D030 Task 2 UUM1 — UUM1 TASK 1: NURSING SERVICE LINE Paper

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 Do30 Task 2 UUM1 — UUM1 TASK 1: NURSING SERVICE LINE Paper
 Do30 Task 2 UUM1 — UUM1 TASK 1: NURSING SERVICE LINE Paper
LEADERSHIP AND MANAGEMENT IN COMPLEX HEALTHCARE SYSTEMS — D030 PRFA — UUM1
D030: Leadership and Management in Complex Healthcare Systems
Service Plan Brief for a Home Health Program
Nursing leaders are on the frontline in promptly evaluating and addressing their organization’s needs. Nurse leaders balance organizational needs and ensure they are met with the available resources promptly. They also participate in or initiate nurse-led changes that provide sustainable revenue sources and meet patient needs. New service lines should be thoroughly evaluated to ensure they meet the needs of an organization. The need for the service line should also be promptly established to prevent resource and time loss for misappropriated projects. This paper focuses on such a change, a new nursing service line in the organization.
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Proposed Nursing Service Idea
The proposed new service idea is a home healthcare program. The home health program will primarily serve patients discharged from the hospital. It will also serve patients from other healthcare facilities who meet the criteria outlined for the healthcare program by the Center for Medicare and Medicaid (Medicare.gov, n.d.). The purpose of the service line is to serve older adults above 80 years with self-care needs, patients of all ages with chronic illnesses, and patients of all ages with intermittent healthcare provider needs in the county). The primary funding source will be Medicare, hence the need for its criteria. The services offered will fall under short-term and long-term care. They will include assistance with activities of daily living, company, therapy, rehabilitation, nursing care, medical and social care, and primary care assistance. Services will also be offered through telehealth for better delivery and optimal resource utilization. Patients will be in the program until they are stable and no longer need the services.

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The leadership skills required to implement the program include effective communication skills that will help ensure flawless communication with the stakeholders. Clinical expertise is also essential to help select best practices and patient care standards, ensure quality, and make informed healthcare decisions (Collins et al., 2020). Decision-making and problem-solving are vital as they ensure leaders make informed and timely decisions, even under pressure, and address all issues as they arise. Advocacy to address the patient’s needs is also necessary, and crisis management is vital to prepare and handle crises and emergencies. An ethical leadership approach is necessary to help uphold principles such as confidentiality, patient autonomy, and integrity in healthcare leaders (Latta & Clottey, 22020). Another approach is transformational leadership, which will help the facility and employees assimilate the change and participate in its implementation. Collins et al. (2020) note that transformational leadership employs individual consideration, simulates intellect, idolizes influence, and invests in motivation, all necessary for working with diverse teams. These leadership skills and approaches will thus be necessary to succeed in the home health program. The diverse staff included will be included in the team based on their need. For example, nutritionists will be necessary for patients with nutritional needs. The staff needed will include nurses, nutritionists, pharmacists, family nurse practitioners, and DNP nurses.
Importance
The goals of the home healthcare program are to ensure continuity of care delivery in patient homes. There is a growing need for home care services due to the high costs of in-patient care and the need for care continuity in homes (Leonard et al., 2021). The intervention will help reduce the prevalence of fragmented care when patients are discharged without adequate care. The program’s focus is on the county. The county is selected primarily due to ease of access from the organization for follow-up and management purposes while maintaining access to an adequate clientele or the program. The program will also enhance follow-up, prevent complications, and prevent hospital readmissions (Medicare.gov, n.d.). Another importance of the program is to reduce healthcare costs by ensuring patients are discharged early and preventing the high healthcare costs associated with prolonged hospitalization. In addition, the home health program will help improve relationships with the community through improved interaction. The program will ensure quality lives of patients and better health outcomes by providing quality care across the continuum (Medicare.gov, n.d.). Lastly, it will provide additional revenue to the facility and create new changes, leading to its growth and expansion.
                                                              Market Analysis
The target population is older adults above 80 years with self-care needs, patients with chronic illnesses, and patients with intermittent healthcare provider needs in the county. The county is the population of interest, given that individuals can be easily accessed for service delivery, assessment, and management interventions. According to Maresova et al. (2019), about 1 in 3 adults have multiple chronic illnesses needing healthcare assistance, and the number of elderly patients is growing exponentially. In addition, the number of chronic illnesses has risen exponentially over the years, with increased exposure to these illnesses. In addition, Jones and Bowles (2020) show a growing need for home health services, given their ability to meet health needs conveniently, affordably, and in familiar environments. Thus, there is a growing need for home healthcare services.
The home health program will likely receive referrals from the hospital’s discharged patients and other smaller hospitals that do not offer home health services. In addition, satisfied patients and their families will form a vital referral basis for the home health program. The program may face competition from hospice care provider organizations offering similar services. Other competitors include extensive healthcare facilities offering telehealth services and home health programs.

Target Population
Potential Referral Bases
Potential Competitors

The target population is patients with chronic illnesses, older adults above 80 years with self-care deficits, and patients requiring intermittent healthcare provider assistance.
 
The expected referrals to the service line will be from patients discharged from the facility who meet home health need criteria, patients from other hospitals with no home health programs, and referrals from satisfied patients and their families.
The potential competitors will include hospice care provider organizations (Bristol Hospice), hospitals with telehealth services, and home healthcare organizations (such as Comfort Keepers Home Care).

 
SWOT Analysis
 

Strengths
Weaknesses

Vast medical expertise and skilled healthcare professionals to extend the home health program.
Lack of staff training. Despite the rich network of care providers, the hospital lacks adequately trained staff for the home health program implementation.

Strong reputation and trust among the community members, given the vast experience and many years of service.
Economic factors that include patient’s inability to pay for these programs.

Availability of infrastructure and supporting services such as telehealth, medical equipment, and supplies for effective home health.
Inadequate staff. The hospital has vast medical experts and skills to plan and initiate the program but lacks adequate staff to implement it and influence its success.

Financial stability. The healthcare facility has adequate funds to meet the needs of the new home health program.
Resistance to change where the organization has many structural barriers and reluctance to accept and implement change.

 

Opportunities
Threats

Strategic partnerships with local healthcare agencies such as insurance providers and community organizations to help reach and impact the home health program.
Competition from established home healthcare organizations and other large organizations offering home healthcare.

An ageing population leading to a growing need for home-based healthcare services.
Lack of patient awareness of the hospital’s home health program.

Favorable healthcare policy changes include recent telehealth and home health services reimbursement policies.
Patient preference for in-person care and negative community perception of home health program.

Lack of market saturation. Around the facility, only a few established organizations offer home healthcare, providing an open market for the home health idea.
Legal liabilities pose a heightened risk to the organization because home health introduces new legal considerations in addition to those of hospital settings.

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SWOT Analysis Results
The hospital has vast medical expertise and skilled healthcare professionals to extend the home health program. It has adequate skills and expertise to help see through the change. The skilled worker will also train staff and influence the other members to accept and implement the change, managing the weaknesses. The hospital also has a strong reputation and trust among the community members, given the vast experience and many years of service. It will help communicate with the community members and inform them of the new program and the importance of home healthcare. It can also help convince them to accept the proposed change.
The organization is also financially stable, with adequate resources to implement interventions such as staff training and hiring staff for the new program to eliminate the current weaknesses. In addition, the hospital has adequate infrastructure and resources, including telehealth, that will help facilitate the program. It will use its vast resources to help purchase the missing required technological resources. Current favorable policies favor telehealth, including reimbursement and requirement policies, which are not stringent. The facility also has strategic partnerships with other organizations, which will help meet regulatory needs, form a referral basis, and help initiate healthy competition with other facilities. The home health market is also relatively young, and the market is not saturated, meaning there is a ready market despite the availability of competition. The opportunities and strengths in the organization will help address the weaknesses and threats. The new service line idea is viable; thus, the organization will implement it successfully.
Cost-Benefit Analysis

Category
Description of Service Plan Costs
Description of Service Plan Benefits

The Organization
Hiring new staff, training, and paying them (nurses, physicians, dieticians, home health managers, and telehealth specialists)
Additional revenue to the health facility

Transportation van for staff
Costs savings for the patients and their families as opposed to in-patient care service costs

Technology equipment – EHR for the program, laptops, and computers for telehealth providers
Reduced hospital readmissions

Day-to-Day Operations
Medical supplies – medications, fluids, and supplements
Improved patient healthcare experiences

Non-medical supplies and patient education materials
Improved community engagement in care delivery

Patient and family/caregiver education materials
Improved caregiver and family involvement, thus improving communication and patient care quality and safety.

 
Utilities such as fuel, electricity, cellphone
Improved care coordination and delivery of healthcare services

 
Administrative support (communication, tracking billing, scheduling, and others)
Improved patient outcomes related to continued care in homes, early diagnosis of complications, and prompt management

 
Risk Assessment and Strategies

Risks
Possible Results of the Risk
Strategies for Minimizing the Risks

Staff shortage (Shang et al., 2020)
Compromised patient care delivery and poor-quality care
Robust recruitment and retention plan, including training.
Subcontracting care providers from other organizations

Regulatory non-compliance
Results include fines, legal actions such as lawsuits, and reputational damage.
Engage legal experts to ensure legal compliance
Create a dedicated team to ensure legal compliance

Data breaches and privacy (Sockolow et al., 2021)
Data breaches can lead to privacy and confidentiality violations, loss of patient trust, legal actions by clients and families, and damaged reputation.
 
Investing in robust cybersecurity measures and secure data storage and access and educating staff on data protection (Sockolow et al., 2021)

Community resistance to the programs
Negative community perception of the change due to misconceptions, thus decreased uptake of the program services.
Robust community education to raise awareness of the importance and benefits of home health programs

Poor coordination of home healthcare program activities (Sockolow et al., 2021)
Poor communication among home healthcare members, fragmented care, role confusion, conflicts among care providers, and poor care quality
A clear leadership and care coordination system, with regular meetings
Utilization of electronic health records system for home healthcare with timely updates (Sockolow et al., 2021)
Assigning care coordinators for each patient

 
Financial Projections
Methods for Generating Revenue
The method of collecting revenue will entail out-of-pocket and reimbursement fees from insurance companies and Medicare, as Medicare.gov (n.d.) states. The services will be collected based on the number of days the patients will be on the program. The charges will include telehealth services, physical vests, medications, and other care procedures performed. The patients will pay for the services offered. The fees will be calculated based on Medicare and other insurance firms’ recommendations to facilitate healthcare service delivery.
Revenue Graph for Year 1
The revenue projections in the first year are pretty low. The institution will likely spend more money on the program’s start-up than the revenue collected from the project. A negative graph is expected. However, some revenue is expected from the home health program. The program aims to enroll and serve at least 200 patients per month by the end of the first year, every 3 hours a day, four days a week, to meet the regulatory requirements of Medicare for at least a month. The cost per hour will be $25. The number of patients is expected to rise gradually, serving at least 200 patients per month by the end of the year. The average yearly costs per patient will thus be $15600 per year.
Service Payers
The financial service payers for the new service line are patients and their families and insurance companies. The fees for the services offered will be billed to Medicare or the insurance providers of the specific patients. Out-of-pocket fees will also be acceptable for patients without insurance coverage. These two sources will be the primary income sources.
Operational Expense Budget

Category
Description and cost ($) of Each Type of Expense

Personnel Expenses
Salary – $2000000
Home care nurses: 20 nurses ($70000 each)
Family Nurse practitioner; 2 FNPs ($110000)
Physicians: 1 ($170000)
Primary care physicians: 1 PCP ($210000)

Benefits – $300000

Other (utilities such as training)- $ 100,000

Other-than-Personnel (OTP) Expenses
Start-up Costs – $300000

Monthly Bills – $10000 ($120000 annually)

Medical Supplies – $400000

Non-medical supplies (such as gloves) – $ 100,000

Travel costs – $40000

 
Budget Pie Chart
Key Performance Indicators (KPIs)

Service Plan KPIs
How will the KPI be Measured
Frequency of Evaluation
How will the KPI be Used for Future Decision-Making

Structure: Staff-to-patient ratio
Measurement of the number of all healthcare professionals compared to the number of patients receiving home healthcare services
Weekly
The KPI will be integral to the daily activities and future planning. It will help with staffing and scheduling to ensure staff have a manageable workload and all patients have caregivers assigned to them.

Process: Visit completion rate
The KPI will be measured as a percentage of the number of planned home vests completed compared to the total number of planned visits.
Monthly
The visit completion rate will help investigate the quality of care, lead investigations into the significant barriers to vast completion, and address them promptly.

Outcome: Patient satisfaction score (Karaca & Durna, 2019)
 
Patient satisfaction scores will be measured using questionnaires during and after care delivery, entailing several questions on the quality of care, communication, and other factors affecting the overall home healthcare experience.
Monthly
The KPI will be used to determine the services that patients are satisfied or not satisfied with, help launch investigations into the causes, and address them to improve patient satisfaction and ensure quality outcomes and patient safety (Karaca & Durna, 2019)

 
System-level Improvement
Staff training is one of the strategies necessary to support staff improvement and improve interprofessional teams. The new service line will come with its demands, including legal, service, staff, and policy requirements. A dedicated leadership team is also required for effective care coordination. Some staff will change roles to fit the new changes, and there is a need to ensure adequate care delivery and a smooth flow of activities for the new service. Educating the new staff will improve leadership for the new service and promote interprofessional collaboration and care coordination, which are necessary for quality patient outcomes. According to Payne (2022), staff education/training helps improve skill, knowledge, perception, and attitude towards a service or intervention, improving its uptakes and minimizing resistance. Staff education also orients staff to their roles and responsibilities in a team and increases awareness of other factors, such as regulatory compliance necessary for project success. Thus, staff education will help support staff improvement and improve interprofessional teams.
Interprofessional conflicts and poor staff collaboration are undesirable in healthcare. Belrhiti et al. (2021) note that interprofessional conflicts significantly affect patient care delivery, as the fight over dominance affects team collaboration and efforts. Johansen and Ervik (2022) note that nurses play crucial roles in home healthcare, hence their central role in planning and implementing these services. Home healthcare is not a nursing-only service line, and other staff need to understand the significance of their involvement in the program and the importance of their contributions. Studies thus propose staff training as an integral step in improving collaboration in interprofessional teams and ensuring quality outcomes (Belrhiti et al., 2021).
Tasks and Timelines

Task
Task Owner Title/Position
Timeline Prior to Opening Service
Frequency of Task Status Meetings

Program goals and Objectives development
Project manager
2 ½   months
An initial meeting, then quarter yearly

Conducting market research and analyzing it
Risk management director
2½ months
Weekly

Obtaining the required license and permits or the service
Project manager
1 ½ months
Weekly

Establishing the legal and regulatory framework, such as policies, procedures, and protocols
Project manager
1 ½ months
Monthly

Securing funding for the program
Finance director
Two months
Once

Hiring/recruiting, training, and orienting staff
Human resources director
1½ month
Once then half-yearly

Designing market and outreach strategies
Marketing director
1 month
An initial meeting, then quarter yearly

Set up the necessary technology infrastructure, such as the data management systems
Sustainability director
1 month
Monthly

Developing program evaluation metrics
Sustainability director
1 month
Monthly

Conducting a test run with home visits, virtual consultation, and practice scenarios
Sustainability director and project manager
1 month
Weekly

v

Executive Summary
Proposed Nursing Service Idea
The proposed nursing service idea is the introduction of a home health program. The program will offer both short-term and long-term care services, with a broad spectrum of services offered. The program will help reduce fragmented care and improve healthcare service delivery. It will also help ensure care continuity in patient homes, reduce readmissions, reduce healthcare costs to patients, and be a revenue source for the healthcare organization.
Market Analysis
            The project will serve individuals from the county. The target population of the home health program is patients discharged from the facility and referred from other facilities that meet the criteria for home health: older adults with self-care deficits, patients with chronic illnesses, and patients needing intermittent care provider services. The program may face stiff competition from larger established hospitals offering telehealth services, home health programs, and home healthcare organizations.
SWOT Analysis
            The organization has several strengths and opportunities that will help address the threats and weaknesses and improve the project’s success. It has skilled and experienced staff who will help initiate and oversee the desired change and train staff. It has adequate finances and technological advancements, which will help support the program through interventions such as hiring adequate staff and procuring supporting technologies and resources for success in role execution. In addition, the finances can help bridge the market gap and allow the institution to compete healthily through advertising. A good reputation and trust from clients will help address stereotypes and increase the uptake of services. Overall, the strengths and opportunities outweigh the threats and weaknesses, enhancing the success of the new service line’s implementation.
Cost-Benefit Analysis
            The new service line will benefit the organization and influence its success. The new service plan includes hiring and training staff, increasing medical and non-medical supplies, transportation services (minivan), an increased need for administration support, utilities, and patient and family education materials. These costs will entail financial, structural, leadership, and staffing issues. However, the benefits included reduced costs of care for the patients, an added source of revenue for the facility, reduced patient readmissions, improved care coordination, and improved patient health outcomes. The benefits of the plan outweigh its costs.
Risk Assessment
The new service line faces various risks, including staff shortage, regulatory non-compliance, community resistance to the program, and poor coordination of home healthcare services. The risks are preventable through the implementation of various strategies in the planning and implementation of the program. Thus, The program is viable and will benefit the healthcare organization.
References
Collins, E., Owen, P., Digan, J., & Dunn, F. (2020). Applying transformational leadership in nursing practice. Nurs Stand, 35(5), 59-66. https://doi.org/10.7748/ns.2019.e11408
Latta, G. F., & Clottey, E. N. (2020). Ethical leadership: Understanding ethical failures and researching consequences for practice: Priority 8 of the National Leadership Education Research Agenda 2020–2025. Journal of Leadership Studies, 14(3), 82-89. https://doi.org/10.1002/jls.21711
Belrhiti, Z., Van Belle, S., & Criel, B. (2021). How medical dominance and interprofessional conflicts undermine patient-centered care in hospitals: historical analysis and multiple embedded case study in Morocco. BMJ Global Health, 6(7), e006140. http://dx.doi.org/10.1136/bmjgh-2021-006140
Johansen, M. L., & Ervik, B. (2022). Talking together in rural palliative care: a qualitative study of interprofessional collaboration in Norway. BMC Health Services Research, 22(1), 314. https://doi.org/10.1186/s12913-022-07713-z
Jones, C. D., & Bowles, K. H. (2020). Emerging challenges and opportunities for home health care in the time of COVID-19. Journal of the American Medical Directors Association, 21(11), 1517–1518. https://doi.org/10.1016/j.jamda.2020.09.018
Karaca, A., & Durna, Z. (2019). Patient satisfaction with the quality of nursing care. Nursing Open, 6(2), 535-545. https://doi.org/10.1002/nop2.237
Leonard, C., Dumayas-Booth, G. L., Zomorodi, M., Lashley, T., & Sullivan, T. (2021). Increasing home healthcare referrals and access to community resources in response to high emergency department utilization. Home Healthcare Now, 39(3), 135-138. https://doi.org/10.1097/NHH.0000000000000965
Maresova, P., Javanmardi, E., Barakovic, S., Barakovic Husic, J., Tomsone, S., Krejcar, O., & Kuca, K. (2019). Consequences of chronic diseases and other limitations associated with old age–a scoping review. BMC Public Health, 19, 1-17. https://doi.org/10.1186/s12889-019-7762-5
Medicare.gov, (n.d.).  What’s home health care? Accessed August 17, 2023, from https://www.medicare.gov/what-medicare-covers/whats-home-health-care
Payne, H. (2022). Teaching staff and student perceptions of staff support for student mental health: a university case study. Education Sciences, 12(4), 237. https://doi.org/10.3390/educsci12040237
Shang, J., Chastain, A. M., Perera, U. G. E., Quigley, D. D., Fu, C. J., Dick, A. W., Pogorzelska-Maziarz, M., & Stone, P. W. (2020). COVID-19 preparedness in US home health care agencies. Journal of the American Medical Directors Association, 21(7), 924-927. https://doi.org/10.1016/j.jamda.2020.06.002
Sockolow PS, Bowles KH, Pankok C, Zhou Y, Potashnik S, Bass EJ. (2021). Planning the Episode: Home Care Admission Nurse Decision-Making Regarding the Patient Visit Pattern. Home Health Care Management & Practice. 2021;33(3):193-201. https://doi:10.1177/1084822321990775
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TASK OVERVIEW          SUBMISSIONS          EVALUATION REPORT
COMPETENCIES
7064.1.1 : Determine Leadership Skills and Approaches
The learner determines the effective leadership skills and approaches required to navigate a diverse staff in a changing healthcare environment.
7064.1.2 : Create Communication and Change Management Plans
The learner creates communication and change management plans to foster a culture of innovation.
7064.1.3 : Analyze Data for Progress Indicators
The learner analyzes data to measure progress in meeting organizational performance indicators in complex healthcare systems.
7064.1.4 :  Determine Support Factors for Interprofessional Teams
The learner determines system-level factors necessary to support and empower interprofessional teams.
7064.1.5 : Validate Performance Measurement
The learner validates key performance indicators to measure the impact of nursing care on patient and population outcomes.
7064.1.6 : Propose Strategic Plan
The learner proposes a strategic business plan to start a nurse-managed practice.
INTRODUCTION
Nurse leaders have many opportunities to develop innovative organizational projects. For this assessment, you will assume the role of a nurse leader who is interested in starting a new nursing service line. The proposed nursing service should meet the following criteria:

can be any service that meets a demonstrated patient health need
contains a major nurse-led component
has the ability to generate revenue that is sustainable

 
Here are a few examples of the diverse opportunities for organizational growth:

physical and mental health services provided through wellness centers
vascular access care services
diagnosis-specific support clinics
nurse-directed medical day care services
wound care services
diabetes management services
care coordination for supervising and evaluating interdisciplinary care services

 

home health and hospice services

 
These varied examples demonstrate the impact that nurse leaders have on healthcare delivery.
 
In this task, you will use the attached “Nursing Service Line” template to develop your brief. Using an interprofessional focus, you will explain the need for the service and present the results of various business analyses to determine the feasibility of starting the new service line within an organization. Use the information provided in the course to determine an area of service and to complete the analyses required in this assessment.
 
REQUIREMENTS
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. The similarity report that is provided when you submit your task can be used as a guide.
 
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
 
Tasks may not be submitted as cloud links, such as links to Google Docs, Google Slides, OneDrive, etc., unless specified in the task requirements. All other submissions must be file types that are uploaded and submitted as attachments (e.g., .docx, .pdf, .ppt).
 
Note: You must complete the clinical practice experience (CPE) before attempting this assessment.
 
Complete the following using the attached “Nursing Service Line” template to support the area of need you have identified.
 

Provide an introduction to your proposed nursing service line by doing the following:

Describe your nursing service idea, the purpose of the nursing service line, and the effective leadership skills and approaches needed to implement the plan using a diverse staffing
Explain why the service will be important to the population it will

 

Provide a market analysis that includes the target population, potential referral bases, and potential competitors for the planned

 

Using an interprofessional focus, analyze the following strengths, weaknesses, opportunities, and threats (SWOT) to the service line:

four internal factors that are potential strengths of the nursing service line
four internal factors that are potential weaknesses of the nursing service line
four external factors that are potential opportunities for the nursing service line
four external factors that are potential threats to the nursing servic

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