Improving Patient Throughput Essay

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

In 1986, the Emergency Medical Treatment and Labor Act (EMTALA) was enacted. The federal government enacted the law to provide everyone with access to emergency medical care, even for those unable to pay. EMTALA declared that any individual who enters a “qualifying hospital” is entitled to an “appropriate” medical examination to determine if an “emergency medical condition” is present. The individual cannot be “transferred” until the “emergency medical condition” is “stabilized.” Only if the individual cannot be “stabilized,” an “appropriate transfer” may be performed. Hospitals must accept

The study revealed several issues in this department. Voluntary emergency patients have to wait extended periods of time before being transferred to the appropriate department. The majority of those who have to wait are those seeking mental health assistance. Keeping people in the emergency department longer than necessary cause operational costs skyrocket, and worse, keeps the needs of patients from properly being met.

One of the contributors to the rising cost of Healthcare can be attributed to the over use of emergency departments (EDs) for non-emergency needs. In the greater Capitol/First/Beacon Hill area there are three major hospitals (Virginia Mason, Harborview, and Swedish) with emergency rooms and no urgent care centers with the exception of Group Health which is restricted to Group Health insurance members.

With the current healthcare reform, all organizations around the globe are aiming to redesign their operations. Healthcare systems, that use the omnibus leadership model, need to function in an environment in which the needs of society will have a positive reaction. Nevertheless, the dynamic culture leadership model argues that healthcare organizations need to always work in ways that they can definitely give services that the society can use (Kennedy et al., 2011).

The filing of the complaint must be completed within 72 hours of the transfer (Sally Austin, 2011). As a result of this, it has been difficult to see whether or not EMTALA has truly been successfully implemented and effective (Sara Rosenbaum, 2012). Another disadvantage is that EMTALA only requires hospitals to treat “true emergencies”, which are subjective in nature. The last revisions in 2003 for EMTALA by policymakers and CMS limited EMTALA to only patients that arrived to the emergency department, not to other areas of the hospital, such as a doctor’s office appointment or outpatient surgery (Sara Rosenbaum, 2012). Another negative consequence of EMTALA that is not addressed by the law is that emergency department physicians can still be held liable and face malpractice issues by uninsured patients (Singer, 2014). There have been legislative proposals by members of Congress that are working to change this to include physicians as members of the Public Health Services, which would address these concerns (Singer, 2014). These hesitations by physicians has forced some hospitals to close their emergency departments in California to avoid these financial consequences of lawsuits (Friedman, 2011).

The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in 1986 as a part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. EMTALA was enacted to prevent hospitals with Emergency Departments from refusing to treat or transferring patients with emergency medical conditions (EMC) due to an inability to pay for their services. This act also applies to satellite locations whom advertise titles such as “Immediate Care” or “Urgent Care,” and all other facilities where one-third of their patient intake are walk-ins. Several rules and regulations to this act have been established and it has become a very serious piece of legislation and health

Since the development of the EMTALA Act in 1986, any individual which presents to the emergency department, must be accessed and triaged by qualified medical personnel. (www.cms.gov) Individuals are aware that if they present to the emergency department, regardless if it is for just a tooth ache or a major illness like a heart attack, they will have to be treated. “This mandate does not extend to private physician offices, however, which creates an incentive for those without the means to pay for care to

This paper seeks to look into organizational behavior in health care management and most importantly its impact on health care management and delivery. Organization behavior is crucial in guiding the regulatory activities, the staff activities and the overall culture that directs an organization. Organizational behavior in health care setting is paramount to ensuring patient safety, ethical behavior among the medical practitioners, patient-centered care and effecting change in the facilities which is bound to improve healthcare delivery and patients’ satisfaction. The strategic management of any health

There is a tremendous amount of literature regarding Organizational Culture as it relates to corporate business. Peters and Waterman (1982) book, In Search of Excellence: Lessons from America’s Best Run Companies, became the blueprint for organizational success. With the paradigm shift of hospitals becoming more “business- like” through mergers, acquisition, and pay for performance, organizational culture in a hospital setting will need to be furthered analyzed and defined as a predicator of success.

The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).

Fixing problems that face health care in many health facilities demand a system wide set of solutions. The systems used in these facilities must be assessed and redesigned to identify factors that will aid in the achievement of the set goals. The enormous task of achieving the goals should be undertaken collaboratively by all the key stakeholders, who include, health care professionals, planners and policy makers, administrators, payers, and patients and their families. These partnerships must begin with a common understanding of the problems together with a shared commitment to cooperate and work together to eliminate the problems. With this knowledge, therefore, an action plan for redesigning the health care system can be developed and later implemented. For a successful health care service to be realized, there are various factors which should be employed and which are not found in the traditional business setting. These include unique economic processes, proper regulatory requirements and the perfect quality indicators. This creates a need for every leader within the healthcare industry to create or develop unique skill sets that will harmonize both organizational leadership and the inter-professional team development. It is, therefore, important to understand the comprehensive approach to the management of patient care and also how the concepts of team development and organizational leadership support healthcare leaders in creation of a patient-centric

The Organizational culture and structure can have real big impact on the quality of care either negatively or positively. If the organizational culture is poor then it is really hard to provide best health care that can work effectively. Poor organizational culture creates poor work condition at the facilities for workers, which leads to lots of stress and low quality of patient care. A many medical errors caused by employees, who were under lots of stress and workload (Imhof & Kaskie, 2008).

Organizational culture includes an organization’s values, language, traditions, customs and specific issues that are so foundational that they cannot or will not be changed. UMC’s organizational culture is immediately experienced when entering the facility. The internal stakeholders display pride in their work, display the values of integrity, excellence, compassion and collaboration. This was demonstrated by welcoming visitors to the hospital, being greeted with smiles, volunteering to assist anyone and working together as a team to ensure patient and visitor well-being. During meetings,

Hospitals have organizational structures that allows them to carry out their duties efficiently and successfully. What separates the organizational structure of a healthcare organization from a business, essentially that the hospital 's organization is chiefly founded on the amalgamation of medical and administrative staff (Carayon, et al., 2014). The organizational structure of the twenty-first century solutions in health care hospitals involves, both divisional and hierarchical structure. In the of the chain of command hierarchy, there are various levels of professional’s that fall under other levels within the facility, and each staff member is organized in regards to departments that are related to their (KSA’s) skills, attributes and job duties (Carayon, et al., 2014). Hospital organization philosophies is based on development of values and ethics, with the understanding on moral principles relating to human conduct. These systems are comprised with the processes in decision making and determining the best actions to consider between the difficult alternatives when pertaining to patient care.