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Decision-Making Case Study Health Care Management Essay

Stoddard County Public Health Clinic is located on Highway 25, North of Bloomfield, Missouri. The clinic provides services to infant and child; young and middle aged adults; older adults; environmental services; and group/community services. When the 2009 budget cuts were distributed among the different departments, the manager of the Young and Middle Aged Adult Department noted a 15% budget cut. This paper is a case study of how the Young and Middle Aged Adult Department Manager will decide what tools she will use to decide which clinical service should be eliminated or introduced to better serve the Medicaid population at while at the same time make a 15% cut in its budget.

Clinic Services Available and StaffingThe services available for the Young and Middle Aged Adult Department includes: breast and cervical screening project, anemia screening, sexually transmitted diseases, pregnancy testing, immunizations, nutrition education, W.I.C, women’s health screenings, high risk pregnancy counseling and case management for prenatals (Stoddard County, 2008). Staffing for the department includes: Department Manager; 2 full-time LPNs to perform screenings, draw blood samples and administer immunizations; 1 full-time nutritionist for the nutrition education; and 1 RN Case Manager to manage the women’s health screenings, high risk pregnancy counseling. The clerical staff is shared among the entire clinic.

The Department Manager looked at the year-to-date information for each service provided under her department with the thought of possibly eliminating a service to make up for the 15% budget cut. Upon reviewing the all statistics concerning frequency of use and after surveying all staff members within the clinic, it was determined that each service was very important to the Medicaid recipients of Stoddard County. One suggestion from a staff member was to convert one of the full-time LPN positions to a part-time position and starting a clinical volunteer program.

Another position that could be changed from full-time to part-time is the Nutritionist. Statistics have shown that her services are only needed 4 hours a day instead of the full 8 hours. The volunteers would be clinically proficient and could conduct the screenings that are very popular within Stoddard County. In order for the decision to be made, the Department Manager will need to make a decision to use a decision making analysis tool.

The Informed Decisions ToolboxOne option for the department manager can use to make a decision on how to manage a 15% budget cut for her clinic, is to use The Informed Decisions Toolbox developed by Thomas G. Rundall, PhD and his associates (University Of Phoenix, 2008). The toolbox is divided into six steps to help managers make an informed decision. The six steps include: Step 1: Framing the question behind the decision; Step 2: Finding sources of information; Step 3: Assessing the accuracy of information; Step 4: Assessing the applicability of information; Step 5: Assessing the actionability of information; Step 6: Determining if the information is adequate (University Of Phoenix, 2008).

Step 1: Framing the Question Behind the DecisionBefore making an informed decision, the manager must formulate a research question out of the management question. In this case study the management question is “How will the Young and Middle Aged Adult Department operate with a 15% budget cut?” The research question is “What clinical services should be eliminated or added to allow for the 15% budget cut within the Young and Middle Aged Adult Department’s and how will it affect the profitability and quality of care outcomes during the 2009 budget year within the Medicaid population?” (University Of Phoenix, 2008).

Step 2: Finding Sources of InformationStep 2 of The Informed Decisions Toolbox discusses different avenues of researching the management question. These avenues include, but are not limited to: healthcare organization libraries, webmasters intranet information and in-house support systems; and the Internet. Step 2 also describes search tips that were very useful (University Of Phoenix, 2008).

Step 3: Assessing the Accuracy of InformationStep 3 guides the user to asking the following questions to help ascertain whether the information is accurate: “Is the information valid and reliable? Is the information comprehensive? Am I missing important perspectives or aspects of my decision?” (University Of Phoenix, 2008).

Step 4: Assessing the Applicability of InformationThis step guides the user to decide if all the information accessed was applicable to making a decision.

Step 5: Assessing the Actionability of InformationStep 5 will guide the user to determine if the information collected will provide useful recommendations to be implemented, what the expected effects may be of the decision and what are the possible effects that were not expected (University Of Phoenix, 2008).

Step 6: Determining if the Information is AdequateThis last step will guide the user in making the determination as to when there has been enough information gathered to make a decision (University Of Phoenix, 2008).

After reviewing the information on The Informed Decisions Toolbox, the Department Manager decided this tool wasn’t useful for the type of decision that needed to be made.

There are four key strategies that have been recommended for use that affects an organization when the toolbox is used:1.”Strategy One: Recognize and Respond to the Growing Demand for Accountability as a Strategic Issue” (University of Phoenix, 2008).

2.”Strategy Two: Establish Organizational Structures and Processes for Knowledge Transfer” (University of Phoenix, 2008).

3.”Strategy Three: Build a Questioning Organizational Culture” (University of Phoenix).

4.”Strategy Four: Build Organizational Research Capabilities” (University of Phoenix, 2008).

By using these strategies, an organization will be able to ensure that have all the research information at hand to help them stay accountable for their actions. It is also a way for sharing of knowledge and always questioning so as to build a stronger organization.

Devil’s Advocate TechniqueDevil’s Advocate is a technique that is used in gathering the positive and the negative aspects to a decision that needs to be made (Liebler & McConnell, 2008, p. 159). In this case, the Department Manager assigned the 2 LPNs and Case Manager the task of brainstorming and writing down the negative aspects of her proposal and all the positive aspects to the proposal.

Negative AspectsThere were some strong negative aspects that the team was able to verbalize during the brainstorming session. Some of the stronger comments were:1.A full-time staff member will be required to have a change of status from full-time to part-time. This could cause the staff member make the decision to resign and find a position elsewhere. This will cause the Department to incur the expense of recruiting and training a replacement.

2.Cost of recruiting and training volunteer staff to make up for the ½ FTE position lost.

3.Loss of expertise from taking already fully training long-time employee out of the full-time position and replacing them with an inexperienced volunteer.

Positive AspectsThere were some strong positive aspects that came from the brainstorming as well. Some of the stronger comments/aspects are:1.Cost savings from using volunteer services. The LPN is making an hourly wage of $17.50 per hour equates to approximately $36,400 annually. By using the volunteer for part-time, there will be a savings of $18,200 annually.

2.Cost savings for changing the dietician to part-time would be $22,500, which is half of the $45,000 annual salary paid.

The total budget from previous year was $154,800. The new budged, which excludes the 15% cut is $131,580, which equates to a total $23,200 difference. If the decision was made to change the two positions to part-time, there would be a cost savings of $40,700.00.

In conclusion, the decision-making tool that best suited the Department Manager of the Young & Middle Aged Adult was the Devil’s Advocate. By allowing those who the decision was going to affect the most have a part in the decision making process ensured better understanding of budget cuts. The Informed Decisions Toolbox is an excellent tool for those decisions requiring a lot of research data; however, not best suited for this Department Manager. The final decision was made to proceed with changing 1 FTE LPN to Part-time and 1 FTE Dietician to Part-time, which will create a total budgeted savings of $40,700.00.


Liebler, J., & McConnell, C. (2008). Management Principles for Health Professional (5th ed.). Sudbury, MA: Jones and Bartlett.

Stoddard Conty. (2008). Stoddard County Public Health Center. Retrieved November 30, 2008, from http://www.stoddardcountyhealth.com/ServicesAvailable.htmUniversity Of Phoenix. (2008). The informed decisions toolbox: Tools for knowledge transfer and performance improvement. Retrieved November 30, 2008, from University of Phoenix, Week Two, Resource HCS 514 – Managing in Today’s Health Care Organizations Web site.

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