Discussion: Health System Issues

Discussion: Health System Issues ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Health System Issues Can you help me understand this Health & Medical question? This is a 150-200 word answer. We just need to pick one from the list below. I will attach the reading. Discussion: Health System Issues In this chapter the health system faced a number of major issues: Diminishing operating margins Acute nursing shortage Fluctuating market dynamics Licensed bed complement that did not reflect reality Aging facilities PICK one and discuss. chapter_9.docx Developing a Ten-Year Capital Investment Strategy for a Multihospital System: A Case Study EE MEMORIAL HEALTH System1 (LMHS) is the largest com- munity-owned healthcare system in southwest Florida and is the largest, public, not-for-profit system in the state that receives no direct tax support. It is governed by a publicly elected 10- member board of directors and has served the citizens of Lee County and the surrounding communities since 1916. This progressive, finan- cially sound healthcare provider has more than 6,700 employees, 830 physicians on staff, and 928 licensed beds. Its three acute care cam- puses include the following: • Lee Memorial Hospital (LMH), founded in 1916, is located about a mile south of downtown Ft. Myers along a major north-south access road in the midst of a struggling commercial district. Its urban campus includes a 427-bed hospital and a medical office center that houses physicians’ offices and the Rehabilitation Hospital, which has 60 inpatient beds and occupies the fifth Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com 161 L and sixth floors. Numerous medical/surgical specialty services are provided, including a Level II trauma center. • HealthPark Medical Center (HPMC) opened in 1991 to serve the growing and affluent market south of Ft. Myers and north of Naples, and it was designed with 220 beds. During the planning stage, a decision was made to relocate the cardiac surgery program from LMH to this new healthcare center and to also offer high-risk obstetrics. The Children’s Hospital of Southwest Florida operates 30 beds on the second floor of HPMC, including a pediatric ICU, 40 neonatal intensive care beds (27 Level II and 13 Level III), a dedicated pediatric ED, and a range of pediatric outpatient services. • Cape Coral Hospital (CCH) opened in 1977. It has served the residents of Lee County, including the communities of Cape Coral, North Ft. Myers, and Pine Island for almost 30 years and is located across a waterway with access by toll bridge. The Cape Coral community is younger, less affluent, and somewhat isolated because of its geography. Initially constructed with 94 beds, CCH has grown to its present 281 beds and provides general medical/surgical and specialty services, including high-risk obstetrics. It was acquired by LMHS in 1996 and maintains a separate medical staff. All three hospitals have been consistently rated among the top 100 hospitals across the United States (Solucient 2005), and LMHS has received awards for its cardiac, orthopedic, and stroke programs. For several decades, it has strived to be the best patient-centered healthcare system in the state of Florida. Figure 9.1 illustrates the relative location and key characteristics of the three acute care campuses. 1999 CAPITAL INVESTMENT STRATEGY (FACILITY MASTER PLAN) A comprehensive strategic planning process was conducted in late 1998 that identified the need for $155 million in capital investment across the three campuses, including $55 million for IT. In addition, the health system was also considering a $22 million expansion project for the Children’s Hospital of Southwest Florida on the HPMC site and an investment in a “medical mall” to be located across the street. 162 Healthcare Facility Planning: Thinking Strategically Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com FIGURE 9.1 LMHS’S EXISTING HOSPITAL SITES AND CHARACTERISTICS Developing a Ten-Year Capital Investment Strategy 163 Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com By 1999, the health system faced a number of major issues, including the following: • Diminishing operating margins. Like many hospitals across the United States, LMHS’s operating margins had been declining. • Acute nursing shortage. The region had an acute shortage of nursing staff, particularly during the peak winter season when premium wages are paid to traveling nurses. • Fluctuating market dynamics. There was concern that LMHS’s high market share could diminish over time as new competitors focused on its growing market. • Licensed bed complement that did not reflect operational reality. Compared to 928 total licensed beds, significantly less beds were needed even during the peak winter season. Even considering the most optimistic (high-bed) scenario, LMHS determined that it still would have a surplus of beds at the end of the decade. However, a significant portion of the licensed beds were at LMH, which was plagued by aging inpatient nursing units and lacked a sufficient number of private rooms and adequate support space to actually operate at the licensed capacity. At the same time, HPMC was at capacity and was concerned about its ability to accommodate current and future demand in its rapidly growing market. • Aging facilities at the flagship facility. Almost half of LMHS’s licensed beds were located at LMH, where two-thirds of the total space was constructed prior to 1970. Moreover, ongoing capital investment had been minimal over the past decade. LMH was currently staffing 324 beds during its peak winter season. However, deployment of all of its 427 licensed beds was not possible. If all 427 beds were staffed, only 37 percent of the beds would be in private patient rooms, and 17 percent of the beds would need to be placed in three-bed and four-bed wards. In contrast, the 25-year old CCH had been consistently maintained and upgraded, and the HPMC facility was just over 10 years old. Both the CCH and HPMC facilities were designed with only private patient rooms. 164 Healthcare Facility Planning: Thinking Strategically Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com The LMHS decided that it needed a comprehensive facility master plan to guide capital investment over the ten-year period from 2000 to 2010. The organization also wanted to reevaluate the alignment of key clinical services among its three acute care campuses. THE PLANNING PROCESS The facility planning process included a review of historical utilization and market dynamics, identification of current facility assets and liabilities at the three acute care campuses, and an assessment of current and future space need by department and service line. Future bed need and ancillary workloads were forecasted, and a ten year capital investment strategy for the health system was developed. Individual interviews were conducted with department and service-line leader- ship, and extensive input was solicited from the physician executive committee and other physicians through individual interviews and focus group meetings. Periodic progress reports were made to the LMHS executive council and the board. MAJOR FACILITY ASSETS AND LIABILITIES BY CAMPUS An assessment of each campus resulted in an inventory of the facility assets and liabilities as shown in Table 9.1. Key conclusions included the following: • Both the LMH and CCH facilities were underutilized. • Although HPMC was at capacity, physician offices occupied over 50,000 DGSF throughout the hospital that could be made available for other patient services if a new medical office building were constructed. Discussion: Health System Issues • Expansion of HPMC would require additional investment in the energy plant to increase its capacity. • LMH has an aging physical plant that will require significant capital investment over time just to maintain the status quo. Developing a Ten-Year Capital Investment Strategy 165 Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com TABLE 9.1 LMHS’S MAJOR FACILITY ASSETS AND LIABILITIES BY CAMPUS 166 Healthcare Facility Planning: Thinking Strategically Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com TABLE 9.2 LMHS’S 1999 BED COMPLEMENT MARKET DYNAMICS AND FUTURE BED NEED In aggregate, LMHS serves an older but growing population. Its service area population is expected to grow by 20 percent through 2010, with 25 percent of the population being over 65 years of age. Although the highest growth rate is occurring in south Lee County, HPMC’s primary market, the highest growth in absolute numbers is occurring in Cape Coral. The consensus was that LMHS must protect its southern flank relative to cardiovascular surgery and general medical/surgical services. It was also agreed that the major competitive threat to obstetrics services will come from the east. Table 9.2 summarizes LMHS’s bed complement in 1999. A detailed bed-need analysis indicated that LMHS needed approximately 500 acute medical/surgical beds (including the ICU) during its peak winter season and about 320 beds during the summer compared to the 543 beds that are typically staffed. Use rates for Lee County were starting to decline, resulting in lower patient days despite a growing population. However, the health system consistently maintains an unusually high market share of about 67 percent. The planning team projected that by 2010 LMHS will still have a surplus of about 150 beds compared to the current licensed capacity, even in the high-bed scenario, despite the significant population growth in Lee County. Because of fluctuating market dynamics and Developing a Ten-Year Capital Investment Strategy 167 Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com uncertainties, LMHS leadership was reluctant to de-license beds at the time, particularly given the substantial growth to the south. Also, because Cape Coral serves a distinct market from Ft. Myers, it was agreed that surplus beds at CCH should not be de-licensed until future population projections become evident. KEY FACILITY PRIORITIES Several key facility investment priorities were identified that required action regardless of LMHS’s long-range facility investment strategy. These included the following: Lee Memorial Hospital • Reconfigure customer intake and outpatient services on the first floor to improve wayfinding, access, and convenience. • Upgrade the surgery suite and invest in new equipment and technology to create a stateof-the-art facility. • Combine the existing medical ICU (currently on the seventh floor) and the existing surgical ICU (currently on the eighth floor) to be on the second floor near the surgery suite to reduce staffing costs and enhance operational flexibility. • Relocate the administrative services currently in the older Cox and Jewitt wings to the seventh and eighth floors to allow for their demolition, thus avoiding further costly maintenance of these non-code-compliant wings. HealthPark Medical Center • Create an express testing area adjacent to the main entry in the space to be vacated by the community pediatric clinic. • Immediately add unlicensed short-stay and observation beds to provide additional capacity—for example, an ED holding unit, pediatric observation unit, and adult short-stay beds. • Expand or reconfigure surgical services and add an MRI unit. Cape Coral Hospital • Upgrade the ED and selected clinical services (noninvasive cardiology, sleep lab, and outpatient surgery recovery area). 168 Healthcare Facility Planning: Thinking Strategically Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com • Convert a portion of the second floor to administrative offices and clinical support space. LONG-RANGE FACILITY DEVELOPMENT SCENARIOS Three preliminary long-range facility development scenarios for the health system were identified and evaluated as follows. Scenario 1: Maintain the Status Quo This scenario maintains the current distribution of beds and services between the three hospital campuses and assumes the conversion of three floors of LMHS’s north wing (no longer needed for inpatient space) to administrative services. The remaining five nursing units at LMH would be upgraded, and the number of private patient rooms would be increased. Scenario 2: Decompress HPMC The intent of this scenario was to capitalize on the underutilized Women’s and Children’s Pavilion at CCH by relocating high-risk obstet- rics and the Children’s Hospital from HPMC to CCH. In this scenario, low-risk obstetrics would remain at HPMC, and the space occupied by pediatric services and the neonatal ICU would be redeployed for additional medical/surgical bed capacity and the expanding cardiology program. The neonatal ICU would be expanded at CCH, the underuti- lized second-floor nursing units would be redeployed for pediatrics, and physician offices on the first floor would be reassigned for obste- tricians and pediatricians. Scenario 3: Decompress LMH In this scenario, LMH would become a specialty center focused on orthopedics, neurosciences, and rehabilitation and would continue to maintain its trauma-center status. Its bed complement would be reduced from the licensed capacity of 427 beds to approximately 172 beds (20 ICU, 72 acute care, 20 short stay, and 60 rehabilitation). By substantially reducing its bed capacity, significant dollars would be saved that had previously been slated for upgrading its nine existing nursing units. The conversion of vacant inpatient space at LMH to office occupancy would allow the health system to consolidate various administrative services at LMH and discontinue the leasing of office space around the community. Developing a Ten-Year Capital Investment Strategy 169 Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com TEN-YEAR CAPITAL INVESTMENT STRATEGY FOR LMHS The LMHS executive council concluded that Scenario 1 was not feasible, because capital dollars were not available to maintain LMH at its current licensed bed capacity given the amount of renovation (and space) required to provide contemporary accommodations for 427 inpatients; this would be difficult even at its current staffed capacity of 324 beds. At the same time, HPMC’s inpatient census continued to rise, and there was concern that LMHS was not positioned to aggressively compete for its share of the growing market south of Ft. Myers and north of Naples (one of the fastest growing areas in the United States).Discussion: Health System Issues Everyone agreed that CCH had surplus capacity that could be readily used for obstetric and pediatric services—HPMC had 36 LDRP rooms and exceeded 3,000 annual births while CCH had 23 LDRP rooms and ample support space with only 900 annual births. However, getting the high-risk obstetricians and pediatric specialists to move their practices from HPMC to CCH was not likely, at least not in the near future. The executive council ultimately decided to pursue a variation of Scenario 3 that involved the transfer of 122 beds to HPMC by moving 81 medical/surgical beds from LMH and 41 beds from CCH. Specific strategies, related actions, bed allocation, and capital needs were iden- tified over the ten-year period from 2000 to 2010, as illustrated in Figure 9.2 and described in Table 9.3. DETAILED PROJECT PHASING/IMPLEMENTATION PLAN LMHS’s ten-year capital investment strategy was translated into distinct projects for which costs were estimated and time frames assigned, as shown in Figure 9.3. The ten-year capital investment plan for LMHS will require approximately $69 million, excluding the cost of major equipment and IT, and will be allocated as follows: • $19 million for immediate projects to be completed within two years • $38 million for short-term projects to be completed within three to five years 170 Healthcare Facility Planning: Thinking Strategically Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com FIGURE 9.2 GRAPHIC ILLUSTRATION OF LMHS’S TEN-YEAR CAPITAL INVESTMENT STRATEGY Developing a Ten-Year Capital Investment Strategy 171 Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com TABLE 9.3 SUMMARY OF LMHS’S TEN-YEAR CAPITAL INVESTMENT STRATEGY (2000–2010) 172 Healthcare Facility Planning: Thinking Strategically Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com Developing a Ten-Year Capital Investment Strategy 173 Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com FIGURE 9.3 LMHS’S TEN-YEAR PROJECT PHASING/IMPLEMENTATION PLAN (2000– 2010) 174 Healthcare Facility Planning: Thinking Strategically Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com Developing a Ten-Year Capital Investment Strategy 175 Copying and distribution of this PDF is prohibited without written permission. For permission, please contact Copyright Clearance Center at www.copyright.com • $12 million for long-term projects to be completed beyond five years UPDATE TO THE LMHS STRATEGY IN 2002 From 1999 to 2002, Lee County’s population continued to grow, and the average length of stay at LMHS’s facilities leveled off while its market share remained high. This resulted in improved financial performance for the health system as the census at all three campuses increased. At the same time, a significant initiative was launched by the Ft. Myers Economic Development Office to rejuvenate the downtown area and the commercial district surrounding the LMH campus. Because of these changes, LMHS leadership decided to revisit the capital investment strategy for LMH in 2002. Lee Memorial Hospital’s Functional Layout As shown in the building section diagram in Figure 9.4, the majority of the inpatient beds at LMH are located in the older north wing. The ED and diagnostic services are located on the first floor, and the surgery suite is on the second floor. The newer Medical Office Center (MOC) is a multiuse building that houses the kitchen, laboratory, and pharmacy on the first floor and hospital administrative offices and building sup- port services on the third and fourth floors. The inpatient orthopedics unit is located on the second floor, and inpatient rehabilitation beds (the Rehabilitation Hospital) are located on the fifth and sixth floors. Physician offices are located on the seventh and eighth floors. The third and fourth floors of the MOC could be converted to inpatient units, because the bay spacing and utility configuration is similar to that of the inpatient floors below and above. Of LMH’s 427 licensed beds, 54 percent are located in the older north wing. In particular, the medical/surgical units on the seventh and eighth floors have been closed, and the remote location of the remaining ICU beds creates significant operational inefficiencies. The Cox and Jewett wings are in severe physical disrepair and are slated for demolition as soon as the services that they house can be relocated. Review of the Previous Facility Master Plan for LMH Key actions identified for LMH in the 1999 facility master plan included 176 Healthcare Facility Planning: Thinking Strategically Copying and d …Discussion: Health System Issues Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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