Many healthcare programs have modified their operational design and culture to one of being patient-centered while being fiscally viable. As part of your interview of a healthcare manager or executive selected for module 1 discuss how the program was or will be transformed to be patient-centered. In your discussion please address the following questions.
1. How was the program restructured or reengineered to adapt to internal and external factors impacting it? 2. What internal and external factors were considered in the transformation? 3. What were the barriers or obstacles were encountered (e.g. internal politics, economics, resource limitations, time constraints, etc.). 4. What is the potential impact on the program of technology, legislation, etc on the services provided on the program. *Please note that you may add any additional questions that tie into the themes presented in module 2.
1. Q: I have been at this unit for 4 years when I went to work at the hospital everyone was complaining about all the changes made why did these changes occur.
A: Like it or not everyone had a budget including the military, but during the war no one cared about the budget but as the war started to wind down people start to pay a closer eye to our budget. This causes some real eye of concern.
2. Q: What were the some of the thing that cause the restructuring of the fire center clinic to where it’s only soldier and some the other changes they made in the last 5 years?
A: Originally soldier and their family member were all seen at the Fire Center Clinic which causes three major issues. First was overcrowding and over booking, second was patient care civilian vs. soldier attitude of both patient and doctor, thirdly was miss use of appointment and missed appointments.
3. Q: How did they decide on what changes were to be made and what internal changes were made or consider and external?
A: For many years patient both civilian and military had complain about care but no solution. Now with the war going on and soldier need treatment after the war funding could be justified. Things we consider for external was funding, location, and how our location would affect use. Internal thing was patient doctor ratio, hour of operation since it was soldier and civilian, and level of care we would provide.
4. Q: What was some of the barrier did ya’ll run into when trying to make these changes?
A: At first the major concern was what level of care we was going to provide which everyone wanted: Acute Inpatient—The highest intensity of medical and nursing services provided within a structured environment providing 24-hour skilled nursing and medical care. Full and immediate access to ancillary medical care must be available for those programs not housed within general medical centers (APS HealthCare2012). This required and 24 our operational clinic which the clinic we had now did stay open 24 hour with one doctor/ physician assistant and two medic after 22:00 or 10:00pm civilian time but they could only due minimal treatment. None of the unit was authorized a nurse to function on civilian and in a real clinic level we would need nurse.
The idea was to move into hospital was brought to use by the hospital due over crown of patient during the day for none emergency room issue so both could have ability to provide care and get patient to right level of care without denying care. This offer open up another area we were dealing with patient vs. civilian which hospital couldn’t denied civilian care. The Fire center came to agreement and decides to divide the clinic in half family practices which the hospital would run and Fires center which military would run. This divides allowed for two big changes more funding and different care. The Fire Center from there divide doctor or PA up to each brigade and doctor was responsible for those patient.
This allowed a few things better patient doctor relationship. Medic and doctor better training and work relationship. Some of the other issue this cleared up was location and hour we now open from 6 AM to 5 PM. This relieves some stress of long hour of medic and doctor. With the divide these reduce the overcrowding and over booking. This also allowed the army to keep better track of miss appointment and held soldier accountable for missed appointment and show how many soldier was receiving care which increase our funding. This whole process took about year and a half. In this time we ran two clinics for about 3 months and was not completely running 100% 1 year than in swing of it was year and half out.
5. Q: What are some of the things technology wise that made this transition easier?
A: With use now been located in the RACH Hospital we now had access to all there technology with just a simple referral which speed up patient process and allow use great care access. Also with all doctor required to use the Medpros, ALTHA, and E Profile system this allow use to keep better track of our patient care.
* The Medical Protection System (MEDPROS) was developed by the AMEDD to track all immunization, medical readiness, and deployability data for all Active and Reserve components of the Army as well as DA Civilians, contractors and others. It is a powerful tool allowing the chain of command to determine the medical and dental readiness of individuals, units, and task forces. Commander’s and Medical leaders at various echelons are responsible for the use and implementation of MEDPROS to measure their unit/individual medical readiness status.
* Armed Forces Health Longitudinal Technology Application (ALTHA), replacing the military’s paper based medical records system with an electronic medical records (EMR) system, and the Defense Medical Logistics Standard Support (DMLSS) program which streamlines the management of medical supplies (Aruban network,2010)
* e-Profile is a software application within the Medical Operational Data System (MODS) suite that allows global tracking of Army Soldiers who have a temporary or permanent medical condition that may render them medically not ready to deploy. Components of the application include the following: * Automated Profile Form using the Artificial Intelligence Process * MOS Medical Retention Board (MAR2)
* Medical Evaluation Board (MEB) Status Tracking
* Physical Evaluation Board (PEB) Status Tracking
* Statistical Reporting of all Components of the e-Profile Application
* Medical Specialty Referral for Soldiers
* e-Profile Contains PHI and is Required to be HIPAA Compliant (E Profile 2011)
1. APS Healthcare,2012 MEDICAL NECESSITY AND LEVEL OF CARE DETERMINATION CRITERIA, APS Healthcare Inc., 2012 2 of 19 Adopted 10-21-98 Last Approved by CAP: 2/24/12 2. E Profile 2011, Electronic Profiling System e IAW ALARACT 017/2011 Army Implementation of Electronic Profiles (e-Profile), 24 JAN 2011, https://medpros.mods.army.mil/eprofile/Public/About.aspx, Dec2012 3. Aruban network,2010,U.S. Department of Defense Military Health System prescribes Aruba for wireless connectivity, WWW.ARUBANETWORKS.COM |http://www.arubanetworks.com/pdf/solutions/CS_MHS.pdf© 2010 Aruba Networks, Inc. AirWave®, Aruba Networks®, Aruba Mobility Management System®, Bluescanner, For Wireless That Works®, Mobile Edge Architecture®, People Move. Networks Must Follow®, RFprotect®
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