumar et al., 2015). While leaders focus on improving healthcare service delivery, various tools are employed to evaluate every aspect of care to help in guiding quality improvement.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is among the top tools recognized in the US to guide quality care delivery and process improvement. The HCAHPS scores posted on Hospital Compare, which is part of the government’s Medicare website, allow consumers to make fair and objective comparisons between hospitals and state and national averages on important measures related to the patient’s unique perspective of the care received. This discussion analyzes how strategic leadership can be used to improve HCAHPS scores through the implementation of evidence-based practices and stakeholder involvement.

Banner Boswell Medical Center HCAHPS Scores

Survey Questions	BANNER BOSWELL MEDICAL CENTER
Patients who reported that their nurses “Always” communicated well	74
Patients who reported that their doctors “Always” communicated well	72
Patients who reported that they “Always” received help as soon as they wanted	69
Patients who reported that staff “Always” explained about medicines before giving it to them	60
Patients who reported that their room and bathroom were “Always” clean	60
Patients who reported that the area around their room was “Always” quiet at night	47
Patients who reported that YES, they were given information about what to do during their recovery at home	88
Patients who “Strongly Agree” they understood their care when they left the hospital	50
Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)	65
Patients who reported YES, they would definitely recommend the hospital	68

Application of Strategic Leadership State and National Averages

Banner Boswell Medical center is generally rated two-star by the Medicare and Medicaid services and the HCAHPS survey results indicate room for improvement in various aspects. The facility compares well with Arizona and national average scores according to the latest survey scores. The first aspect is the question on patients who reported that their nurses “Always” communicated well which has a score of 74% compared to 77% and 81% of the state and national average respectfully (U.S Centers for Medicare and Medicaid Services (a), n.d.). The aspect of communication from the doctors has a score of 72% which is slightly below 76% and 82% of the state and national average respectfully. The healthcare facility seems to perform well on the aspect of patients who reported that they “Always” received help as soon as they wanted. The hospital average is 69% representing two points above the state average and one point below the national average. Another aspect is on patients who reported that staff “Always” explained about medicines before giving it to them which has a score of 60% compared to 65% and 66% of the state and national average.

Banner Boswell Medical Center seems to be far below the state and national averages on the issue of cleanliness and quietness of the rooms at night. Regarding cleanliness, the facility has a score of 60% compared to 72% and 76% of the state and national averages respectfully. A score of 47% is observed in the area of quietness compared to 57% and 62% of the state and national average. The stronghold of the hospital is on patients who reported that YES, they were given information about what to do during their recovery at home. The results indicate a score of 88% compared to a state score of 86% and a national score of 87% (U.S Centers for Medicare and Medicaid Services (a), n.d.). The area on Patients who “Strongly Agree” they understood their care when they left the hospital has a score of 50% compared to 51% of the state and 54% of the national average. Another crucial aspect is on patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest) which demonstrates a score of 65% compared to 69% and 73% of the state and national average respectfully. Lastly, 68% of the patients would recommend the hospital compared to a state score of 69% and a national score of 72%.

Comparison to Other Hospitals

I choose to compare Banner Boswell Medical center with two hospitals from Arizona including Arrowhead Hospital and Banner Baywood Medical Center. All three hospitals are acute care facilities rated two stars by the Medicare and Medicaid services. The first aspect of comparison is on Patients who reported that their nurses “Always” communicated well of which all the three facilities are below the state and national average. Boswell medical center has a score of 74% while Arrowhead and Banner Baywood have a score of 73% and 70% respectfully (U.S Centers for Medicare and Medicaid Services (b), n.d.). The three facilities seem to have almost similar scores on communication by doctors scoring 72%, 72%, and 70% respectfully. These scores are below the state average with 76% and the national average which has 82%. An aspect that is well-performed is timely help provision where 69% represents Boswell Medical Center, 64 % for Arrowhead, and 55% for Banner Baywood Medical Center.

Banner Boswell Medical Center’s scores on patients who reported that staff “Always” explained about medicines before giving it to them is 60% which represents two and four points below their counterparts respectively. The same can be said on the aspect of room cleanliness where Banner Boswell scored 60% compared to 68% and 65% for Arrowhead and Baywood hospitals respectively. Low scores are observed in all the facilities regarding the aspect of quietness at night. Banner Boswell has a score of 47% while Arrowhead and Banner Baywood have scored 52% and 50% respectfully (U.S Centers for Medicare and Medicaid Services (b), n.d.). These scores are far below the state and national averages indicating room for improvement. Banner Boswell has performed better on the aspect of patients who reported that YES, they were given information about what to do during their recovery at home. The facility has a score of 88% compared to 85% from the other two institutions.

Understanding of care during the hospital stay is an important aspect of determining quality service delivery. Banner Boswell demonstrates better performance in this aspect where it scored 50% compared to 49% and 45% from the other institutions. Additionally, patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest) demonstrates a fair performance from the three institutions. Banner Boswell has a score of 65% compared to 67% of Arrowhead and 64% of Banner Baywood Medical Center (U.S Centers for Medicare and Medicaid Services (b), n.d.). The last aspect of comparison is on patients who reported YES, they would definitely recommend the hospital whereby Boswell and Arrowhead tie at 68% score while 65% represents Banner Baywood Medical Center.

Application of Strategic Leadership Survey Response Rates

The three facilities demonstrate varied survey response rates depending on the number of surveys conducted. Arrowhead Hospital has the highest number of conducted surveys, 1827, but equally demonstrates the lowest survey response rate of 17% (U.S Centers for Medicare and Medicaid Services (c), n.d.). Banner Boswell Medical Center is the second with 596 completed surveys and a survey response rate of 30%. Banner Baywood Medical Center has the least amount of completed surveys, 511, and demonstrates a survey response rate of 26% as shown below.

Demographics and Services Provided

Located in West Thunderbird Boulevard Sun City, Arizona, Banner Boswell Medical Center serves to provide a variety of healthcare services to the population served. The facility is dedicated to strengthening patient care by continuously focusing on patient outcomes and service, training of the engaged workforce, and using innovative technologies. With over 50,000 employees in the country, Banner Health is the largest non-profit employer in Arizona and also one of the largest in Nothern Colorado. The hospital mainly serves patients from Sun City with a total population of 39,348. The population involves people from diverse ethnic and racial backgrounds. The whites represent 94.93% followed by the Black or African American with 2.92% (United States Census Bureau, 2019). Asians occupy 0.99% while other races represent 0.51% of the total population. The median household income in the region is $50,139 while individuals living below the poverty line represent 9.09% of the total population.

Banner Boswell Medical center has been the anchor of community healthcare specializing in the diseases of the elderly. This means the majority of the population served are the elderly above 65 years. The healthcare facility provides numerous healthcare services including cancer care, emergency services, endoscopy, geriatric care, imaging, integrative therapy, neurology, orthopedics, wound care, endocrinology, renal care, cardiology services, intensive care, palliative care, surgery, nutrition, and women’s health (Banner Health, 2020). The Heart Center at Banner Boswell has been nationally recognized for its care and expertise in cardiovascular preventive care, diagnostic services, medical and surgical treatment, and rehabilitation. The institution has managed to maintain quality service delivery and it ranked among the nation’s top 100 hospitals by Truven Health Analytics, a leading national health care research, and quality assessment organization.

Cultural Dynamics

HCAHPS scores are dependent on positive relationships between healthcare providers and patients during hospitalization. With more than 50% of the HCAHPS survey questions focusing on communication, culture plays a critical role in positive patient outcomes. First, the institution must ensure diversity among its healthcare workers to promote a culture of safety and belonging. Diversity ensures members of the healthcare team get to understand the patient better especially those that share racial or ethnic backgrounds. Secondly, the facility can promote cultural sensitivity by incorporating interpreter services. These interventions can improve interaction and communication between patients and healthcare providers. Demonstrating diversity in the institution can help improve HCAHPS scores on discharge information, nurse communication and communication about medicines.

Application of Strategic Leadership Educational Dynamics

Healthcare delivery is a two-way process that requires constant communication between the patient and the healthcare worker. Sometimes it becomes difficult for providers to provide care when the patient has a low level of education. Education is important in determining acceptance of treatment and it influences the understanding of care during the healing process. Additionally, effective communication is dependent on the language used and understanding of basic medical terms. HCAHPS scores on aspects such as understanding of care upon discharge and communication by nurses and doctors can be affected if the patient is not well educated. Poor communication and understanding can also delay medical interventions leading to dissatisfaction. On the other hand, well-educated patients are able to express their concerns and they get the necessary attention leading to improved satisfaction.

Socioeconomic Dynamics

The socioeconomic status of individuals characterized by income and poverty levels influences access to healthcare services and how the care provided is perceived. Individuals with good socioeconomic backgrounds seek medical care with high expectations of getting better because of their financial capabilities. This perception greatly influences the way they relate to healthcare providers and how they understand their care. The result is a better understanding of care, improved communication with physicians, and improved HCAHPS scores. Poor socioeconomic status affects healthcare-seeking behavior including positive relationships with care providers, communication during care delivery, and quality of services received. These patients are unable to afford certain services in the hospital and failed attempts to get what they came for lead to poor satisfaction. The result is poor HCAHPS scores that reflect failed relationships between the patients and healthcare providers.

Financial Impact

The data on current surveys point to the congruence between better provider care, patient satisfaction, and reimbursement. There is supporting evidence that quality care delivery demonstrated by improved HCAHPS scores affects reimbursements from Medicare and Medicaid Services (Akinleye et al., 2019). On a short term impact, good HCAHPS scores mean healthcare organizations receive more funding that can be used to improve processes with organizations. These facilities can expand their organizations and attract more patients which increases revenue. Poor HCAHPS scores lead to retention of some percentage of reimbursements by Medicare and Medicaid Services. This means the organization has to struggle to raise revenue to run basic services. On a long-term perspective, improved HCAHPS scores generate more capital that leads to organizational expansion and growth (Akinleye et al., 2019). The facility can implement new processes that attract patients even more. Poor scores lead to financial shortage within the organization due to decreased Medicare funding and reduced revenue from their consumers.

Application of Strategic Leadership Impact on Quality

HCAHPS surveys are used by healthcare organizations to determine areas that require improvement for better realization of results. Upon collection of the results, the hospital analyzes areas that performed poorly and implements processes to improve on quality. The HCAHPS scores help the organization to set goals and utilize other approaches to improve services delivered (Akinleye et al., 2019). For example, Poor communication from nurses and doctors is an indicator of poor organizational performance. The organization can then decide to dwell on improving communication for the realization of better results. Poor communication between healthcare teams can lead to poor quality outcomes such as increased medication errors, delayed responsiveness to patient care and increased mortality rates. Additionally, low HCAHPS scores kill the morale of healthcare workers and they might fail to have trust in their management leading to impaired communication and coordination of services.

Application of Strategic Leadership Causes of Scores

The first area that demonstrates poor HCAHPS scores is on patients who reported that their room and bathroom were “Always” clean which has a score of 60%. The state average for this aspect is 72% while the national average is 76% leaving room for improvement. According to the hospital data, poor cleanliness is attributed to a lack of enough supportive staff and poor coordination of services between the available staff. Additionally, the facility mainly admits elderly patients with different conditions that hinder self-care. These patients are likely to make it difficult for maintaining cleanliness in the patient rooms and bathrooms. The second area that has a poor HCAHPS score is on patients who reported that the area around their room was “Always” quiet at night. The survey results indicate a score of 47% compared to 57% and 62% of the state and national average respectfully. The main causes of noise at night in the institution include the location of the nursing station close to patients’ rooms and the lack of clear guidelines on hospital quiet hours.

Application of Strategic Leadership, Organizational Change

Organizational change involves the process through which the structure, strategies, operational methods, technologies, and organizational culture are altered to achieve set goals. The areas that require change in Banner Boswell Medical Center include maintenance of cleanliness and maintenance of a clam quiet environment at night. Various strategies can be used to improve on these two aspects of patient care including hiring more support staff and developing a regular cleanliness plan to maintain hygiene. These changes can help to ensure that the patients’ rooms are kept clean always which can positively impact hospital HCAHPS scores. Secondly, the institution should set clear policies on quiet hours between 10 pm and 4 am to allow patients to get enough sleep. All services at the nursing desk apart from admissions should be carried out before or after the quiet hours. These changes can help improve the patient experiences leading to improved HCAHPS scores on the identified areas.

Structure, Process, and Outcomes

The quality improvement practices to be implemented will aim at increasing the cleanliness of rooms and toilets and decreasing noise at night. To improve on cleanliness, the healthcare organization will design a plan that will see regular cleaning of the patient’s rooms. Additionally, the management will assess the number of subordinate staff available to conduct the cleaning, especially at night to ensure all shifts are covered. Noise reduction at night will mainly focus on maintaining a regular schedule of quiet hours between 10 pm and 4 am. The nursing department will collaborate with other healthcare professionals during night shifts to ensure the policy is followed carefully.

The process of implementing these strategies will involve the identification of a quality improvement team that will work for hand in hand with the management to set goals and timeframe for each activity. The healthcare providers will be notified of the new changes and the relevance of the QI practices to the improvement of HCAHPS scores. The expected outcome is improved cleanliness of patient rooms and bathrooms throughout the day and at night. Additionally, the quiet hours’ policy should be followed and the nurse managers should give a progress report on the effectiveness of the strategy. Implementation of the two practices should improve the HCAHPS scores on patients who reported that their room and bathroom were “Always” clean and patients who reported that the area around their room was “Always” quiet at night.

Improving Organizational Quality

Evidence-based practice is an approach that improves quality, safety, and patient outcomes through the implementation of best practices in healthcare. Quiet time intervention is an evidence-based strategy observed to improve patients’ sleep quality and have positive physiologic effects on patients (Lim, 2018). Additionally, the practice promotes a healthier working place environment and increases patient satisfaction. This evidence-based strategy will be used to improve organizational quality and promoting improved HCAHPS scores. Shared governance is a strategy that involves teamwork and accountability while working together to solve problems that affect practice and patient care. Implementation of the two approaches will involve diverse healthcare teams including nurses, doctors, subordinate staff, and hospital administration. These teams will be allowed to make recommendations for the new practice change and identify measures that they think can help improve on the new program.

Shared Accountability

Quality improvement in healthcare is not an individual effort, but shared responsibility among patients, healthcare workers, and other stakeholders. During the quality improvement process in the facility, the patients will actively participate in evaluating the new programs by providing feedback. To engage medical providers in shared accountability, the Chief Medical Officer will be consulted for ways to have medical providers participate in committees. Participation in committees will ensure they are able to assess organizational performance and provide feedback. For demonstration of accountability among the payers, working with the finance department will ensure timely analysis of the HCHAPS scores and provision of feedback. The department will also provide clinical and claims data to enhance healthcare organization’s perspectives on health status of patients. In order to engage personnel in shared accountability, the management will be asked to promote their participation in committees and regular provision of feedback on the organizational processes and performance.

Application of Strategic Leadership, Technology Trends

Healthcare service delivery today is characterized by the incorporation of technology to improve the quality of care provided to patients. The new strategy will incorporate the use of technology, especially on patient documentation using electronic health record systems. The use of computer systems will ensure healthcare providers get to organize tasks early so that paperwork is reduced especially during the night. Secondly, communication of results will be done through the hospital website and the patient portals demonstrating the use of technology. Additionally, the facility can implement the strategy of replacing the overhead pager system which is a primary cause of noise and disturbance at night with the use of personalized phone communication.

Application of Strategic Leadership, Improving Care Delivery System

Banner Boswell Medical Center can improve the quality of services provided by incorporating the use of evidence-based practices. Implementing strategies like the use of quiet times and designing regular cleanliness plans will ensure quality service provision to patients leading to improved patient satisfaction. Secondly, methods like the use of communication whiteboards will ensure patients are informed about their care on time and have opportunity to ask questions or raise their concerns. Regarding the cost of healthcare delivery,implementing communication strategies will translate to patient satisfaction which will improve HCAHPS scores. Improved HCAHPS scores will lead to more reimbursements. Implementing and strengthening hourly rounding for nurses will increase accessibility of timely services to patients. The organization can also work to strengthen interpreter services across all hospital departments to increase access to services. Patient-centered care will be improved by promoting communication between patients and healthcare providers using the communication whiteboards. Additionally, patients and families will be allowed to give feedback on the improvement of care delivery upon the implementation of the new strategies.

Application of Strategic Leadership Improving Financial Stability

The strategy to improve financial stability in Banner Boswell Medical Center will involve focusing on improving the HCAHPS scores. Today, healthcare organizations are reimbursed depending on quality care delivery assessed through the HCAHPS survey. Making patient-centered care a priority in the hospital will be the best method of improving financial stability. Improving communication between physicians, involving patient in their care and incorporating the use of whiteboards will enhance patient-centered care. These methods will improve quality, decrease readmission rates, and lead to more reimbursements to stabilize the financial status of the organization.

Stakeholder Role and Responsibilities

The implementation of the new strategies will involve the hospital administration, nurses, and subordinate staff. The administration will function to coordinate the phases of implementation by involving all members of the healthcare team. Secondly, the allocation of necessary resources will be required to implement the new change and the administration will be actively involved. This will include allocation of finances, collaborating with eternal stakeholders and monitoring the progress of the implementation.

The nursing team will be involved in implementing quiet times during night shifts to ensure the maintenance of a quiet environment for patients. During the implementation, the nurses will act as educators and advocates for patients, respond promptly to patient needs, conduct hourly rounding and provide feedback to the nurse managers. Additionally, the team will evaluate the progress of the plan and recommend extra measures to achieve the set goals. The role of the subordinate staff will be ensuring the cleanliness of the patient rooms and bathrooms for maintenance of a safe clean environment. The staff will perform hourly assessment of the patient rooms and bathrooms for cleanliness and later provide feedback to the QI team on the effectiveness of the new plan.

Application of Strategic Leadership Stakeholder Accountability

To ensure stakeholder involvement, regular communication will be used as a strategy to actively engage the nurses, administration, and the subordinate staff. The quality improvement team will organize briefing sessions each week where representatives from each department will present their progress reports. The administration department will ensure accountability by following up on the implementation plan, checking on alignment with the set timeline, and taking necessary disciplinary action for stakeholders that will fail to meet the set standards.

Application of Strategic Leadership Training

Prior to implementing any new policy, procedure, or organizational plan, it is vital to properly train staff in order to be successful. Training should be provided on any new technology,policy or procedure as well as on HCAHPS survey questions. Nurses will require training on how to implement the new practice of ensuring quiet hours between 10pm to 4am. Regarding formulation of a cleanliness plan, subordinate staff will trained on how to perform periodic assessments of the patient rooms and bathrooms. Additionally, new equipment to enhance the speed of cleanliness will be purchased and necessary training on the use and maintenance of the equipment will be required.

Application of Strategic Leadership Plan Implementation

The change will commence by the selection of a task force to guide staff and other stakeholders on the implementation process. The implementation phase will take six months with periodic reviews being done every two months. The first month will involve the allocation of resources, selection of the QI team, and communication of the strategies to the stakeholders. The time will also be used to purchase cleaning equipment and developing new policy on quiet hours and hourly rounding to assess cleanliness of the rooms by subordinate staff. The implementation of a plan to guide cleanliness together with quiet hours implementation for nurses will be done as from the second month. Between the second and the third month, training of nurses and subordinate staff will begin. This period will also involve communication of practice guidelines, timeline for implementation and evaluation strategies to the nurses, patients and other staff.

Upon the establishment of a solid ground for implementation, the third to fifth month will be used to evaluate understanding of training, full implementation of the quiet hours at night and compliance with the hourly cleanliness rounding by the subordinate staff. Intermittent evaluation through collection of feedback will be done at this point. The QI team will meet each week to discuss the progress and present the findings to the administration. Auditing for nurses and subordinate staff will be done at the end of each month to ensure compliance with the set guidelines. The sixth month will involve rounding and obtaining statistics through evaluation reports for the success of the intervention programs. HCAHPS surveys and patient interviews will be used to summarize the effectiveness of the interventions.

Evaluating the Strategic Plan’s Success

The success of the strategic plan will be evaluated using the HCAHPS scores on the aspects of the cleanliness of the rooms and maintenance of a quiet environment at night. Although the initial evaluation will be done after six months, the success of the plan will be evaluated after one year. The method of analysis will involve comparing the new HCAHPS scores with the previous scores on the identified survey aspects.

Involvement of Stakeholders

The key stakeholders for the evaluation process will involve the administration, nurses, and subordinate cleaning staff. The healthcare administration will evaluate the success of the plan by considering the aspects of accountability and teamwork among the process improvement team. The team will also engage in analysis of the HCAHPS scores and communication of results to other team members. The nurses and subordinate cleaning staff will be part of the team to provide feedback on the whole process and any areas that might require improvement in the future.

Application of Strategic Leadership, Communication of Results

The internal communication of the results will be done using the hospital newspaper, direct communication to the stakeholders, emails and internal memos addressed to the departmental heads. Direct communication with the patients and other staff will be done during daily rounding and staff meetings. External communication will involve the use of the hospital website, local newspapers, and social media such as organizational Instagram and Facebook pages. Additionally, patient portals will be utilized to provide direct communication to consumers outside the healthcare facility.

References

Akinleye, D. D., McNutt, L. A., Lazariu, V., & McLaughlin, C. C. (2019). Correlation between hospital finances and quality and safety of patient care. PloS One, 14(8), e0219124. https://doi.org/10.1371/journal.pone.0219124

Banner Health. (2020). Banner Boswell Medical Center.

https://www.bannerhealth.com/locations/sun-city/banner-boswell-medical-center

Kumar, S., Kumar, N., Adhish, V. S., & Reddy, R. S. (2015). Strategic management and leadership for health professionals – skills to leverage resources to achieve health goals. Indian Journal of Community Medicine : Official publication of Indian Association of Preventive & Social Medicine, 40(3), 158–162.

https://doi.org/10.4103/0970-0218.158845

Lim R. (2018). Benefits of quiet time interventions in the intensive care unit: A literature review. Nursing Standard (Royal College of Nursing (Great Britain) : 1987), 32(30), 41–48. https://doi.org/10.7748/ns.2018.e10873

US Centers for Medicare and Medicaid Services. (n.d.-a). Hospital compare: Survey of patients’ experiences.

https://www.medicare.gov/hospitalcompare/profile.html#profTab=1&ID=030061&state=AZ&lat=0&lng=0&name=BANNER%20BOSWELL%20MEDICAL%20CENTER&Distn=0.0

US Centers for Medicare and Medicaid Services. (n.d.-b). Compare Hospitals: Survey of patients’ experiences.

https://www.medicare.gov/hospitalcompare/compare.html#cmprTab=1&cmprID=030061%2C030094%2C030088&cmprDist=0.0%2C0.0%2C0.0&stsltd=AZ&dist=25&state=AZ&lat=0&lng=0

US Centers for Medicare and Medicaid Services. (n.d.-c). Hospital compare: Survey of patients’ experiences-details.

https://www.medicare.gov/hospitalcompare/details.html?msrCd=prnt1grp1&ID=030061,030094,030088&stsltd=AZ

United States Census Bureau. (2019). Quick facts: Arizona.

https://www.census.gov/quickfacts/AZ

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