Hospital Readmission Proposed Solution
Hospital Readmission Proposed Solution
The problem that will be discussed and the need for change is hospital readmission problem. The organization that I am currently employed with is a managed care organization Molina healthcare Inc. that insures over 4.2 million across the United States and Puerto Rico. One of the problems that case managers have seen is the need to implement a plan to help patients stay home and not be readmitted to the hospital. Hospital readmissions is a problem in the United States and until organizations come out with a solution it will continue to see patients readmitted and cost for health care will continue to rise. Hospitals spent $41.3 billion in the year 2011 from patients that were readmitted within 30 days of discharge this was according to the Agency for Healthcare Research and Quality (AHRQ) (Shinkman, 2014). The top medical conditions with Medicare insurance: Congestive heart failure, with 1.35 million readmission with a cost of $1.7 billion. Septicemia was in second place, with 92,000 readmission rate, costing $1.4 billion, and then PNX was third with 88,000 readmissions that cost $1.1 billion in additional costs (Shinkman, 2014). Medicaid patients’ readmission patients suffered from mood disorders and serious mental illnesses like schizophrenia; schizophrenia patients had 77,400 readmissions and cost $588 million. Diabetes led to 23,700 readmissions and cost $251 million in cost.
ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS
Molina Health Care, mission is to provide health services to financially vulnerable families and individuals; vision statement to provide quality care and accessible services in a caring manner and lastly core values to be an exemplary organization, care for the people being served and advocate on their behalf (Molina HealthCare, 2017). To implement a change, it is important to always have the organizations mission statement when making a plan, helping the most vulnerable to prevent readmission to hospital is fundamental in following with the Molina Healthcare Mission statement. Following the Lewin’s change theory will help prevent readmissions to hospitals and keep patients home and well taken care for. Lewin identified three phases through which change agent must proceed before planning a change this includes: unfreezing, movement, and refreezing (Marquis & Huston, 2017). Unfreezing occurs when the agent has convinced members of the organization to change because of a concern or problem within the organization (Marquis & Huston, 2017). Movement the change agent starts with a plan and starts appropriate strategies, ensuring that driving forces exceed restraining forces (Marquis & Huston, 2017). Lastly in Lewin’s theory is refreezing, this is when the agent helps in stabilizing the system change so that it becomes integrated into the status quo (Marquis & Huston, 2017).
Lewin’s theory first stage unfreezing: bring together supervisors, managers, and case managers to a meeting to gather all the statistics on hospital readmissions and the cost to the company and the hospital (Marquis & Huston, 2017). The meeting will provide information on how hospital readmission is costing the company money but also that the patient is not getting better, how can the organization decrease the number of readmissions. Second stage would be to introduce the plan to the supervisors, this would begin in the hospitals the case managers can work with the hospital discharge planners to have appropriate discharge plans. The discharge plans would be reviewed by the nurse case manager making sure the patient has a good support system at home, be knowledgeable with medications, follow up appointment with PCP/specialist have been scheduled but also that the patient understands and has transportation, have physicians order for home health services to have medication management at home and registered nurse to follow home after discharge. The last stage would be the unfreezing, by having all the data and what should be implemented to case managers and hospitals attempt convincing the organization to start this program for one year to see how this new strategy could help reduce hospital readmissions. The organization would assign a nurse case manager to visit the hospital when a patient is admitted to the hospital, to work with the patient and the discharge planner on what the patient would most benefit from, for example home health services, therapy, nursing staff, home meal delivery services; whatever the need, working together with the hospital staff to have all resources available for the patient will help patient from a relapse to disease.
Successful leader-managers are well grounded in change theories are able to apply the theory appropriately (Marquis & Huston, 2017). The leader plans the change and will have the knowledge and skills to bring about change (Marquis & Huston, 2017). As leaders bring about change it is important to know that change is never easy, regardless of the type of change, when making a change in policy, protocols, etc. will bring positive feelings but also lots of stress (Marquis & Huston, 2017). It is important for the leader to use developmental, political, and relational expertise to ensure that needed change is not sabotaged (Marquis & Huston, 2017).
In conclusion hospital readmission will at times be unavoidable but as nurses it is important to help the patient to the fullest to prevent hospital readmissions. It is the nurses’ duty in any department to educate the patient and family on how to manage diseases to prevent exacerbation of diseases. Patients need to be heard and if the patient needs additional resources from community then the discharge planner as stated in plan, to connect the dots to help patients stay home.
References
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in
nursing: Theory and application (9th ed.). Philadelphia, PA: Wolters Kluwer.
Molina HealthCare. (2017). Retrieved from
http://www.molinahealthcare.com/providers/oh/medicaid/manual/PDF/Provider_Orientation.pdf
Shinkman, R. (2014). Readmissions lead to $41.3B in additional hospital costs.
FierceHealthcare. Retrieved from https://www.fiercehealthcare.com/finance/readmissions-lead-to-41-3b-additional-hospital-costs