Category Archives: Healthcare

Transformational Theory of Leadership

Transformational Theory of Leadership


Leadership in health care organizations is critical in improving the quality of care accorded to patients. Health care organizations are currently facing immense challenges ranging from shortage of medical personnel, high number of patients, increasingly diverse demographics, and fewer resources to support service provision. With regard to this, health care practitioners need to employ innovative strategies in order to enhance quality service delivery to patients. One of the ways that leaders in health care organizations can improve management practices is by deploying an effective health care administration leadership theory. Clinical leaders are essential in improving the quality of health care organizations and helping them overcome the modern-day challenges. The transformational theory of leadership can significantly help in improving management practices in health care organizations through inspiring and motivating employees. The purpose of this paper is to expand our current knowledge and understanding on the role of transformational theory of leadership in improving patient safety through service delivery across health care organizations.


The transformational theory of leadership asserts that leadership is all about inspiring employees to become self-directed (Jones, 2007). The theory contradicts motivational theories, which partly assert that leaders should motivate employees to work hard to external rewards such as higher pay. Transformational leaders inspire employees to work hard not for external rewards or exchanges, but for self-actualization. Transformational leaders establish mutual relationships with their followers; they establish motives among their followers, engage them, and evaluate their higher needs with an aim of meeting these needs. The mutual relationship that results transforms followers to mortal leaders in their respective fields. The transformational leader must have a strong self-esteem that leads to feelings of self-worth and adequacy. In transformational leadership, employees are able to contribute towards decision making in the organization. As a result, it is possible to identify the hidden talents of the employees.

Revised Literature Review and Problem Statement

Vast volumes of literature exist on the role of transformational leadership in health care administration. This section analyzes extant literature on this subject, drawing from peer-reviewed articles and other academic literature.

The effectiveness of nurse leaders significantly determines the ability of the health care organization to achieve optimal care outcomes, including patient safety. Huston (2008) examines the role of nurse executives in strategic management in health organizations. The study identifies eight core competencies that nurse leaders must gain in the modern world. Key among these competencies is developing collaborative skills, which are essential in team building. Capuano, Bokovoy, Hitchings, and Houser (2005) employ a structural model to examine the impact of work environment, resources, staff expertise, work environment, and leadership on patient outcomes. The findings indicate that transformational leadership approach is positively associated with staff expertise, which invariably contributes to improved patient outcomes. Some studies have examined the efficacy of the transformational leadership style when applied in the emergency department. By employing a multifactor leadership questionnaire, Raup (2008) notes that there is reduced turnover rate among nurses in health organizations practicing transformational leadership.

Gregory (2006) conducts a survey in an effort to examine the relationship between transactional and transformational leadership and the attitude of various service providers. This study hypothesizes that transformational leadership contributes to the development of positive attitudes with regard to implementation of evidence-based practices. The study included 322 participants, majority of whom were employees in a medical health organization. The study indicates that transformational leadership had a significantly higher impact on the attitudes of employees in implementing evidence-based practices compared to transactional leadership. Julie (2013) conducts a literature review to evaluate the efficacy of transformational leadership in health care. The findings indicate that transformational leadership is key in improving the performance, motivation and moral of health workers. This contributes to patient safety. These findings echo those by Robin (2016) on transformational leadership, which indicates that this form of leadership significantly improves the performance of health workers.

An important concern in the health sector regards patient safety. Some studies have focused on the role of transformational leadership in enhancing patient safety. McFadden, Henagan, and Gowen (2009) examine the impact of transformational leadership style to patient safety. The trio conducted an empirical review drawing data from 626 US hospitals. The findings indicate that there is a strong correlation between transformational leadership and patient safety culture in the organizations surveyed. Some scholars have explored the efficacy of the Multifactor Leadership Theory in the management of health care organizations. This theory recommends the application of three different leadership styles: transformational, transactional, and laissez-faire type of leadership (Kanste, Miettunen, & Kynqas, 2007). According to this theory, application of the three styles of leadership can significantly improve patient outcomes in health care settings.

A number of researchers have focused on the role played by transformational leadership in enhancing the safety performance of employees. There are concerns that majority of health organizations are yet to achieve high levels of safety despite the tremendous changes in health systems over the years. Inness, Barling, Turner, and Stride (2010) examine the role of transformational leadership to safety performance of the employees. The study utilizes an empirical analysis using a sample of 159 respondents. Data was obtained through self-reporting of the respondents. Structural models are used to test the hypothesis in the study. The findings indicate that transformational leadership is key in enhancing the safety performance of employees. Transformational leadership enhances the development of a learning culture, which is critical in ensuring patient safety.

Wong, Cummings, and Ducharme (2013) conduct a meta-analysis of existing literature with an aim of identifying the relationship between nursing leadership practices and patient outcomes. The three examined 20 studies that analyze nursing leadership. The study finds a positive correlation between relational leadership and lower medication errors and improved patient outcomes. This study identifies a gap in available literature that supports specific leadership styles in improving patient outcomes. As such, there is need for robust studies that examine the efficacy of various leadership styles in health care settings. Little is known about the relationship between nursing leadership styles and patient outcomes.

Some studies aim at investigating the efficacy of different leadership styles in improving patient safety and quality of care. Verschueren, Kips, and Euwema (2013) conduct a meta-analysis of existing literature from 200 to 2011. The meta-analysis of literature indicated that transformational leadership style was the most effective in improving patient outcomes in health care organizations. Transformational leadership is associated with improved organizational citizenship behaviors among employees. Humphrey (2012) defines the organizational citizenship behaviors as those activities that employees engage in during the course of their job but are not formally recognized in their job specifications. Organizational citizenship behaviors are important in helping develop a positive image of the organization. This study employs a survey methodology using a sample of 128 participants. The findings indicate that transformational leadership greatly improves the organizational citizenship behavior of employees.

Some studies have raised concern over the overall impact of the leadership style employed in a particular organization. The major issue of concern concerns whether one type of leadership is context-specific or whether it exhibits characteristics of context-spillover. Ritter and Lord (2007) examine this issue with positive results. The duo concludes that experiences obtained by employees in one context are likely to be transferred to another job or different context. For instance, employees who experience high job motivation may continue to feel so even when they move to new organizations. Moreover, a single employee may hold more than one job. Evidence of context specific transference is also available. Transformational leadership can at times influence employees at a particular context without the occurrence of a transference. For instance, context-specific effect of this style of leadership is evident among employees who are able to distinguish the experiences of one leader from that of a different leader.

The quality of care provided to patients partly depends on how the nurses receive training and their willingness to observe all medical procedures. One of nurses’ key role is providing medication, which also greatly reflects on the quality of care at the organization. Vaismoradi, Griffiths, Turunen, and Jordan examine the role of transformational leadership in enhancing medication safety education among nurses. The major role of this study is to examine how transformational leadership reduces cases of adverse drug events in health care organizations. The results indicate that transformational leadership plays a significant role in teaching medication safety among nurses. The study notes that for this style of leadership to be effective, there should be mutual relationship between the policy makers, managers and the educators concerned.

Application of appropriate leadership styles in health care organizations is essential in promoting job satisfaction among nurses. A study conducted by Armstrong, Laschinger, and Wong (2009) indicates that transformational leadership is critical in promoting a healthy nursing environment. Transformational leadership also improves patient safety in health care organizations. This study included a sample of 300 participants from different Canadian hospitals. The study supports the results of other researches, which indicate that the transformational leadership style is the most effective leadership style in health care organizations. Although errors may naturally occur in the field of nursing, the style of leadership determines the frequency and severity of the errors. According to Katz-Navon and Stern (2005), few medical errors are reported in hospitals that have instituted a culture of safety. Fewer errors are reported in hospitals that have redesigned their workplace environment or those that have modified their systems.

Fischer (2016) conducts a conceptual analysis on transformational leadership in health care settings using a meta-analytical approach. The aim of the study is to gain a deeper understanding of the role of transformational leadership in the field of nursing. The findings support the conclusions made by previous studies concerning the efficacy of the transformational leadership concept. The study concludes that transformational leadership contributes to high performance of health care workers and consequently, improved patient care. The study notes that the concept of transformational leadership can be put in the category of teachable competencies. This means that nurse leaders can learn the concept of transformational leadership in training situations and apply these concepts effectively in the hospital environments. Fischer (2016) employs the Multifactor Leadership Questionnaire (MLQ) to measure the efficacy of transformational leadership in health care organizations. This questionnaire has been widely used in measuring the effectiveness of various leadership models.

An eminent gap within the existing literature regards the identification of the actual mechanisms or ways by which the transformational theory of leadership affects patient outcomes. The specific mechanisms through which transformational leadership style in organizations influences various measures of outcomes such as patient safety and the quality of care remains unclear. There is also a gap in existing literature regarding the comparison of the transformational theory of leadership with other leadership theories in health care settings. Few studies exist comparing transformational leadership style with other forms of leadership, and providing support for the most robust theory of leadership. The empirical references by which the theory is hedged on are also weak. More researches are necessary in order to support the current empirical references. For instance, some critics argue that the inherent processes of the transformational theory of leadership are not clear.

Personal Health Care Administration Leadership Theory

My personal health care administration leadership theory involves the transformational theory of leadership. Transformational theory helps health care organizations to clarify vision. The theory of leadership is important in empowering employees by increasing their self-confidence in making critical decisions within the organization. The theory helps in developing alternative solutions to problems that arise in the workplace (Fischer, 2016). Another key aspect of the theory is that it helps in inspiring employees. This increases the productivity of an organization that employs this theory in management. The foundations of transformational theory lie on developing personal interpersonal relationships that transcends the hierarchical levels in the organization. Communication is another key aspect of the theory. The leadership approach requires that employees maintain open communication irrespective of their position. Transformational leadership instills confidence and innovativeness among employees to handle day-to-day challenges that may arise (Fischer, 2016). This is critical in improving patient outcomes.

Transformational leadership has a number of defining attributes (Fischer, 2016). The first attribute is idealized influence. This involves the leader acting as a role model in the organization. The leader behaves in an ethical manner and is responsible for making tough decisions when the need arises. The second attribute is inspirational motivation, which involves inspiring employees to commit towards achieving organizational goals. Leaders must communicate expectations to employees and challenge them to achieve the organizational goals (Armstrong, Laschinger, & Wong, 2009). Intellectual stimulation is the third attribute. This attribute emphasizes on the ability of the employees to evaluate the current assumptions held in the organization as well as develop creativity in solving problems. This attribute encourages employees to become innovative in handling various challenges in the organization. The last attribute is individualized consideration, which involves examining the specific manner in which a leader interacts with employees (Fischer, 2016). This helps in the development of a supportive culture.

An example of transformational leadership in health organizations is where the leader demonstrates a caring attitude towards workers and is passionate concerning the team’s mission. The transformational leader should make the followers experience warmth and security while relating to him or her (Armstrong, Laschinger, & Wong, 2009). This is based on the idealized influence attribute. The leader should develop trusting relationships with the employees. Another key aspect is demonstration of ethical behavior. A transformational leader should follow the ethical guidelines established by the organization (Fischer, 2016). This helps in making tough decisions and avoiding legal issues that may arise out of making the wrong decisions. The leaders should exhibit honesty and integrity in dealing with other people. The transformational leader should be keen to put forward his/her personal career growth and that of the employees. Transformational leaders are known to make value-based decisions that inspire motivation among the followers.

Transformational theory of leadership holds that in order for the leader to inspire followers, he must modify behavior in ways that allow him to accommodate the behavior of others. This is similar with the assertion of the congruent leadership model (Fischer, 2016). Transformational leadership is preventive or proactive in nature. This is contrary with the assertions of the transactional model, which calls for reactive type of behaviors in organizations. The proactive attribute encourages leaders to identify potential problems in the environment before they lead to damages. Contingent rewards are given to followers who achieve specific goals in order to keep them motivated. Transformational leadership is recognized as one of the leadership styles that can help in transforming the organizational culture and process (Armstrong, Laschinger, & Wong, 2009). This is achieved through inspiring, motivating, and engaging employees to adapt new behaviors.

Revised Visual Representation of your Health Care Administration Leadership Theory

The transformational theory of leadership in health care administration is key in achieving positive outcomes. Nurse leaders can apply the transformational model in health care settings to achieve positive outcomes among patients. However, there is a lack of extant literature on the role of nurse managers with regard to the transformational theory of leadership. Existing literature fails to provide details concerning how the nurse leaders may involve nurse managers in order to help in transforming the health care organization. It is worth noting that the nurse manager has a more formal role in the health care setting compared to the nurse leader. Nurse managers are expected to fulfill certain duties in the health care organization. The major concern is how the nurse leader can build mutual relationship with the nurse manager in order to bring change to the organization. Nurse leaders cannot work alone to bring change in the organization, but they need help from other key stakeholders in the organization to bring change.

The management is concerned with designing, developing, maintaining, and implementing various tasks and processes. Most often, these kind of competencies cannot surface to support the entire strategies and visions identified by the organization. As such, there is need for other forms of leadership that can help in bringing change in the organization. The nurse leader is different from the nurse manager. The nurse manager is concerned with coordinating resources in the organization (financial and human resources), setting goals and objectives, ensuring ethical guidelines are followed, and other managerial roles. It is difficult to teach the competencies of the transformational leader to others in the organization, including the nurse manager. Organizations wishing to teach the competencies of the transformational leader can begin by first examining the characteristics associated with the transformational leadership. Some of these characteristics are honesty, effective communication skills, accountability, listening skills, and others.

The four dimensions of transformational leadership

The transformational leader is involved in motivating and increasing the morale of the employees. This can be achieved through a number of ways, which include leading by example, coaching & empowerment, inspiring employees to reach new heights, and encouraging growth and learning. The transformational leader acts as the role model so that followers can get inspiration. The inspirational leader must also challenge followers to go beyond working for external rewards. Employees are more productive when they value their work not for external rewards but for its intrinsic value. It is also important for the leader to take into consideration the strengths or weaknesses of the workers. This enables the leader to align followers with jobs or tasks that match their abilities.

Systems thinking in health care settings refer to an approach that defines and takes into consideration the various aspects of complex adaptive systems. Complex adaptive systems are dynamic social systems that keep on changing depending on various factors (Swanson et al., 2012). The various components of complex adaptive systems include patients, health care providers, communities, policy makers, citizens, and other stakeholders. These components are dynamic due to the changes in the environment. Health organizations, which are part of the adaptive systems, have certain characteristics such as constant changes, time differences in inputs and outcomes, self-organization characteristics, and feedback loops. Systems thinking take into consideration the impacts of complex adaptive systems and in doing so attempts to achieve maximum positive effects. Systems thinking hold great potential in addressing the challenges that the public health sector is currently facing.

Under the concept of systems thinking, three major themes are evident. These include collaboration across disciplines and organizations, ongoing learning, and transformational leadership (Swanson et al., 2012). In the application of systems thinking, a number of tools and strategies are applied. Organizations that utilize systems thinking often develop a common vision or purpose that guides employees. These organizations may also put into use a number of system thinking tools such as concept mapping, systems dynamics modelling, social network analysis, knowledge synthesis, and program budgeting. Organizations utilizing the concept of systems thinking may evaluate their health programs on regular basis with the aim of enhancing capacity. These organizations may also spend a great deal of time and resources in capacity development and implementing transformational leadership. Systems thinking is also characterized by the application of feedback loops, careful monitoring of processes, and transparent use of information.

Empirical Evaluation Plan for a Health Care Administration Leadership Theory

It is important to examine the efficacy of the transformational theory of leadership in improving patient safety outcomes. Patient safety is a significant area that health care organizations cannot choose to ignore. Patient safety outcomes reflect the overall effectiveness of service delivery at any health facility. In order to examine patient safety, it is important to establish applicable patient safety indicators. Patient safety indicators are the adverse events encountered by patients during their stay at the health facility. The patient safety indicators under consideration in this study are as follows:

  • Accidental punctures and laceration.
  • Specific hospital acquired infections.
  • Incidences of foreign body left at the area of operation.
  • Transfusion reaction.
  • Complications involving anesthesia.
  • Incidences involving administration of wrong drugs or injections to patients.

All patient safety indicators are preventable. It is worth noting that the lower the case of these patient safety indicators the safer the health facility is considered to be. Lack of adherence to safety standards or protocol touches on the patient safety indicators mentioned above. The consequences resulting from this can be referred to as hospital-acquired conditions (HAC), which is the adverse effect as it manifests itself on the patient. Process Quality Scores (PQSs) will be used as a measure of the hospital’s ability to provide care to a given set of patients with particular needs.


This study will employ a survey methodology. The study will use health care facilities as the unit of the analysis. The first part of the study entails developing an initial questionnaire that is sent to various hospital directors countrywide. This will be a pilot survey meant to obtain response from the hospitals about their willingness to participate in the study. Telephone interviews will be employed during the initial phase to reduce any ambiguities that could be there. If hospital directors are not available, the researchers will contact patient safety director, risk management director, quality director, or even the chief quality officer. This will also be a good opportunity for the team of researchers to convince the hospital management of the need to participate in the study. The inclusion criteria recommend that the study utilize only the hospital based organizations with a bed capacity of 50 beds and more. This means that mammography centers, clinics, and other small private facilities will face exclusion from the study.

From the list of all eligible hospitals that make a response, the researchers will email surveys bearing appropriate questions. The focus of the research questions will be on quality, patient safety, medical errors, and leadership style exhibited by the management. It is imperative to identify the leadership style exhibited in each of the hospitals involved in the survey. With this regard, the researchers will provide a list of leadership characteristics whereby the respondents will pick the best match or one that fits their organization. This list will detail characteristics of various leadership styles such as transformational leadership, transactional leadership, democratic leadership, authoritarian leadership, and laissez-faire leadership. Respondents will use the four categories to detail the kind of leadership style in their respective organizations.

Data Collection

Data concerning patient safety indicators will be obtained from relevant government websites such as and These websites contains information about all hospitals in the U.S. They also provide detailed comparisons of various patient care indicators in different hospitals. The aim is to provide consumers with detailed information about where they can obtained quality health services. Data for all hospitals will be collected from the same period or year. This will help in avoiding bias. In addition, hospitals will be at liberty to make a choice on whether to submit data concerning the patient safety indicators. This data is available in all hospitals and is similar to that contained in the government-run websites. Hospitals must report data concerning the leadership style applied since this data is not available anywhere else.

It is important that the data submitted by the respondents concerning patient safety indicators should match to that obtained from the websites. This will be a way of ensuring that the respondents submit accurate and reliable data. Transformational leadership will be measured using a questionnaire having 8 items. The items will prompt respondents to list the frequency with which the top leadership applied the specific item. The other leadership styles will be analyzed using questionnaires having 5 items. Measures of skewness and kurtosis will be used to measure whether the data obtained deviates from the norm. Statistical modeling will be used to analyze data obtained from the survey. This will provide an accurate report of the efficacy of the transformational leadership model in health care organizations.


The transformational theory of leadership is effective in improving patient outcomes in hospitals. The model of leadership is associated with positive impacts on patient safety culture within the hospital, patient safety initiatives by nurses, and improvement in overall patient safety outcomes. The literature review indicates that majority of studies support relational models of leadership in health care organizations. Transformational leadership improves almost every aspect of healthcare organizations – from effectiveness of emergency departments, general staff expertise, staff motivation, development of positive attitudes, patient safety, and in among other areas. Today’s health care leaders cannot afford to ignore the benefits of transformational theory of leadership in helping transform their organizations positively and in improving patient outcomes. Patient safety is one of the most important considerations in health care organizations. Since the transformational model helps improve patient safety, it is important that health care organizations should consider it imperative to adopt and implement the model in practice.

Some studies have investigated the efficacy of different leadership styles in improving patient safety and quality of care. These studies conclude that transformational leadership style is the most effective in improving patient outcomes in health care organizations. Transformational leadership is associated with improved organizational citizenship behaviors among employees.. The findings also indicate that transformational leadership greatly improves the organizational citizenship behavior of employees. This is significant in improving the overall performance of the organization. Application of appropriate leadership styles in health care organizations is essential in promoting job satisfaction among nurses. Transformational leadership is critical in promoting a healthy nursing environment. Transformational leadership also improves patient safety in health care organizations. Although errors may naturally occur in the field of nursing, the style of leadership determines the frequency and severity of the errors. Few medical errors are reported in hospitals that employ transformational leadership model.


Armstrong K.J., Laschinger H. & Wong C. (2009). Workplace empowerment and Magnet            hospital characteristics as pre-dictors of patient safety climate. Journal of Nursing Care     Quality, 24(1): 55-62. Available at:

Capuano T., Bokovoy J., Hitchings K. & Houser J. (2005). Use of a validated model to evaluate the impact of the work environment on outcomes at a magnet hospital. Health Care    Management Review, 30 (3), 229–236. Available from

Fischer, S. A. (2016). Transformational leadership in nursing: A concept analysis. Journal of       Advanced Nursing, 72(11), 2644-2653. doi:10.1111/jan.13049

Gregory, A. A. (2006). Transformational and transactional leadership: association with attitudes toward evidence-based practice. Psychiatric Services; Arlington, 57(8): 1-9.

Humphrey, A. (2012). Transformational leadership and organizational citizenship behaviors: The            role of organizational identification. The Psychologist-Manager Journal, 15(4), 247-268.             doi:10.1080/10887156.2012.731831

Huston, C. (2008). Preparing nurse leaders for 2020. Journal of Nursing Management, 16(8):       905 – 11.  doi: 10.1111/j.1365-2834.2008.00942.x.

Inness, M., Barling, J., Turner, N., & Stride, C. B. (2010). Transformational Leadership and         Employee Safety Performance: A Within-Person, Between-Jobs Design. Journal of    Occupational Health Psychology, 15(3): 279–290.

Jones, R. A. P. (2007). Nursing leadership and management: Theories, processes, and practice.             Philadelphia, PA: F.A. Davis Co.

Julie, T. (2013). Exploration of transformational and distributed leadership. Nursing         Management, 19(4): 30-49.

Kanste, O., Miettunen, J., & Kynqas, H. (2007). Psychometric properties of the multifactor          leadership questionnaire among nurses. Journal of Advanced Nursing, 57 (2): 201–212.

Katz-Navon, E. T., & Stern, N. Z. (2005). Safety climate in healthcare organizations: a     multidimensional approach. Academy of Management, 48 (6):1075–1089.

McFadden, K. L., Henagan, S. C., & Gowen, C. R. (2009). The patient safety chain:         Transformational leadership’s effect on patient safety culture, initiatives, and outcomes. Journal of Operations Management, 27(5): 390–404.

Raup G.H. (2008) The impact of ED nurse manager leadership style on staff nurse turnover and   patient satisfaction in academic health center hospitals. Journal of Emergency Nursing,    34 (5), 403–409.

Ritter, B. A., & Lord, R. G. (2007). The impact of previous leaders on the evaluation of new        leaders: An alternative to prototype matching. Journal of Applied Psychology, 92, 1683–         1695.

Robin, S. (2016). Health care reform, care coordination, and transformational leadership. Nursing Administration Quarterly, 40(2): 153-163.

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Vaismoradi M., Griffiths P., Turunen H. & Jordan S. (2016). Transformational leadership in        nursing and medication safety education: a discussion paper. Journal of Nursing           Management, 24, 970–980.

Verschueren, M., Kips, J., & Euwema, M. (2013). A review on leadership of head nurses and       patient safety and quality of care. Advances in Health Care Management, 14, 3.

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Healthcare Industry Overview


Healing Hands Hospital Final Draft-HCM 307


Key Assignment Final Paper – Report of Findings to Mr. Magone, CEO, Healing Hands Hospital and the “Future of Healing Hands” Task Force
Continue to use the scenario to assist you with this assignment.
There are two parts to this assignment:

Part 1:

Using your instructor’s and peers’ feedback and suggestions from Week 4, complete your final draft of the Key Assignment, Report to the Future of Healing Hands Task Force. Add the following analysis to complete your paper from Week 4 and then submit the entire paper including the analysis for this assignment:

Mr. Magone and the senior leadership of Healing Hands Hospital understand the importance of evaluating operational performance in the healthcare industry and its impact not only on patient satisfaction but also maintaining sound financial management. This is increasingly important in the era of value-based care including Medicare’s Quality Payment Program.  Both qualitative and quantitative analysis of data related to patient care is needed.  This data includes average length of stay, readmission rates, mortality rates and compliance with standard of care guidelines.

In addition, Healing Hands Hospital is preparing financially for the many different reimbursement changes associated with Medicare Advantage Plans and the need to demonstrate improved quality of care delivered to the hospital’s patients. As part of the Task Force you have been asked to research and analyze data regarding 1) length of stay and 2) hospital acquired infections and the impact of both metrics on the hospital budget and reimbursement. As reimbursement payments become increasingly linked to quality of care, it is important for Healing Hands Hospital to continue to improve in these areas. You have been asked to help the Chief Financial Officer  and Chief Nursing Officer evaluate these aspects of patient care as part of your report to Mr. Magone and the Task Force. Submit a 7-10 page paper incorporating your unit 1-4 Individual Project topics including the analysis of how Healing Hands Hospital compares to other hospitals in the nation, state and region in:

Average length of stay
Hospital acquired infection rate 

Describe how these statistics impact the organization’s budget and reimbursement opportunities in the future.  Be sure to include how Medicare reimbursement will be impacted.
For your research, remember to use the hospital that you chose to represent Healing Hands Hospital and use data for the same state and region for comparison in your analysis.  Put your data for comparison in a table or graph in your paper.
For the final paper reference list, be sure to include a minimum of 3 reference sources besides the textbook identifying where you found your data on hospital statistics and add this to your references for the other sections of your final paper from the previous week’s assignments.  Document your references using APA format.

Part 2: 

Being asked to be part of the Task Force was recognition of your abilities and value to Healing Hands Hospital.  When you started to work on the Task Force, you were not an expert in all of the aspects of the healthcare industry on which you were asked to report. Your manager, Ms. Woods, the Chief Operating Officer, recognizes this and that you had not previously had the opportunity to present to the Chief Executive Officer and other members of the executive team.   She tells you that this is a good opportunity to develop skills as a professional and expand your expertise level in the healthcare field.  She is curious about how you feel about the opportunity and what skills you feel you already had and those that you developed in this process.  She also would like to know what skills you feel you still need to develop to continue to advance in your healthcare management career.  Write a 2-3 paragraph memo to Ms. Woods that answers her questions and reflect on your professional development through the work that you did for the Task Force (as a part of this course) and how you will continue to maintain your acquired skills and knowledge base.
Please submit your assignment.
For assistance with your assignment, please use your text, Web resources, and all course materials.

Sample paper

Healing Hands Hospital Final Draft

In the recent period, value-based programs have gained prominence in the health care industry. Value-based programs reward health practitioners with incentive payments basing on the quality of care they give to those under Medicare plans. The major goal of the value-based programs is to transform the delivery of health care to people by improving quality of care. Value-based programs aim to achieve three key goals: lower cost of health care, better health for populations and improved care for individuals. In the past, health care reimbursements dwelt on the quantity of care provided to patients. This means that quality was not a key consideration during reimbursements, which is of critical importance in the healthcare industry. This paper presents an analysis of data regarding length of stay and hospital acquired infections including how these metrics affect the hospital budget. Part 2 of the paper is a reflective memo of my professional development.

Centers for Medicare & Medicaid Services (CMS)


The Centers for Medicare & Medicaid Services (CMS) is a federal agency under the Department of Health and Human Services (HHS) that provides the Medicare program and works hand in hand with state governments to coordinate Medicaid and other programs such as the State Children’s Health Insurance Program (SCHIP) (CMS, n.d). CMS provides health coverage to over 100 million people through the SCHIP, Health Insurance Marketplace program, and Medicare and Medicaid programs. The major goals of the CMS include provide access to quality care, modernizing the country’s health care system, strengthen family and individual engagement, and to provide affordable and quality care to individuals. CMS has become increasingly involved in the reimbursement component of health care in an effort to reach the aforementioned goals.

The involvement of CMS in reimbursements has significantly transformed the quality of care among a majority of practitioners. Healing Hands Hospital and other health care organizations must transform their health care delivery in order to receive higher reimbursements under the new CMS model. Currently, CMS provides reimbursements through a value-based program whose emphasis is quality of care, rather than quantity. Some of the aspects considered in determining payment amounts include hospital acquired infection rates, hospital stay, catheter removal, patient weight management, readmission rates, errors resulting out of negligence, and among other quality indicators.

It is important for Healing Hands Hospital to implement various tools to ensure it is meeting the policies and procedures set by CMS. The first tool is discharge planning, which involves planning on whether the patient needs transition through the different levels of care. This ensures the patient is included for reimbursement purposes. Another important tool is regular audits to ensure that the hospital is meeting requirements set by CMS. The hospital should implement a non-discriminatory policy to ensure patients receive proper medical services. Another measure is compliance to ambulatory care guidelines outlined by the National Quality Forum.

Related: Managed care


Medicare is a health insurance program under the Federal Government. The program covers individuals above 64 years, those under 65 years but with certain disabilities, and individuals with end-stage renal disease across the ages. Some of the disabilities covered under Medicare include dementia, mental illness, Parkinson’s disease, and other disabilities that may qualify. It is worth noting that there are no specific disabilities excluded from Medicare coverage; it all depends on whether a potential beneficiary meets the coverage criteria. Medicare covers specific services, all depending on the particular plan.  Medicare Part A plan covers hospice care, home health care to some extent, skilled nursing facility care, and inpatient hospital stays. Medicare Part B covers outpatient care, select doctor’s services, preventive services, and medical supplies. Private insurers in conjunction with Medicare provide Medicare Part C plan. Beneficiaries enjoy Part A and Part B services. Part D is the prescription drug coverage.

Quality Payment Program. The Quality Payment Program has significant impacts on the payments Healing Hands Hospital receives. Healthcare providers can choose between Advanced Alternative Payment Models (APMs) and Merit-Based Incentive Payment System (MIPS) (“Quality Payment Program,” 2017). Healthcare providers must meet certain requirements in order to qualify for positive payment adjustment. One of the key requirements is the provision of accurate data on quality of care provided and application of new technology. Healthcare providers that comply with this requirement earn a 5 percent incentive payment. Healthcare must send the data before a particular date in order to earn the positive payment adjustment. This plan commenced in 2017, with healthcare providers given the opportunity to start collecting data from January, and closing on October 2017 (“Quality Payment Program,” 2017). Failure to collect data results into a negative 4 percent payment adjustment.


Medicaid is a state-run health coverage program. The Federal Government established the program. States develop their own Medicaid programs and set rules on the duration, amount, type, and the scope of services provided under the program. However, the Federal Government provides mandatory benefits under the Medicaid program. Mandatory benefits include inpatient and outpatient services, x-ray and laboratory services, home health services, physician services, and others. Optional services include physical therapy, case management, prescription drugs, and among others. Medicaid aims at ensuring that low-income citizens get access to health services.


MACRA refers to Medicare Access and CHIP Reauthorization act of 2015. Title I of MACRA has four main goals (CMS, 2015). First, the act abrogates the sustainable growth rate formula, previously applied by CMS to control the level of spending under Medicaid and Medicare programs. The second goal involves reimbursements based on quality over quantity (CMS, 2015). The third goal is to ensure smooth coordination of various quality programs under the Merit-Based Incentive Payments System (MIPS). The last goal is to offer bonuses to health organizations that participate in the eligible alternative payment models (CMS, 2015). It is critical to ensure that Healing Hands Hospital complies with the requirements of this act. Compliance with the act would guarantee higher reimbursements, thus improving its budget position.

Comparison, Similarities, and Differences

Average Length of Stay

Bear River Valley Hospital (as Healing Hands Hospital) is a not-for profit community hospital, that has served the suburban community since 1923 in Tremonton, Utah.  The healthcare facility is a level IV trauma center that is among the top 20 rural community hospitals in the U.S (Becker 2017).  Bear River Valley Hospital provides exceptional high quality of care at the lowest possible cost while using a state of the art technology close to home.

The length of stay represents the number of patient days spent in a health facility for a particular inpatient episode. The length of stay is calculated by subtracting discharge date from the admission date. If the length of stay improves, Bear River Valley Hospital can have improved payment adjustment from CMC, since this would be an indication that quality of care has increased. Bear River Valley Hospital has average length of stay of 15 days (“Open Data Catalogue,” 2013). The total stays are 20, with a capacity of over 40 beds. The total Medicare allowed amount is $83,802, while the payment amount is $71,518 (“Open Data Catalogue,” 2013). Lower average length of stay would attract higher reimbursements through the Medicare program since it is value-based.

The University of Utah Hospital is an academic medical center providing medical services to the community since 1965. The medical facility has grown from a small health facility to an extensive one over the period. The medical facility currently has four hospitals and twelve neighborhood health centers providing medical services to the community and students. The average length of stay at Utah Hospital is 5 days (“Utah Health Data Committee,” 2016). This discrepancy may be due to the nature of ailment or medical condition affecting the patient. Bear River Valley Hospital could be handling serious cases compared with Utah Medical Hospital. Some procedures may take a relatively longer period. For instance, bone marrow transplant may take up to 26 days. Increased number of stay for particular conditions may negatively affect Medicare reimbursement. Increased length of stay would lead to low reimbursements since this is an indication of poor service delivery.

Hospital Acquired Infection Rate

Hospital acquired infections (HAIs) are infections that occur between two days following patient hospitalization and within thirty days following patient discharge. HAIs have no direct association with the condition that led to the patient’s admission. Presence of HAIs indicates poor health or hygiene standards at the health care facility. HAIs may arise due to poor sterilization methods, overcrowding, unhygienic hospital conditions, and generally poor sanitation at the healthcare facility. HAIs increase the length of stay and bring additional costs of treating the patient. In serious cases, HAIs can lead to loss of life or permanent damage. HAIs are key indicators of the level or quality of care at healthcare facilities. As such, it is important to ensure that these infections remain minimum.

The following table shows the HAI rates among select Utah hospitals in 2015.

Table 1.1.

Health Facility Number of HAIs
Utah Valley Regional Medical Center 10
Salt Lake Regional Medical Center 10
LDS Hospital 10
Intermountain Medical Center 10
Riverton Hospital 10
McKay Dee Hospital 9
Castleview Hospital 9
Bear River Valley Hospital 9
Mountain View Hospital 2
Brigham City Community Hospital 2


In 2015, Bear River valley Hospital had nine confirmed cases of hospital-acquired infections. The highest rates of HAIs in the Utah region were reported in six healthcare facilities, each having ten confirmed cases. The health facilities with the highest rates include Utah Valley Regional Medical Center, Salt Lake Regional Medical Center, LDS Hospital, Intermountain Medical Center, ST Marks Hospital, and Riverton Hospital (“Open Data Catalogue,” 2015). Four health facilities in the Utah region recorded the best HAI rates, with only two reported cases in each. These include Mountain View Hospital, Brigham City Community Hospital, Jordan Valley Medical Center, and Timpanogos Regional Hospital (“Open Data Catalogue,” 2013). These healthcare facilities will receive higher reimbursement compared with those that recorded high hospital-acquired infection rates. Two healthcare facilities did not provide data on HAIs. These include Landmark Hospital of Salt Lake City, LLC and Lone Peak Hospital (“Open Data Catalogue,” 2013). These would also face lower reimbursements since they failed to provide official data.

Related: Healthcare Industry Overview

According to Health Finance (2016), 2015 saw an increase in the number of hospitals to receive low payments because of high HAI incidents. The cutoff mark by CMS is the 75th percentile of the HAI incidents. In 2016, the 75th percentile coincided with the scores 6.75 to 7.0. Those scoring higher face a 1 percent reduction in the payment. This constitutes savings to the CMS. Further, Health Finance (2016) noted that about 53.7 percent of worst performing hospitals in 2015 were also in the worst performing category in 2016. This indicates little or no efforts by the healthcare facilities’ management to improve the care delivery outcomes.

To conclude, value-based programs will increasingly determine the amount of payments that healthcare facilities receive from the CMS. Over the recent past, there have been concerted efforts by various healthcare bodies to shift the payment model from quantity-based to value-based models. The value based-models hinge payments based on quality of care. The major drive behind this change is the need to improve the quality of care provided in healthcare facilities. Some of the key elements included under the value-based program are length of stay and hospital acquired infection rates.

Part 2


To: Ms. Woods, the Chief Operating Officer

From: Junior Nurse Practitioner

Date: 8/8/2017

Subject: Skills I need to advance

This memo brings to your attention some of skills I feel there is need to advance and develop further through in-job training or seminars. The first skill I would like to develop further is overcoming grief in adult critical care. Although I have learned a lot at school about adult critical care, I do feel there is a void in me regarding this area. My greatest concern is that I may experience emotional consequences relating to grief. This may detrimentally affect my productivity and even my emotional health. There is need for training on coping mechanisms such that I do not end up in grief when a patient dies. I fear that I may experience grief especially when someone I have cared for dies.

I also need to develop more skills in emergency response. The emergency department is very critical in healthcare delivery. The department is also very sensitive to the quality of care provided by the physicians and nurse practitioners. For instance, failure to identify the conditions that are most serious and require immediate attention may lead to death of a patient. In addition, there is a high chance of confusion arising during emergencies. I feel there is need to improve my skills in this area to improve my emergency response.

I have gained a lot through the work I have done for the Task Force. One of the key things I have learned is how healthcare facilities such as Healing Hands Hospital can integrate modern technologies to improve quality of care. Data mining has become an integral part of care delivery in modern healthcare facilities. Lastly, I have gained immensely in areas relating to health reimbursements or payments. I believe that the knowledge I have gained will be of great use in helping this organization comply with CMS standard guidelines.


Becker (2017). Bear River Valley Hospital| 100 Great Community Hospitals 2017. Retrieved from:

Centers for Medicare & Medicaid Services (CMS). The Medicare Access & Chip Reauthorization Act of 2015. Retrieved from        Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-    APMs/MACRA-LAN-PPT.pdf

Open Data Catalogue. (2013). Medicare skilled nursing facility provider aggregate report Utah CY 2013. Retrieved from

Open Data Catalogue. (2015). Hospital Acquired Conditions Reduction Program Results Utah Hospitals. Retrieved from

Quality Payment Program. (2017). Modernizing Medicare to provide better care and smarter        spending for healthier America. Retrieved from

Utah Health Data Committee. (2016). 2014 Utah Inpatient Hospital Utilization and Charges         Profile Hospital Detail. Salt Lake City, UT: Utah Health Data Committee. Retrieved from   


Integrating Health Information Technology in Healing Hands Hospital

Integrating Health Information Technology in Healing Hands Hospital

Integrating Health Information Technology in Healing Hands Hospital

Future Health Care Reimbursement Trends

Information technology has led to a radical shift in health care management, and especially in the reimbursement sector. One of the possible future health care reimbursement trends is increased adoption of value-based reimbursement that takes advantage of improved electronic health records to collect data (Lee, 2016). Data analytics, whether genomics, predictive analytics, or big data will be critical in shaping value-based reimbursements. Data analytics will provide reliable information concerning quality delivery of services in health care settings. As such, data analytics will become integral in determining the amount of reimbursements to health care facilities. Currently, there are alternative payment modes in place that align with value-based reimbursement models, such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (Lee, 2016). Health care organizations will lean more on data analytics in analyzing their outcome measurements.

Another future reimbursement trend in the health care industry is Bundled Payments for Care Improvement Initiative (BPCI). The BPCI initiative comprises of four models of care. The four models link payments to the particular service beneficiaries involved during care delivery. This has been possible with the introduction of data analytics. This is because patients can receive episode data that allows them to estimate how much it will cost to get treatment. The BPCI initiative continues to become increasingly important in the value-based reimbursement model. Another future health care reimbursement trend is accountable care organizations (ACO). This concept aims at establishing a coordinated health care system and improving on clinical best practices by ensuring that members involved in a patient care team are responsible for the costs and quality of care (Karabinos, 2013). The technologies necessary to support ACOs include business intelligence, interoperable electronic management records, data analytics, and other technologies.

Information System Technologies and Interoperability and Scalability

The issues of interoperability and scalability will significantly affect Healing Hands Hospital. Interoperability relates to the ability of a particular technology or system to allow integration with any application (Lee, 2016). Currently, health care facilities including Healing Hands Hospital are still grappling with challenges involving interoperability of medical records software systems. In order to overcome interoperability challenges in the future, health care organizations must adopt ways of sharing data freely. In addition, there is need for a more collaborative electronic health records system that encourages sharing of patient records among health care facilities (Lee, 2016). Currently, some health care facilities still rely on medical records software that does not support interoperability. This makes it difficult to access data from such systems. In the future, advancements in medical software technology will enhance interoperability in such a way that physicians will be able to interact with health care entities or providers outside their organization.

Scalability refers to the ability of an information system to accommodate more workload or adapt to new changes. The increased workload may result from more users, high scope of demands, expansion of the health facility, and other reasons. The system should be able to accommodate mire users or data volumes. The hospital’s system should be able to accommodate new technologies as they emerge, for instance, GPS technologies, imagery technologies, and mobile technologies. Future systems should be able to integrate with new technology platforms with ease, permitting the transfer of data from one platform to another. Healing Hands Hospital should adopt a system that allows for extension of its capacity to handle increased volume of data or users as well as innovations.

Innovations in Telemedicine and Tracking Devices

Innovations in telemedicine and tracking devices have taken root in the health care industry. Telemedicine refers to the application of communication and information technologies to offer medical services to patients from a distance (Beck, 2016). Health organizations such as Healing Hands can apply telemedicine to reach out to its patient population. By doing so, the hospital will improve the quality of care, thus receive higher value-based reimbursements. Although the proliferation of internet technologies and smartphone devices has mainly contributed to the emergence of telemedicine, the changing insurance policies have also played a significant role (Beck, 2016). For instance, Medicaid is currently providing value-based reimbursement, a shift from the service-based models. This means that hospitals have to look for innovative ways to increase the quality of care. Telemedicine is one of the effective ways that hospitals can apply to improve health care standards among the patient population.

Tracking devices have become increasingly available in the medical field. This is because of lower costs, increasing access, and more convenience to consumers as the devices are now smaller (Chiauzzi, Rodarte, & DasMahapatra, 2015). Tracking devices enables the collection of personal data that is vital in patient management, and especially with regard to chronic illnesses. Tracking devices have shown positive health outcomes among a cohort of recovering cardiac surgery patient, diabetic patients, and those who undergo pulmonary rehabilitation (Chiauzzi, Rodarte, & DasMahapatra, 2015). The improved health outcomes translate to higher value-based reimbursements to such hospitals. By adopting the tracking technologies, Healing Hands Hospital will be able to improve patient outcomes and thus higher value-based reimbursements.


Beck, M. (2016, June 26). How telemedicine is transforming health care. The Wall Street Journal. Retrieved from        health-care-1466993402

Chiauzzi, E., Rodarte, C., & DasMahapatra, P. (2015). Patient-centered activity monitoring in      the self-management of chronic health conditions. BMC Medicine13, 77.

Gelburd, R. (2017). Bundled payments and episodes of care: what’s next? Forbes. Retrieved        from           of-care-whats-next/#6bcc5e37e468

Karabinos, D. (2013). Technology’s role in the pursuit of ACO sustainability. Retrieved from           sustainability

Lee, K. (2016). Data analytics aids value-based reimbursement, but bigger goals loom. Pulse,      4(3): 3-9.


Healthcare Industry Overview

Managed care


Managed care has had a profound impact on the way that health care is delivered and paid for in the United States. A large portion of Healing Hands Hospital’s revenue comes from managed care reimbursement making managed care a very important part of the business process. Part of the Task Force’s work will include obtaining feedback from the community and a public relations committee has been formed to help educate the community when decisions are made about changes to Healing Hands Hospital.   Mr. Johnson, Healing Hands Chief Financial Officer, has asked you to help provide some training to the members of the public relations committee to help them understand managed care and other possible models for reimbursement including value-based reimbursement and Accountable Care Organizations (ACOs), so this can be included in their campaign of community education. Your report to Mr. Johnson should include:
Identify three types of managed care plans, such as Preferred Provider Organizations (PPO) and how they impact the way that health care is delivered at Healing Hands Hospital.
Managed care has changed dramatically in the United States over the years. What did managed care look like 10 years ago compared to how it looks today?
Discuss the future of managed care as a viable reimbursement model for Healing Hands Hospital compared to Accountable Care Organization model and valued based reimbursement.
Reimbursement by CMS for Medicare patients is also an important source of revenue for Healing Hands Hospital.  Include a description of the different models for Accountable Care Organizations (ACOs) and what would be a good strategy for Healing Hands to ensure the highest level of Medicare reimbursement for the future. 
Through legislation such as the Affordable Care Act and MACRA, there are regulations and requirements that are designed to improve patient quality of care and ensure highest levels of reimbursement.  Include how these laws impact Healing Hands Hospital and its financial plans.
Mr. Johnson, like all healthcare management professionals, believes that the data and information presented must be backed by good research and the reference sources must be listed appropriately in the written report. 
Be sure to include at least three references for the information presented in your report using APA formatting.

Sample paper

Managed care

The healthcare industry is one of the most important industries in any country considering that they help in maintaining the standard health of the populations as well as preventing diseases.  However, the rising cost of medication and treatment is increasingly becoming a burden to most people, especially those from low-income families.  To curb this challenge, the government is promoting managed care plans in the country.  Managed care refers to a group of activities undertaken by individual health care organization or a group of health care facilities to reduce the cost of offering health care facilities while enhancing the quality of the services provided (Todd, 2009).  Research shows that managed care has essentially become an exclusive system of delivering and receiving American health care.  This study will attempt to analyze and describe types of managed care plans as well as their functionalities.

Question 1

There are three types of managed care organizations that are widely used throughout America, and they include:

  1. Health Maintenance Organizations (HMOs) – they are the most prohibitive kind of managed care design as they regularly request individuals to choose a primary care doctor from whom a referral is normally required before accepting consideration from a specialist or other doctor.
  2. Preferred Provider Organizations (PPOs) – they allow members to outsource treatment, but members must incur the extra cost of receiving treatment or care outside the organization (Todd, 2009).
  • Point Of Service (POS) – this plan integrates characteristics and characteristics of both the HMOs and PPOs, but its premium is usually higher than those of HMOs.

Despite the fact that managed care helps in reducing the cost of treatment while improving the quality of the services provided, there is a higher probability of the caring physician having a conflict of interest and failing to act in the best interest of the patient. This conflict is brought by the limitation in locations of diagnostic tests, the length of hospital stay and choice of specialist.

Question 2

Managed care today is different from how it operated ten years ago.  For example, back in 1993, managed care was paying much attention to customers’ role in scoring physician presentation. Back them fulfilling the needs of the customers was the priority.  Back then a physician would be judged by the number of patients treated a day, unlike today where patients are becoming an important source of data regarding medical outcomes (Baicker & Robbins, 2015). With time, patients are increasingly becoming aware of the importance of the value of the services provided and thus are judging the outcome based on the value they get for the money they spend on the services. Additionally, patients can now be sensibly involved in satisfaction with outcomes, considering that information runs both ways to the patients and to the physician.

Question 3

With the current innovations in the market, the feature of the managed care seems uncertain.  Additionally, the passing and implementation of Obamacare which increases the number of patients visiting a hospital or accessing medical services without increasing the number of caregivers, it is becoming extremely difficult for the caregiver to provide high-quality services.  It is difficult to meet the increasing demand without increasing the number of people providing the services (Baicker, Chernew, & Robbins, 2013).  Therefore, the government needs to increase the number of caregivers in all healthcare facilities as well as training and educating the current ones to increase their efficiency, effectiveness, and performance which in turn improves the quality of the services provided.


Baicker, K., Chernew, M., & Robbins, J. (2013). The Spillover Effects of Medicare Managed Care: Medicare Advantage and Hospital Utilization. doi:10.3386/w19070

Baicker, K., & Robbins, J. A. (2015). Medicare Payments and System-Level Health-Care Use: The Spillover Effects of Medicare Managed Care. American Journal of Health Economics, 1(4), 399-431. doi:10.1162/ajhe_a_00024

Todd, M. K. (2009). The managed care contracting handbook: Planning and negotiating the managed care relationship. Boca Raton, FL: Taylor and Francis.


Healthcare Industry Overview

Healthcare Industry Overview


Read the scenario that you will use for the Individual Projects in each week of the course. The Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health care delivery. Many changes have transpired to improve patient safety along with the implementation of additional quality metrics, and these changes impact reimbursement rates.

Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee structure of Medicare and Medicaid reimbursement for health care services.  Other legislation including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015 (MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use of data to improve quality and delivery of patient care.

Mr. Magone, CEO of Healing Hands Hospital, has asked you to join the “Future of Healing Hands” Task Force, and your first assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a summary of the current regulations regarding Medicare reimbursement including how MACRA will impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with physician practices.  
For this assignment, write a 2-3 page report that you will deliver to Mr. Magone on how the new CMS initiatives and regulations will impact the organization’s revenue structure. In your presentation, address the following questions:

Why did CMS become more involved in the reimbursement component of health care? How does CMS’s involvement impact the reimbursement model for Healing Hands Hospital and other health care organizations?  If CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other insurance providers change their policies on reimbursement?
What tools can be implemented to ensure organizations such as Healing Hands Hospital and physician practices are meeting the policies and procedures set forth by CMS?
Identify 3 tools from the CMS Web site that are helpful in meeting the requirements for Medicare reimbursement set forth by CMS. 

Sample paper

Healthcare Industry Overview

The Centers for Medicare & Medicaid Services (CMS) became more involved in the reimbursement component of healthcare as part of an effort to transform the way health care is delivered and the way in which it is paid for by those insured. The aims of CMS were threefold: to provide better care for patients, provision of better health opportunities, and ensuring lower cost for healthcare services. CMS’s involvement has significant impacts on the reimbursement model for Healing Hands Hospital and other health care organizations. Currently, CMS pays providers by relying on a value-based program that emphasizes on quality, rather than the traditional approach that emphasized on quantity of care (CMS, n.d). Reimbursements under the traditional approach depended on the number of services that a health care facility provided.

In the current approach, there are four value-based programs considered. These include Hospital Value-Based Purchasing Program (HVBP), Value Modifier Program, Hospital Readmission Reduction Program, and Hospital Acquired Conditions (HAC) Programs (CMS, n.d). These value-based programs affect the reimbursement model for Healing Hands Hospital. For instance, the higher the HACs the lower the payment received. Similarly, when Healing Hands Hospital records excessive readmissions, Medicare lowers the share of payments the hospital should receive.  The HVBP adjusts payments based on the quality of care delivered and includes measures to assess resource utilization by the hospital. The higher the efficiency in resource utilization the higher the payment received.

If CMS reimbursement regulations for Medicare and Medicaid change, then it would mean that other insurance providers would have to change their policies on reimbursement in order to conform to CMS reimbursement regulations. The policy framework provided by CMS guides insurance providers. As such, any changes in the regulations would lead to insurance providers changing their policies too (Larrat, Marcoux, & Vogenberg, 2012). This is informed by the fact that CMS works closely with state governments to ensure there is compliance with health insurance accountability and consumer protections outlined by the federal law (CMS, n.d). As such, CMS has some level of control over other insurers.

Healing Hands Hospital can implement a number of tools to ensure it is meeting the policies and procedures set by CMS. The first tool is discharge planning, which involves planning on whether the patient needs transition through the different levels of care. This ensures the patient is included for reimbursement purposes. Another important tool is regular audits to ensure that the hospital is meeting requirements set by CMS. The hospital should implement a non-discriminatory policy to ensure patients receive proper medical services. Another measure is compliance to ambulatory care guidelines outlined by the National Quality Forum.

The CMS website lists a number of tools that are helpful in meeting the requirements for Medicare reimbursement. One of them is Quality Assurance and Performance Improvement (QAPI) program (CMS, n.d). This program aims at assisting transplant surveyors to complete an organ transplant program. The program enables nurses to deliver quality services to their patients. The second tool is the inpatient prospective payment system (IPPS). This system provides a mode of payment for costs relating to acute care and hospital inpatient stays. The system follows future set rates. It classifies patients into diagnosis-related groups with specific payment weights assigned on each group (CMS, n.d). The last tool is the Medicare Access & Chip Reauthorization Act of 2015, whose main role is to ensure compliance in the delivery of health care.


Centers for Medicare & Medicaid Services (CMS). (n.d). The center for consumer information &             insurance oversight.           Insurance-Market-Reforms/compliance.html

Larrat, E. P., Marcoux, R. M., & Vogenberg, F. R. (2012). Impact of Federal and State Legal       Trends On Health Care Services. Pharmacy and Therapeutics37(4), 218–226.


Oxycodone Research Paper 

Oxycodone Research Paper 


Oxycodone is one of the powerful analgesics in the market. The drug has been used for more than a century in the treatment of postoperative pain and pain resulting from chronic conditions such as cancer. The development of oxycodone in the early 1900s was seen as a major hallmark in establishing an opioid with a lower risk of user addiction. In the recent period, however, oxycodone has been classified as a highly potent drug with stronger addiction potency than morphine. In addition, the drug has been largely abused leading to serious health concerns.


Oxycodone is a narcotic painkiller developed in 1916. The drug was first manufactured in Germany in 1916. Clinical use of the drug began in 1917 in Germany. The drug is derived by modifying some elements of an organic compound known as thebaine, which naturally occurs in opium (Kalso, 2005). Oxycodone is used in moderating post-operative and acute pain. The drug may be used alone or in combination with others to moderate pain. The development of the drug arose out of the need to create a non-addictive painkiller. Heroin, clinically used at the time as a clinical painkiller, was found to be highly addictive. Heroin had been introduced into the market in the 1890s. However, it was banned for use in the U.S. in the late 1890s. Other common opiates during this period were laudanum and morphine (Frankenburg, 2014). Other countries also saw the need to develop a non-addictive painkiller. This led to the creation of oxycodone by two German scientists as a possible replacement for the addictive heroin.

Oxycodone was introduced to the U.S. market in 1939. In 1950, Percodan, made by combining aspirin and oxycodone, was used as a prescription drug for moderate pain. In 1963, Percodan was recognized as responsible for about one-third of all drug abuse cases in California. Just like other opiates, oxycodone is addictive and thus subject to abuse by drug users. In 1970, oxycodone became recognized as a Schedule II drug. Schedule II drugs are those drugs or substances that are subject to abuse by drug users, have reduced abuse potential compared with Schedule I drugs, and whose continued use can lead to serious psychological issues (Frankenburg, 2014).

In 1995, a time-release version was introduced into the market. This was known as OxyContin, which replaced oxycodone. The time-release version was meant to eliminate the growing issue of oxycodone abuse (Frankenburg, 2014). However, this has not been successful in curbing the issue of abuse. Crashing the drug and snorting it inhibits the time-release mechanism, meaning that the new drug is still susceptible to abuse. Drug users are able to obtain OxyContin as prescription for pain from doctors or pharmaceuticals. This has become a major concern as deaths from the drug overdose have increased significantly (Frankenburg, 2014). It is worth noting that oxycodone, just like other opiates, is likely to be abused.

Related: Legalization of Marijuana in the United States

The Pharmacology

Oxycodone works by binding onto opioid receptors within the central nervous system. The receptors include kappa, delta, and mu receptors (Smith, Pappagallo, & Stahl, 2012). Specifically, oxycodone reduces the number of calcium ions (Ca2+) among the pain receptors. This leads to declining levels of neurotransmitter within the central nervous system. Oxycodone also causes the outflow of potassium ions (K+) within the postsynaptic level (Smith, Pappagallo, & Stahl, 2012). This results in heavy polarization of pain receptor neurons within the central nervous system. This reduces pain perception among individuals. Oxycodone, just like other opioids also produces an analgesic effect on the peripheral sites. All these actions cause the user to experience significant reduction in pain.

Oxycodone and other opioids also instill an emotional response among users. Oxycodone and other opioids cause a euphoric feeling among users by stimulating the pleasure points found on the brain (Webster & Dove, 2007). In addition, taking oxycodone activates the pathways that control the additive processes in the body. Oxycodone works with mu receptors in the brain to control the rewarding feeling of drugs (Webster & Dove, 2007). By working on the mu receptors, individuals develop oxycodone receptors. Research has shown that knockout mice do not become physically dependent on opioids because they lack mu-opioid receptors.

Oxycodone causes the release dopamine into the nucleus accumbens of the brain, the part of the brain that controls positive behavioral reinforcement (Webster & Dove, 2007). Drugs such as oxycodone cause a significant increase in the level of dopamine in the nucleus accumbens. The increase of dopamine in the nucleus accumbens causes the pleasurable feelings experienced by users.  Any subsequent decrease in the level of dopamine in the hippocampus leads to cravings and feelings of anxiety. Oxycodone also acts by activating another region of the brain known as the ventral tegmental area (Webster & Dove, 2007). Other chemicals also contribute to addiction apart from dopamine. These include norepinephrine, glutamate, serotonin, gamma-amino butyric acid, and acetylcholine. Glutamine shapes the reward pathway. Glutamine also helps in reinforcing pleasant or euphoric memories among users, leading to cravings for similar experiences (Webster & Dove, 2007). This contributes to addiction.

Related: Health Care Issue Analysis

Growth, Manufacture, Transportation, and Marketing of Oxycodone

As earlier mentioned, oxycodone is derived from an organic compound known as thebaine. Thebaine occurs in opium. Opium is derived from Papaver somniferum, commonly known as the opium poppy plant. The opium poppy plant gives different types of alkaloids. These are thebaine, morphine, oripavine, and codeine. The opium poppy plant is mainly cultivated in Europe and other parts of the world such as India. In the United States, there are strict regulations concerning how the plant may be grown (UNODC, 2018). In the 1940s, farmers in California had begun growing opium poppy plant, but the government outlawed the growing of the plant due to incidences of abuse. The Poppy Control Act of 1942 required farmers to obtain licenses for growing the plant (UNODC, 2018). In the latter years, growing of opium poppy plant reduced significantly as fewer licenses were issued to farmers. Currently, there is no commercial cultivation of opium poppy plant in the U.S. following a national policy directive.

The manufacture of oxycodone begins with the extraction of two main raw materials from the opium poppy plant. These are poppy straw and opium (INCB, 2014). From these raw materials, it is possible to extract alkanoids including thebaine. Poppies from the opium poppy plant can be used to produce alkaloids and for seed production. During manufacturing, thebaine goes through a process of oxidation, hydrogenation, and lastly purification to form oxycodone. India accounts for about 96.8 percent of total global production of opium poppy plant. About 99.2 percent of the plant grown in India is meant for exports (INCB, 2014). The U.S. exports vast of the opium poppy plant product from India. This is used in the manufacture of oxycodone and other pain relievers. The manufacture and consumption of oxycodone has tremendously increased over the last two decades (INCB, 2014). From the 1990s to 2012, the demand for oxycodone has increased driven by high prescription rates.

Oxycodone manufacturers market the drug to physicians. The current drug in the market, OxyContin, is marketed as an effective painkiller with minimal risk of developing dependency among users. The common marketing techniques has been the sending of direct sales force to doctors countrywide in an effort to convince them of the effectiveness of OxyContin. Purdue Pharma is one of the largest drug makers in the U.S. that produces OxyContin (Associated Press, 2018). In the recent past, however, the production and marketing of OxyContin has come under pressure from lobby groups who claim that OxyContin has been largely responsible for the current drug abuse menace. This has prompted Purdue Pharma to withdraw its direct sales representatives from the market and shift to a new opioid drug, which could replace OxyContin.

Dosage, Expected Effects, side Effects, and Potential for Overdose

Oxycodone is a powerful drug compared to other opioid drugs in the market. According to Lew (2014), oxycodone is 1.5-2.0 times more potent than morphine, and approximately 12 times potent compared to codeine. The dosage depends on the particular patients’ needs. Patients who are using oxycodone for the first time should take 5 mg within a span of 4 to 6 hours. The dosage should be adjusted depending on the pain severity as reported by the patient or as per historical records. The maximum dosage per day is about 400 mg.

There are several expected effects. One of the key effects is pain relief. Oxycodone is a powerful analgesic (Frankenburg, 2014). Another effect is decreased pain awareness among patients. Continued use can lead to higher pain sensitivity (Frankenburg, 2014). Another effect is constipation. Oxycodone affects the nerves that control bowel movement, slowing them down. This leads to higher water reabsorption in the body causing constipation. Another effect is on the endocrine system. Oxycodone reduces stress hormones. It also reduces sex hormones, where users report lower libido (Frankenburg, 2014). Oxycodone relieves anxiety. It can also induce hallucinations and cause users to engage in fantasies. When given in high doses oxycodone can affect breathing.

Oxycodone has a number of side effects even when taken under physician prescription. The side effects include nausea, vomiting, constipation, stomach pain, sweating, weakness, dry mouth, mood changes, loss of appetite, headache, flushing, difficulty breathing, drowsiness, and irregular heart rhythm. Some of the side effects could require intervention by the physician as they might be fatal, for instance, difficulty in breathing.

There is a high potential for oxycodone overdose. Due to the high potency of the drugs, those who abuse the drug are likely to overdose. This is worsened by the fact that oxycodone is highly addictive. Continued use of oxycodone leads to dependency. In relation to this, continued use of oxycodone or any other opioids leads to development of a tolerance level. As such, the users will always user higher dosage in order to achieve some meaningful drug effect on the body. This increases the risk of overdose. According to Frankenburg (2014), deaths from overdose of opioids administered through doctors’ prescription surpassed deaths caused by heroin abuse in 2010. This shows the magnitude of the problem and the potential for overdose.

Possible Treatments in Rehabilitation

Continued use of oxycodone leads to addition. An appropriate treatment plan can enable addicted people to get back to their normal lives free of opioid dependence. Individuals addicted to oxycodone will exhibit similar addiction symptoms to those of other addictive drugs, for instance, failed attempts to quit the drug. Attempts to quit may be thwarted by various withdrawal symptoms such as diarrhea, nausea, anxiety, agitation, vomiting, and body tremors. A user is likely to experience severe withdrawal symptoms if he/she was taking large doses of the drug (Lew, 2014). In addition, quickly withdrawing the drug from an addict may lead to serious withdrawal symptoms.

It is possible to help patients quit dependence of oxycodone by providing lower doses successively. This helps in avoiding serious withdrawal symptoms among users. A common medication used to prevent withdrawal symptoms is buprenorphine (Lew, 2014). This drug inhibits the same receptors as oxycodone but with marginal effects. This ensures that the patient does not experience strong cravings. Another drug that can help in recovery is naloxone. Methadone has similar effects as naloxone. This drug ensures that the patient does not become dependent on buprenorphine (Lew, 2014). Medical treatment should be used in combination with effective therapies such as cognitive-behavioral therapy and group counselling.

In summary, oxycodone is a powerful analgesic that helps in pain relief. The drug is susceptible to abuse and is highly addictive if frequently used. In the recent period, incidences of oxycodone overdose has increased raising concerns among policymakers. The rime-release version of the drug has been ineffective in curbing abuse since users can crash the drug hence causing rapid absorption of the chemical elements in the bod


Associated Press. (2018, Feb. 10). OxyContin maker will stop marketing opioids to doctors, company says. The Guardian. Retrieved   news/2018/feb/10/oxycontin-maker-purdue-marketing-opioids-painkillers

Frankenburg, F. R. (2014). Brain-robbers: How alcohol, cocaine, nicotine, and opiates have        changed human history. Santa Barbara, California : Praeger.

International Narcotics Control Board (INCB). (2014). Comments on the reported statistics on     narcotic             drugs. Retrieved from            Publications/2014/ND_TR_2014_2_Comments_EN.pdf

Kalso, E. (2005). Oxycodone. Journal of Pain and Symptom Management, 29(5), 47-56.             doi:10.1016/j.jpainsymman.2005.01.010

Lew, K. (2014). The Truth About Oxycodone and Other Narcotics (e-Book PDF). New York: Rosen        Digital.

Smith, H. S., Pappagallo, M., & Stahl, S. M. (2012). Essential pain pharmacology: The   prescriber’s      guide. Cambridge: Cambridge University Press.

United Nations Office on Drugs and Crime (UNODC). (2018). The suppression of poppy            cultivation in the United States. Retrieved from      and-analysis/bulletin/bulletin_1950-01-01_3_page003.html#s001

Webster, L. R., & Dove, B. (2007). Avoiding Opioid Abuse While Managing Pain: A Guide for    Practitioners. North Branch: Sunrise River Press.

Collaborative Leadership

Legalization of Marijuana in the United States

Legalization of Marijuana in the United States

Legalization of marijuana in the U.S. has become a contentious issue in the recent period. Over the last decade, a number of states have decriminalized marijuana, allowing adults to use it like any other recreational drug. Nonetheless, Marijuana use as a recreational drug remains illegal in most states, although in some states there are debates concerning decriminalization of marijuana. A poll conducted by Gullup (2016) indicates that the support for marijuana decriminalization is gaining ground. Currently, about 60 percent of Americans support the decriminalization of marijuana, up from a partly 12 percent of Americans who wanted marijuana legalized in 1969. This paper is a critical analysis of the pros and cons involved in the legalization debate.

Pros of Legalizing Marijuana

There are several benefits in legalizing marijuana. The major benefit is the availability of medical marijuana. The legalization of marijuana has made it possible for people with certain medical conditions such as cancer and other terminal illnesses to access marijuana for medicinal purposes. Marijuana can act as a pain reliever for various conditions such as muscle spasms, nausea, and general pain. Legalizing marijuana use will increase tax revenues for both state and federal governments. According to Dufton (2017), the Department of Revenue will be responsible for taxing marijuana. This translates to additional sources of revenue for the government.

Legalizing marijuana reduces incidences of opioids overdoses in individuals suffering from pain. The findings by Bachhuber, Saloner, Cunningham & Barry (2014) indicated that there were fewer opioids overdose related deaths in states that had decriminalized the use of marijuana. This is because those suffering from pain could choose to use cannabis, thus reducing incidences of opioids overdose. Legalizing marijuana will eliminate the black market and negative aspects associated with the black market such as gang-related drug criminal acts. In states where sale or use of marijuana is still illegal, those who engage in such practices can only result to vigilantism to solve disputes. Where legalization applies, it is possible to solve disputes within the justice system.

The legalization of marijuana is likely to reduce alcohol abuse and alcohol-related consequences such as road accidents (Hall, W., & Weier, 2015). This will likely occur when individuals prefer the use of marijuana instead of alcohol. Another possible benefit is the ease of conducting research on the long-term effects of using marijuana. Legalizing marijuana will make it easier for researchers to study heavy marijuana users and understand the health impacts of using the drug. Legalizing marijuana will lead to a decrease in costs involved in arresting, prosecuting, and imprisoning users and peddlers (Hall & Weier, 2015). The saved resources can help in fighting other crimes. Lastly, rising public support for legalizing marijuana (over 60 percent of Americans support legalization) shows the need to decriminalize marijuana.

Related: Appraising the Secretaries at Sweetwater University

Cons of Legalizing Marijuana

There are serious risks involved in the use of marijuana. Health concerns over the use of marijuana have pervaded the legalization debate for decades. Brooks et al. (2016) asserted that marijuana use could impair the cognitive abilities among users. Children are likely to suffer cognitive deficits if their mothers used marijuana during pregnancy. Further, adults who consume more than 10 mg of THC (chemical compound occurring in marijuana) could be at a significant risk of experiencing cognitive impairments (Brooks et al., 2016). Another negative consequence of marijuana use is addiction. Daily use of marijuana leads dependence issues. According to Leyton (2016), about 15 percent of users become addicted to marijuana. Further, marijuana use increases the chances of developing schizophrenia at an early age (Leyton, 2016).

Fears are pervasive that legalizing marijuana could increase use among adolescents (Hall & Weier, 2015). Legalizing marijuana will have the effect of easing access of the drug as well as lowering its price, hence making it more affordable among the youths. Closely related to this, legalizing marijuana is likely to influence public perception of the health risks related to using marijuana (Hall & Weier, 2015). This will create the perception that marijuana use is acceptable and there are no serious health consequences. Brooks et al. (2016) concluded that marijuana use negatively affects the academic achievement of users. It also increases the possibility of developing psychotic symptoms during adulthood. Another major issue with marijuana use is that it acts as a gateway drug to various hard drugs such cocaine.

Personal Position

My recommendation is that legalization of marijuana use for recreational purposes will have significant negative consequences in the society. Marijuana should strictly be used for medicinal purposes. Extending its use to recreational purposes will likely increase its use among adolescents and create a perception that marijuana use has no serious social and health consequences. Existing research points to the possibility of developing mental health problems such as psychosis in using marijuana. Marijuana is addictive may also influence users to try other hard drugs. It is important for governments to maintain consistency in policy decisions. Inconsistency would create the perception that the policymakers do not have the relevant details concerning the implications of marijuana use. Justice would be an important consideration since a majority of people has faced incarceration for possession or use of marijuana.

In summary, decriminalizing marijuana could have certain implications among users and the community at large. Legalizing marijuana will increase government revenue, make it easy to use marijuana for medical purposes, reduce dependence on other drugs, and will be in line with the current public opinion. On the other hand, decriminalizing marijuana could have serious implications in the numbers of those using marijuana. There are various health consequences of using marijuana including dependency and mental health issues. It is recommended that marijuana should only be allowed for medical purposes.


Bachhuber, M.A., Saloner, B., Cunningham, C.O. & Barry, C.L. (2014). Medical cannabis laws   and opioid analgesic overdose mortality in the United States, 1999–2010. JAMA Internal        Med, 174 (10), 1668–1673.

Brooks, E., Gundersen, D. C., Flynn, E., Brooks-Russell, A., & Bull, S. (2016;2017;). The            clinical implications of legalizing marijuana: Are physician and non-physician providers   prepared? Addictive Behaviors, 72, 1. 10.1016/j.addbeh.2017.03.007

Dufton, E. (2017, Dec. 7). U.S. States Tried Decriminalizing Pot Before. Here’s Why It Didn’t     Work. Time. Retrieved from

Hall, W., & Weier, M. (2015). Assessing the public health impacts of legalizing recreational        cannabis use in the USA. Clinical Pharmacology & Therapeutics, 97(6), 607-615.          10.1002/cpt.110

Leyton, M., PhD. (2016). Legalizing marijuana. Journal of Psychiatry and Neuroscience, 41(2), 75-76. 10.1503/jpn.160012


Pioneer in Surgery Paper

Management Information Systems


Discuss the ways in which this system might align with an organization’s strategic goals, the processes by which an organization would strategically plan for this system, and the primary stakeholders

Application: Addressing Challenges through Management Information Systems

The types of management information systems used across health care may vary by the setting, but they have in common the objective to streamline and enhance administrative processes and thereby support the institution’s ultimate goal of delivering optimal patient care.

In this Application Assignment, you will explore ways that technology might help address health care management problems with which you are already familiar from past coursework and/or professional experiences, such as issues in human resources, operations, organizational management, or financial management.

Prepare for this Application Assignment as follows:

Identify a specific management challenge in health care that you have learned about through coursework or professional experience. This may be an issue you have researched for an assignment in a previous course, but it need not be. (This week’s Learning Resources include numerous examples of these challenges; review these, as needed, for ideas.)

Conduct an online search to identify and learn more about one management information system (or application) that can improve performance in this area. Find out about challenges to adoption that this technology might pose.

Keeping in mind Chapter 13, “IT Alignment and Strategic Planning,” from the course text Health Care Information Systems: A Practical Approach for Health Management consider the various steps an organization would need to take, and the various stakeholders who would be involved, in planning for this system. What would be some of the barriers in planning for this system?

Then write a 2- to 3-page paper that addresses the following:

Briefly summarize the nature and purpose of the management information system you selected, and identify the specific health care setting in which it might be used.

What challenge(s) would this system address? Describe how this system would lead to improvements in particular managerial functions. How would you expect this system to transform the organization?

What are key organizational barriers to adopting this system?

Discuss the ways in which this system might align with an organization’s strategic goals, the processes by which an organization would strategically plan for this system, and the primary stakeholders who would be involved.

Sample paper

Management Information Systems

Addressing Challenges through Management Information Systems     

With technological advancements, healthcare organizations find several management challenges in their systems. Recent research conducted in the field indicates that more than half of our health care providers systems are faced with a model operational crisis. Consequently, a majority of this population feel that the effect full operational model is unsustainable and following this, the future may be implicated (Taylor, Gebremichael, & Wagner, 2007). The same explains why there is the growing pressure to disrupt the currently existing models and at the same time improve on quality while a cut on the cost is implemented. With the rising trend in the demand, many health care leaders feel the need for a redesigned strategic direction but are convinced that the efficient models in most of the health care systems will not lead them there.

Identify one management information system that can improve performance in healthcare

Most health care providers share one objective, which is a provision of high-quality care to their patients (Suter et al., 2009). Consequently, most of such organizations have embedded their operations on measuring performance, which in return provides the feedback on the effectiveness of this goal. It also creates awareness regarding which changes need to be implemented in attempts to enhance performance. Consequntly, measuring performance also enables health care providers to identify what strategies work well and those that need scrapping. The most distinguishable management information system is the performance measurement, which is the regular collection of data in attempts to measure the effectiveness of implemented strategies and to determine whether the results are being achieved. Performance measurement also analyzes an organization’s blueprint and how it intends to carry out the proposed project.

It is also important to single out that performance measurement is more inclined towards the structure performance of the organization itself and not individual or departmental achievements. Some of the positive impacts of measuring performance include:

  • Quality Improvement
  • Accreditation or certification
  • Recognition as a Primary Care Medical Home
  • Transparency for the sake of all stakeholders
  • Participation in financial incentive programs for medical centers

The types of performance measures include:

  • Structural, which measures the conditions such as the organization’s staff and the health IT systems.
  • The process, which measures services provision and whether activities directed towards service delivery to the patients were adequately performed.

Find out about challenges in the adoption of this technology

Some of the downsides of performance management include restriction of employees exclusively towards selective attention to the area being measured at the expense of other areas of organizational functioning. In relation, vague organizational goals have a higher success chance because they can be in different valid ways (Suter et al., 2009). On the other hand, few organizations have benefited from performance management on the performance itself.

Healthcare systems should first devolve the systems in place through a channel of activities such as involving the related stakeholders to find out from the ground what exactly needs changes. The stakeholders, in this case, vary from the organization workers, patients, health leaders and medical stakeholders from other institutions. Challenges include incorporating the reforms in the systems without implicating the current productivity.


Suter, E., Oelke, N. D., Adair, C. E., & Armitage, G. D. (2009). Ten key principles for successful health systems integration. Healthcare quarterly (Toronto, Ont.), 13(Spec No), 16.

Taylor, M. K., Gebremichael, M. D., & Wagner, C. (2007). Mapping the literature of health care management.

Pioneer in Surgery Paper

Pioneer in Surgery Paper



Assignment Objectives:

* Discuss the pioneer contributions to the surgical arena or the impact they had in improving the development of the surgical field.

* Give the background or history of the pioneer

* Discuss why and how this affects\ the role of the surgical technologist

* Explain the contributions that you will make that will affect this profession


Sample paper

Pioneer in Surgery Paper

During the medieval period, the Greek form of surgery became advanced. Owing to the discovery of new materials such as iron, doctors were able to perform more complex medical procedures. For instance, they could be able to perform amputations, bleed patients, or set broken bones. A notable doctor during this period is Hippocrates. Hippocrates was instrumental in changing the belief system at the time, where majority of people attributed diseases with evil spirits and superstitions (Ellis, 2002). He advocated for exercise, diet and sleep as a remedy to various illnesses. However, use of surgery was limited and only done when there was no other available options. In the Roman Empire, surgery was also conducted. Galen became a famous Roman doctor during the medieval period. Galen promoted dissection as the key to gaining a better understanding of the human body

In the 1500s and 1600s, new methods of surgery were introduced. During this period, bleeding was a common problem encountered by surgeons as they performed surgery. Ambroise Pare was a famous physician during this period. He introduced the use of ligatures in controlling bleeding during surgery (Ellis, 2002). He also popularized the use of bandages after surgery which minimized exposure of the wound to germs. Ambroise Pare was born in Bourg-Hersent and later moved to Paris. At Paris, he worked as a barber-surgeon apprentice before joining the army as a surgeon. In 1552, he earned the highest rank by directly serving the king. During this period, boiling oil was commonly used to treat gunshot wounds. Pare discovered that a mixture of rose oil, turpentine, and egg yolk were far more effective in treating gunshot wounds to boiling oil.

During the 18th century, a remarkable discovery was made: Louis Pasteur discovered that diseases in man and animals were caused by small microorganisms or bacteria (Hook, 2011). Louis Pasteur also developed the pasteurization process which was applied in killing microorganisms contained in milk.

Fig. 1.1. Louis Pasteur’s experiments

Louis Pasteur’s experiments
Louis Pasteur’s experiments

This procedure was also known as heat treatment since it involved the use of heat. Sterilization in the surgical field was of great importance since it enabled doctors reduce infection rates through maintaining clean surgical equipment. Prior to this, medical equipment were not sterilized which were a major cause of wound infections. Pasteur was a chemist and renowned microbiologist. He earned his first higher education degree from College Royal de Besancon (Hook, 2011).

Related: Ghost Surgery

In the 1800s, remarkable achievements were realized in the discovery of a better form of anesthesia. In the early period, alcohol and opium were used as anesthetics but these were not effective. In 1846, ether gas was first used as an aesthetic. Chloroform later took shape as a better anesthetic to ether gas. In 1867, Joseph Lister discovered a new method of controlling infections during surgical procedures. His method entailed the use of carbolic acid which was applied on the wound to prevent infections (Pitt & Aubin, 2012). This proved more effective in controlling infections. The new method of controlling germs was known as antisepsis.

Fig. 1.2. Use of carbolic during operation to control infections.

Use of carbolic during operation to control infections.
Use of carbolic during operation to control infections.

Lister showed interest in the field of medicine from an early age. His first school was University College, London. At the age of 26, Lister had joined the Royal College of Surgeons. In 1846, he took part in the first anesthetic-assisted surgery ever. His discovery on the use of carbolic acid meant a significant reduction in postoperative infections and deaths.

In the 1900s, deaths resulting from surgery were still high. The major contributing factors were blood loss and internal infections. In 1901, Karl Landsteiner discovered the different blood groups (Eibl, Mayr, & Thorbecke, 2002). This paved way for successful blood transfusion in the later years. Previously, blood transfusions had been conducted but these were highly unsuccessful. He discovered the blood transfusion between individuals in the same blood group was successful, and those in different blood groups unsuccessful. Landsteiner graduated with a medicine degree from University of Vienna in 1891. He later enrolled for a course in chemistry in Wurzburg. This helped him greatly in his medicine career. Successful blood transfusion significantly improved the survival rate of patients during surgery.

In 1928, a remarkable discovery was made – penicillin, a strong antibiotic was discovered by Alexander Fleming (Bankston, 2001). The importance of penicillin in the field of surgery is that it was applied in surgical wounds to kill germs.

Fig. 1.3. Alexander Fleming

Alexander Fleming a Scottish doctor trained in pharmacology, botany, and biology
Alexander Fleming a Scottish doctor trained in pharmacology, botany, and biology

Alexander was a Scottish doctor trained in pharmacology, botany, and biology. He first attended Loudoun Moor School before proceeding to Kilmarnock Academy. Throughout the 1900s, great strides were made in the field of medicine, more so due to the great advancement in technology during the period. More invasive surgical procedures such as heart surgery became possible in the mid-1900s. For instance in 1967, the first heart transplant was done by Christiaan Barnard.

In my career, I hope to advance the use of prosthetics among those who have lost their limbs. These prosthetics will be more advanced and probable enable persons to lead normal lives just like they had their limbs. The prosthetics will have advanced features such as the capability to be controlled by the patients’ thoughts. The prosthetics will enable patients to touch, grasp, and feel objects and determine what kind they are through an artificial sense of touch.


Bankston, J. (2001). Alexander Fleming and the story of penicillin. Bear, Del: Mitchell Lane        Publishers.

Eibl, M., Mayr, W. R., & Thorbecke, G. J. (2002). Epitope Recognition Since Landsteiner’s         Discovery: 100 Years Since the Discovery of Human Blood Groups. Berlin, Heidelberg:          Springer Berlin Heidelberg.

Ellis, H. (2002). A history of surgery. London: Greenwich Medical Media.

Hook, S. V. (2011). Louis Pasteur: Groundbreaking Chemist & Biologist. Minnesota,       US: ABDO Publishing Company.

Pitt, D., & Aubin, J. M. (2012). Joseph Lister: father of modern surgery. Canadian Journal of      Surgery, 55(5): E8-E9.


John Hopkins Health System Corporation

Appraising the Secretaries at Sweetwater University


Review the Case application: APPRAISING THE SECRETARIES AT SWEETWATER U at the end of Chapter 9 of your textbook. Review the three questions at the end of the case. Think about how you might answer those questions. Now, answer these questions:

Do you think that the experts ‘recommendations will be sufficient to get most of the administrators to fill out the rating forms properly? Why? Why not? What additional actions (if any) do you think will be necessary?

Do you think that Vice President Winchester would be better off dropping graphic rating forms, substituting instead one of the other techniques we discussed in this chapter, such as a ranking method? Why?

What performance appraisal system would you develop for the secretaries if you were Rob Winchester? Defend your answer.

Sample paper

Appraising the Secretaries at Sweetwater University

The experts’ recommendations are sufficient to encourage the administrators to fill out the forms with correct details about the performance of the secretaries. The second form, Appendix II, is more detailed and precise. For instance, instead of merely rating performance as “excellent” or “poor”, the form allows administrators to assess a range of performance indicators such as team work, communication skills, organizational know-how, and other aspects. In addition, since the new ratings will not be tied to salary increments, the administrators will feel more at ease to give accurate ratings. It will be necessary to provide training both to the administrators and the secretaries about the new performance rating system. In order for the new system to be effective, both the administrators and the secretaries must thoroughly understand how it works. This will ensure that they fully embrace the new system.

It is also necessary to establish an appropriate and effective way of reviewing the secretaries’ salaries. First, Sweetwater University should ensure that it provides wages to all the secretaries. This involves paying an amount equal to what other institutions within the industry pay. Sweetwater University can use benchmarking programs to establish the industry average pay. In order to give motivation to the workforce, performance-based salary reviews should also be employed. Secretaries who give satisfactory performance under the new rating system should be rewarded by receiving a pay increase.

Question 2

The Vice President can still do away with graphic rating scales and employ other techniques such as ranking method. Certain ranking methods can be used instead of using the graphic rating forms, for example, using a BARS system or management by objectives (MBO) method. BARS stands for behaviorally anchored rating scales. In this rating system, the administrators should understand each of the secretaries’ tasks, and the specific behaviors that the secretaries are expected to harbor (Deb, 2006). The major difference in using the BARS system is that it requires administrators or supervisors to gauge employees’ performance based on specific behaviors rather than on a whole range of behaviors that may be applicable in any position within the organization. The BARS system would be better to the graphic rating scales since it eliminates the subjectivity common in graphic rating scales. BARS provide more accurate ratings compared to graphic rating scales on employee behavior and performance. In addition, the secretaries would be aware of the actual behaviors they are supposed to display under the bars system.

The Vice President can drop the graphic rating scales for other methods such as Management by Objectives (MBO). In this method, the employees and their superiors come together and jointly develop goals and expected outcomes (Deb, 2006). The objectives and outcomes established are then used to gauge employee performance and to give appraisals. In this method, the objectives are aligned to quantitative measures of performance such as quality of products produced by employees (number of defects). This method can be suitable since employees are also involved in determining the performance objectives and may thus be more willing to accept the method.

Question 3

If I were Rob Winchester, I would use the management by Management by Objectives method. This method would be better since it involves even the employees in developing the objectives. This means that the secretaries will be well aware of what is expected of them. This method also makes the employees to be personally committed towards goal achievement. By using this method, the administrators would be less likely to give inaccurate performance rankings.


Deb, T. (2006). Strategic approach to human resource management: Concept, tools and   application. New Delhi: Atlantic.