Key Drivers of Change

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Part 1.
Imagine you are a student in healthcare administration who is doing an internship in a large primary care organization in an urban city in Florida. The organization has multiple locations and several types of services within a culturally diverse and underserved community. You are asked to prepare a short 1-to-2-page training procedure to help improve the staff’s cultural competence. Include the following:
• Describe the goals of the procedure, including 3 to 4 goals that reflect data on the changing patient population including changing patient demographics. The goals should demonstrate the need to overcome health disparities.
• Create 3 to 4 well-described best practices to be implemented throughout the organization. Include a description of the best practices for ensuring improvement in communication with patients and providers in a diverse population.
• Describe at least 3 organizations that support cultural diversity standards in healthcare including how each will help improve cultural diversity standards.
Part 3
The primary care organization network where you work is interested in the uses of telemedicine to improve outcomes and to lower operational costs for multiple underserved communities. Given the increase in Telemedicine due to the recent Covid-19 Pandemic, a lot of new information and studies have come out on the impact of Telemedicine. Your organization wants to ensure they make the right choice. As a result, you have been tasked creating a 1-2 page proposal for the top must-have features of a Telemedicine program. For example, consider patient privacy, functionality, and compliance, among others. Your proposal should include at least one feature that address each of the following requirements for a successful Telemedicine program:
• Functionality,
• Patient Privacy, and
• Compliance.
Then explain the features you selected and why they are required for a telemedicine program.

Part 4
The United States is projected to experience a significant shortage of primary care physicians (PCPs) and registered nurses (RNs), which is expected to intensify with the aging baby-boomer population. According to the Association of American Medical Colleges (AAMC, 2020), it has been estimated that by 2030 the country could experience a shortage of between 54,100 and139,000 primary care physicians, which often affects those living in inner-city communities and rural America. According to Zhang et al (2018), by 2030 there could be a deficit of Registered Nurses of over 510,000. As the need for healthcare grows, the uneven distribution and growing deficit of resources and providers leaves a large percentage of Americans at risk.
References:
Boyle, P. (2020, June 26) U.S. physician shortage growing. Association of American Medical Colleges. https://www.aamc.org/news-insights/us-physician-shortage-growing
Zhang, X., Tai, D., Pforsich, H., & Lin, V. W. (n.d.). United States registered nurse workforce report card and shortage forecast: A revisit. American Journal of Medical Quality, 33(3), 229–236. http://doi.org/10.1177/1062860617738328
As a healthcare administrator of a healthcare network, you have been asked to analyze physician and registered nurse shortages in either a rural or inner-city community with which you are familiar. Your analysis should include the following:
• Explain why there may be a shortage of PCPs in the rural or inner-city community you selected (1–2 paragraphs)
• How is the Patient Protection and Affordable Care Act (PPACA) addressing the shortage of PCPs and RNs? (1–2 paragraphs)
• What other programs are available to address the shortage of primary care physicians and registered nurses? What action are the programs taking? (1–2 paragraphs)
• How is the shortage impacting healthcare delivery? Be specific by providing examples and support your response with academic resources. (1–2 paragraphs)

 

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Solution

 

Feature of Telemedicine

 

Part 1: Cultural competence

Describe the goals of the procedure

The goals of the training procedure to improve staff’s cultural competence will include helping the staff to use effective cultural communication strategies when engaging with the patients. This will be important in communicating effectively with different age groups seeking health services, as people in different age groups prefer different communication styles. The procedure will also help the care providers understand how cultural beliefs influence patient’s interpretation of health. Obesity is prevalent in the community, approximately 59.6%, which can be attributed to cultural beliefs, and thus to effectively deal with this challenge, the care providers must first understand cultural beliefs concerning obesity. The procedure will also educate the staff on how to recognize and utilize community resources to improve the population’s health. This will be important in identifying community resources crucial, such as public transport, and advocate for its development (Benuto et al., 2018).

Create 3 to 4 well-described best practices to be implemented throughout the organization

Some of the practices should include providing educational sessions on cultural competence and the different cultures the organization is likely to encounter. This will help equip the staff members with the basic skill required for delivering culturally competent care, including culturally competent communication. Introduction of LEARN model for effective communication with patients from different cultures. This model consists of listening, explain, acknowledge, recommend, and negotiate, facilitates effective cross-communication between individuals from different cultures. Introduce cultural competence assessments for all the employees in the organization. This will help them to assess their level and progress of cultural competence skills, which is likely to improve the overall cultural competence in the organization (Benuto et al., 2018)

Describe at least 3 organizations that support cultural diversity standards in healthcare

            Some of the organization that supports cultural diversity include Health Resource and Service Administration, a federal agency that focuses on improving access to care for economically or medically vulnerable and isolated communities. It provides funding for such individuals and also supports the training of care providers and their distribution into various regions where they are required. Providing health funding for vulnerable individuals is likely to increase cultural diversity in healthcare (Health Resource and Service Administration, 2021). Human Resource in Action is another organization that supports cultural diversity in healthcare. The organization’s vision is to create a world where social conditions and equitable resources promote healthy people and healthy communities. The agency has developed several tools that can be used to enhance engagement of different stakeholders, performance, and promote quality improvement (Health Resources in Action, 2021). The engagement of different stakeholders ensures cultural diversity is maintained in healthcare. The center for culture, ethnicity supports cultural diversity by providing training on cultural and health literacy, community education sessions, community action projects, and professional development (Center for Culture, Ethnicity, and Health, 2021).    

Part 3: Features of a telemedicine program

With the increased adoption of telemedicine in healthcare, many health facilities are becoming increasingly concerned about the features that they need to adapt to ensure that patients continue to receive quality care. Some of the features that telemedicine programs must have include video/audio/text consultation features, integrated health records, remote patient monitoring, E-prescription, easy-to-use patient dashboard, easy patient registration, and security features (Bhaskar et al., 2021).

Audio, Video, and text consultation features are necessary when communicating and interacting features. The Video and audio features facilitate real-time interaction and exchange of information between the patients and care providers. These features allow the patients to ask questions regarding their health and also facilitates conversations. Using video and audio features, the care providers can assess the patient’s appearance and observe important details that can be used to reach a diagnosis (Helm et al., 2019). Although not commonly utilized by many care providers, texting can improve communication between the patient and care providers. Almost everyone sends or receives texts daily, including the elderly. Incorporating text features into the can help improve compliance with treatment plans and engage the patients. People are also conversant with the text, and thus, text can provide an easy alternative during consultations and for quick communication between patients and care providers (Monaghesh & Hajizadeh, 2020).

Integrated electronic health records features are an essential feature that any telemedicine program should include. While electronic medical records contain the treatment history of the patients, electronic health records stores information that includes patient blood work, laboratory test results, all the prescriptions, radiological images, and treatment history. Integration of electronic health records into telemedicine programs is thus essential. This feature will allow easy access to all the information concerning the patient that the healthcare provider requires. This will facilitate faster and accurate diagnosis of the patient, easy monitoring of patient’s health to determine their progress, and most importantly, medical errors can easily be avoided (Mena et al., 2020).

Easy to use dashboard and easy registration process is essential to avoid discouraging patients from seeking health assistance. Registration is the initial step into accessing healthcare services, and it is thus important that patients find it easy to register on the platform. Some of the aspects that should be addressed to make the program easy to register on include minimizing details required when registering on the platform. (D’Souza et al., 2021). The dashboard is a crucial feature that outlines the patient’s medical information, updated medical information, chief complaints, insurance information, history of the patient, and ongoing prescriptions. The dashboard is essentially used to navigate the program as the patient seeks care. Other features, including Video, audio, and text, are also displayed on the dashboard, and thus to access them, they need to easily accessible from the dashboard. Only the essential features should be displayed on the dashboard (Mena et al., 2020).

Remote patient monitoring features are also crucial for a telemedicine program that aims to provide quality care. Remote patient monitoring involves using the latest technology advancements to gather patient data outside traditional care settings. It offers several benefits to both the patients and the care providers, such as easy access to patient data, reduced burnout, peace of mind for the patients; being in hospital settings is normally stressful for the patients; however, with remote sensing, patients can relax in their homes. In telemedicine, remote sensing is crucial as care providers take care of patients with different conditions, some chronic and others that can be life-threatening if not properly regulated. Having the feature in telemedicine ensures that the care providers can track a patient’s progress throughout the day and put in place the right interventions (Monaghesh & Hajizadeh, 2020).

E-prescription feature is a necessity in telemedicine programs. It is a framework that allows care providers, including physicians and other practitioners, to write and send patient prescriptions electronically to pharmacists rather than using handwritten notes or calling in for a prescription. An electronic prescribing system acts as a reference book for prescriptions and can also be integrated with electronic health records. E-prescriptions in telemedicine ensure chances of medical errors are significantly reduced (D’Souza et al., 2021).

A with any other software used in the medical industry, security and compliance with HIPAA rules is essential for telemedicine. This serves to protect the pricy of the patients’ data. Before purchasing software, the organization should check for HIPAA certification and assess the software’s security features to ensure they purchase a system that protects the patients’ privacy (Bhaskar et al., 2021).

Part 4: Physician shortage in US

Explain why there may be a shortage of PCPs in the rural

It is expected that by 2033, US will have a shortage of between 54,000 and 139,000 physicians. Two major factors contributing to this include retirement of physicians and an increase in the elderly population. It is expected that in the next decade, 2 out of 5 currently active physicians will attain 65 years, and they will thus retire, leading to physician shortage in the country. While various factors influence retirement, the high burnout rate among physicians is likely to accelerate the retirement process than delay it. Due to high life expectancy, most individuals live longer, with the population of the elderly in the country expected to grow by 45.1%. Taking care of elderly patients is more complex than taking care of younger patients, and often specialists are required. The general population is also expected to increase by 10.4%, thus the shortage in the supply of primary care providers (Zhang et al., 2020).

How is the Patient Protection and Affordable Care Act (PPACA) addressing the shortage of PCPs and RNs?

To deal with physician shortage, the Act has created several reforms in healthcare, such as providing a 10% bonus for Medicare patients. Under the reforms, the physicians are given a 10% bonus for Medicare patients, and also, some services provided to Medicaid patients will be paid out as equal to Medicare. The reforms are meant to increase the willingness of physicians to take more patients. The Act provides loan forgiveness, including nurse and nurse practitioner’s scholarships for those who plan to practice primary care and primary care residency programs. Increasing the scope of practice for advanced nurse practice into primary care is also considered to deal with the physician shortage (Gemelas, 2020).

What other programs are available to address the shortage of primary care physicians and registered nurses? What action are the programs taking?

Programs addressing the shortage of primary care in rural areas include the Physician Shortage Area Program (PSAP), an admission and education program that aims to increase physicians’ supply and retention in small towns and rural areas. The program enrolls, trains, and supports medical students who have spent substantial time in rural areas and intend to practice in a similar environment. The program also provides mentorship services for these students (Malayala et al., 2021).

How is the shortage impacting healthcare delivery? Be specific by providing examples and support your response with academic resources

The physician shortage has been shown to have negative impacts on health delivery. The shortage is decreasing access to healthcare services which has negative impacts on the patient’s health. Due to the shortage, the available physicians are overworked leading to high burnout rates among the physicians. Increased burnout rates among care providers have been associated with low quality of care, increased chances of medical errors, and high mortality rates. A low supply of physicians is also expected to increase the cost of care, including consultation services (Winter et al., 2020).

 

References

Benuto, L. T., Casas, J., & O’Donohue, W. T. (2018). Training culturally competent psychologists: A systematic review of the training outcome literature. Training and Education in Professional Psychology, 12(3), 125.

Bhaskar, S., Nurtazina, A., Mittoo, S., Banach, M., & Weissert, R. (2021). Telemedicine During and Beyond COVID-19. Frontiers in public health, 9, 233.

Center for Culture, Ethnicity, and Health, (2021) Improving the health and well-being of people from refugee and migrant backgrounds Retrieved from: https://www.ceh.org.au/

D’Souza, B., Suresh Rao, S., Hisham, S., Shetty, A., Sekaran, V. C., Pallagatte, M. C., & Suresh Rao, T. (2021). Healthcare Delivery through Telemedicine during the COVID-19 Pandemic: Case Study from a Tertiary Care Center in South India. Hospital topics, 1-10.

Gemelas, J. C. (2020). Post‐ACA Trends in the US Primary Care Physician Shortage with Index of Relative Rurality. The Journal of Rural Health.

Health Resource and Service Administration, (2021) About HRSA Retrieved from: https://www.hrsa.gov/about/index.html

Health Resources in Action, (2021) About Us Retrieved from: https://hria.org/about/

Helms, T. M., Stockburger, M., Köhler, F., Leonhardt, V., Müller, A., Rybak, K., … & Perings, C. A. (2019). Basic structural features of a cardiac telemedicine center for patients with heart failure and implanted devices, cardiac arrhythmias, and increased risk of sudden cardiac death: Recommendations of the working group 33 Telemonitoring of the German Cardiac Society. Herzschrittmachertherapie & Elektrophysiologie, 30(1), 136-142.

Malayala, S. V., Vasireddy, D., Atluri, P., & Alur, R. S. (2021). Primary care shortage in medically underserved and health provider shortage areas: Lessons from Delaware, USA. Journal of Primary Care & Community Health, 12, 2150132721994018.

Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health, 20(1), 1-9.

Winter, V., Schreyögg, J., & Thiel, A. (2020). Hospital staff shortages: Environmental and organizational determinants and implications for patient satisfaction. Health Policy, 124(4), 380-388.

Zhang, X., Lin, D., Pforsich, H., & Lin, V. W. (2020). Physician workforce in the United States of America: forecasting nationwide shortages. Human resources for health, 18(1), 1-9.