NHS FPX 6008 Assessment 3 Developing an Implementation Plan

The above budget was created to exhibit projected revenue, expenses, and economic growth of the organization over five years from 2022 to 2025. The diabetes care unit was constructed on the organization owned land, but the building and equipment cost was $400 thousand. It was expected that it is difficult to exactly predict the cost and varying equipment cost (IQVIA, 2021). Hence, 5% increase in equipment cost and 3% possible losses due to delayed construction or increased pay or expenditure to finish the process within the time limit of one year was considered (Haque et al., 2021). As a result, $50000 was added as equipment costs in FY 2023. The unit is expected to finish by the beginning of FY 2022 and all equipment was procured within the first quarter. As it is expected that 1^st year might not include high patient count, the revenue was limited to $3250 thousands considering 3 to 5% increase in health care costs from 2021 considering $100 as fees. It is also expected that the unit will be fully functional from the third quarter of FY 2022. 

Further, by considering diabetes prevalence rate, 5 to 10% increase in patient count and health care cost is considered (Sathe et al., 2016). Thus, the revenue increased in subsequent years. When it comes to the expenses, basic utilities are considered to vary slightly initially and use of energy efficient and sustainability systems will reduce the cost in the future. Thus, in FY 2025, the cost was $65000. The other operating expenses included marketing, sponsorship, and public awareness programs along with administrative expenses. The cost increased considerably from FY 2022 to 2024 as it is a new unit. However, a better reputation reduces operating cost, thus, the value stays the same at $400 thousands from 2024. 

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

The insurance and staffing cost correlate as they both change with the number of patients and nurse staffing needed. Based on report by U.S. Bureau of Labor Statistics, indeed, Medscape, Glassdoor, Payscale, and other portals, the average salaries for full-time physician, nurse practitioner, medical assistant, receptionist, EHR nurse, and nurse specialist are $294,000, $124,000, $39,000, $35,000, $44,000, and $79,000 respectively (U.S. Bureau of Labor Statistics, 2021). The total salaries were calculated by considering nurse to patient ratio and 1.5% to 10% hike every year based on experience, performance, and salary growth rate (Moucheraud et al., 2019; NurseJournal, 2021). As the number of patients are expected to increase by 2024, more nurses will be recruited, which increases the cost. 

The loan repayment of $55.6 thousands is considered for the first three years to set the loan repayment of $50 thousands from 2024 onwards to reduce interest amount on loan from 2024. Thus, loan repayment value reduced significantly after three years. Based on all of the calculations, the unit showed excellent growth with an expected cash surplus of $8932.8 thousand after five years. 

Implementation plan rollout, stakeholders involved and ethical and cultural consideration

    The timeline or rollout starts from implementing the planning and communicating phase, which will take one month from June 2021 to July 2021. The management will approve the project and an audit will be conducted from July to September to allocate funds and consider mitigation plans. The construction will take 6 months and the unit starts to function from April 2022 with limited functionality and resources. By the end of June 2022, the unit will be fully functional. To reduce administrative hassles, a bi-weekly discussion and progress analysis will be conducted for the first two months where involvement of administration, nurses, physicians, pharmacists, medical equipment suppliers, and lab managers will be included. Both internal and external collaborators will be included in the shared decision-making process (Clapper, 2018). This will aid in responsibility sharing and outcome analysis, which is critical in providing timely reports to all the stakeholders to increase sustainability (Norris et al., 2017). 

Stakeholders such as patients and nurses are the central part of the implementation process. Thus, all the objectives, vision, planning, progress, and goals will be communicated to everyone to achieve sustainability. Further, cultural and ethical considerations such as using the funds efficiently, following the federal regulations, staying loyal to the community by integrating culture-based and culture sensitive care, timely and quick care, ease of access to all irrespective of race, religion, gender, sex, age, color, disability, culture, and other characteristics to create an inclusive Raulson diabetes care unit (Koskenvuori et al., 2017). Further, it is aimed to provide cost-effective care with high-quality services to follow ethical practice models. On top of that, all health care professionals will be treated respectively with better work to life balance, safe space, better salary, insurance, and other incentives to support sustainability and empower stakeholders involved (Hashish, 2015). 

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

An audit system will be implemented to efficiently use spending, pay loan in time, and use funds to extend the services if required. The services might include adding facilities, testing centers and labs, specialist nurses, training and teaching programs, and hiring more nurses to provide care for high in-flow of patients by maintaining good nurse to patient ratio and reducing burnout in nurses (Blouin & Podjasek, 2019).   

Analysis of the impact of your proposed initiative

By implementing the diabetes care unit, overall reputation and service offered by the organization increases as patients can access different facilities on the same campus. For example, diabetes testing will be necessary in most units including cardiovascular care, end of life care, pediatric units, and other units (Koch-Weser et al., 2019). This reduces difficulty in accessing services and thus increases patient satisfaction. The revenue from the unit positively impacts other units and their expansion. It is also expected that negative impacts such as increased work burden on nurses to order and interpret test, burden on pharmacist and other health care professionals to coordinate between different units, and staffing issues such as staff borrowing, rescheduling, and increased in-flow of patients in particular unit affects the outcome negatively (Blouin & Podjasek, 2019). Further, it becomes critical for the healthcare organization to provide better guidance as older and disabled patients might find it difficult to commute between different units to get tests done and get treatment. These negative effects need to be addressed. 

The strategy to reduce work burden and burnout in nurses is to increase nurse to patient ratio and include flexible scheduling to prevent any borrowing. This further addresses the issue of handling high in-flow of patients (Blouin & Podjasek, 2019). It is important to recruit more nurses including assistant nurses in units where workload and burnout is high (Hashish, 2015). Further, the community might find it difficult to find and access different units. Thus, call support or hotline along with GPS-based unit location, pamphlet and direction marking on buildings will increase ease of access. The issue of commuting between units for elderly and disabled can be solved by ward boys who coordinate between units and assist patients in getting tests and reports done.  

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

Strategies to address dynamic environmental forces

There are different environmental risks that might affect the proposed initiative. The very first issue is maintaining the demand and supply chain as at times suppliers might not provide required materials and equipment in time. The second risk is the need for IT systems and community management to manage the increased patient counts as the community prefers to opt for health care, which offers all the needed services (Lenz & Reichert, 2017). The third risk factor is related to pandemic where risk of infection spread increases due to crowding (Lodhi, 2020). The fourth risk factor is availability of other diabetes care units within the vicinity of the organization, which might affect the patient in-flow and revenue. 

Even though the risk of supply chain management is there, efficient stocking and resource management prevents shortage of supply for a long time as it uses dynamic stocking to reduce the gap between supply and demand. The issue of supply and demand can be solved by implementing a resource management unit, which communicates with suppliers to keep steady flow of supply. The aspect of large health care networks, HIPPA compliance, and community education aid in addressing IT systems as the revenue helps in investing the share in deploying IT units to increase patient support (Chen & Benusa, 2017; Lenz & Reichert, 2017). This strategy overpowers other diabetes care units that cannot integrate IT framework in their setting. The aspect of pandemic can be addressed by using large campuses to maintain safer distancing, masks, sanitization, vaccination, and spreading awareness (Lodhi, 2020). However, social distancing is not viable for other competitors as they lack space to accommodate patients. The aspect of affordable care, availability of different services, and reputation has an edge over other diabetes facilities within the vicinity. 

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

References

Alagoz, E., Chih, M., Hitchcock, M., Brown, R., & Quanbeck, A. (2018). The use of external change agents to promote quality improvement and organizational change in healthcare organizations: a systematic review. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-2856-9

Blouin, A., & Podjasek, K. (2019). The continuing saga of nurse staffing. JONA: The Journal Of Nursing Administration, 49(4), 221-227. https://doi.org/10.1097/nna.0000000000000741

Chattopadhyay, S., & Zangaro, G. (2019). The economic cost and impacts of scope of practice restrictions on nurse practitioners.

Chen, J., & Benusa, A. (2017). HIPAA security compliance challenges: The case for small healthcare providers. International Journal Of Healthcare Management, 10(2), 135-146. https://doi.org/10.1080/20479700.2016.1270875

Clapper, T. (2018). TeamSTEPPS® is an effective tool to level the hierarchy in healthcare communication by empowering all stakeholders. Journal Of Communication In Healthcare, 11(4), 241-244. https://doi.org/10.1080/17538068.2018.1561806

Haque, W., Demidowich, A., Sidhaye, A., Golden, S., & Zilbermint, M. (2021). The financial impact of an inpatient diabetes management service. Current Diabetes Reports, 21(2). https://doi.org/10.1007/s11892-020-01374-0

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

Hashish, E. (2015). Relationship between ethical work climate and nurses’ perception of organizational support, commitment, job satisfaction and turnover intent. Nursing Ethics, 24(2), 151-166. https://doi.org/10.1177/0969733015594667

IQVIA. (2021). Diabetes costs and affordability in the United States. Iqvia.com. Retrieved 3 July 2021, from https://www.iqvia.com/insights/the-iqvia-institute/reports/diabetes-costs-and-affordability-in-the-united-states.

Koch-Weser, S., Chui, K., Hijaz, S., Lischko, A., & Auerbach, D. (2019). Investigating consumer hospital choice: Demand and supply-side levers could address health care costs. Healthcare, 7(3), 100353. https://doi.org/10.1016/j.hjdsi.2019.01.001

Koskenvuori, J., Numminen, O., & Suhonen, R. (2017). Ethical climate in nursing environment: A scoping review. Nursing Ethics, 26(2), 327-345. https://doi.org/10.1177/0969733017712081

Lenz, R., & Reichert, M. (2017). IT support for healthcare processes – premises, challenges, perspectives. Data & Knowledge Engineering, 61(1), 39-58. https://doi.org/10.1016/j.datak.2006.04.007

Lodhi, A. (2020). Functioning of radiation therapy during COVID-19 pandemic in red zone COVID hospital. Indian Journal Of Cancer Education And Research, 8(1), 35-38. https://doi.org/10.21088/ijcer.2321.9815.8120.5

Lyford, S., & Lash, T. (2019). America’s healthcare cost crisis: As the costs of U.S. healthcare continue to escalate, three commonsense reforms could reverse this unsustainable trend. Generations, 7-12. Retrieved 2 July 2021, from.

Moucheraud, C., Lenz, C., Latkovic, M., & Wirtz, V. (2019). The costs of diabetes treatment in low- and middle-income countries: a systematic review. BMJ Global Health, 4(1), e001258. https://doi.org/10.1136/bmjgh-2018-001258

Norris, J., White, D., Nowell, L., Mrklas, K., & Stelfox, H. (2017). How do stakeholders from multiple hierarchical levels of a large provincial health system define engagement? A qualitative study. Implementation Science, 12(1). https://doi.org/10.1186/s13012-017-0625-5

NHS FPX 6008 Assessment 3 Developing an Implementation Plan

NurseJournal. (2021). Nursing salaries in 2020 | NurseJournal.org. NurseJournal. Retrieved 3 July 2021, from https://nursejournal.org/articles/nursing-salaries-in-2020/.

Sathe, N., Nocon, R., Hughes, B., Peek, M., Chin, M., & Huang, E. (2016). The costs of participating in a diabetes quality improvement collaborative: variation among five clinics. The Joint Commission Journal On Quality And Patient Safety, 42(1), 18-25. https://doi.org/10.1016/s1553-7250(16)42002-7

Shakya, S., & Plemmons, A. (2020). Does scope of practice affect mobility of nurse practitioners serving medicare beneficiaries?. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3651399

U.S. Bureau of Labor Statistics. (2021). Healthcare occupations. Retrieved 2 July 2021, from https://www.bls.gov/ooh/healthcare/home.htm.