case study:Moreno Medical Center – Issues in Managed Care

Moreno Medical Center (MMC) is a 600-bed, full-service acute care facility located in the Northwest Kelsey community. The hospital is a physician-owned, for-profit hospital that takes pride in the provider-patient relationship. With recent changes in managed care, every dollar, process, and interest of the patient serves as a common ground for making an organization more efficient.

Table of Contents

To remain competitive in the marketplace, the management team at MMC decided to take a look at various processes within the hospital and noted that the overall patient experience in the outpatient surgical clinic was less than satisfactory. The main problem seems to focus on long delays throughout the entire admission to discharge process. If the hospital wants to maintain its competitive position, the administration will have to redesign the current process to improve patient satisfaction.

The hospital administration appointed an internal quality consultant to facilitate the planning process. The quality consultant for this new organizational role is an experienced intensive care RN with a business degree. She understands that health care is a personal encounter and that patients and families expect to have their priority needs met when experiencing a health care issue.

The quality consultant decided to work closely with the surgical department RN administrator who would be a powerful change agent in leading the improvement process. During the review of the surgical department processes, the administrator and consultant identified several major issues:

Surgeons delaying surgery times causing backlog of surgery schedule
Other hospital departments (e.g., admitting, finance, lab) conducting separate encounters with surgical patients without regard to the surgery schedule
Long wait times for patient transportation from surgical area to recovery room
Ancillary staff providing patient discharge instructions when nurses are busy
Nursing staff displaying a culture that the procedure, not the patient, is the priority

The surgical department RN administrator acknowledges that changes need to occur and the new process must be guided by what is in the best interest of the patient. He developed a new vision statement for the department with its first priority to provide a patient and family focused quality care culture.

Review the introduction videos and organizational charts.

Read the case study detailing key issues that have been identified at MMC.

Write a 1,050- to 1,400-word paper in which you:

Analyze MMC’s characteristics and organizational structure to determine how they could be affecting patient satisfaction in both positive and negative ways.
- Could reorganization help drive better patient outcomes?
- Does the current structure empower nurses to provide the best patient care possible?
Analyze social and cultural aspects of MMC that could be exacerbating or helping resolve admission and discharge issues.
- Are the right individuals involved in the admission and discharge process or do roles and team dynamics contribute to the issue?
Assess the responsibilities of MMC leaders and managers to act as change agents in mitigating the patient satisfaction issues.
- What actions have already been taken and what other actions would you suggest to make a greater impact?
Analyze how delegation is contributing to or improving MMC’s issues.
Analyze how MMC’s staffing and performance evaluations could help improve overall patient satisfaction.