Capstone Project Leading the Organization Through Change
MHACB/599 Capstone Project
This course is centered around a Capstone Project that requires you to synthesize the information you have learned in the Master of Health Administration Program. There are 5 progressive parts to the project, and you will complete and submit part 1 to part 5 as mentioned in competency 1 to competency 3.
Note: This document serves as your project guide and template, and you will submit the majority of the project deliverables on this document.
For each item that requires a response, enter your response on a new line.
Scenario
Assume you work in health administration in a hospital system in a metropolitan area in the United States. The board of directors and CEO of the hospital system have established a goal for the year to better address the health care needs of the community. You have been tasked with establishing a physician outpatient clinic focused on treating an endemic health concern in your county.
Objective
You are to examine county health data to determine a health problem of prevalent need and to design a program that can help alleviate these concerns in the community. Integral to program design are factors and considerations such as cost, staffing, facility, policies, and its potential impact on vulnerable populations. The executives also want to ensure that the physicians, staff, and administrators are held to ethical and leadership standards that align with the practices to promote a supportive work environment governed by transformational leadership. You are to research, design, and create a proposal for a program that meets the stated expectations of the board and CEO.
Overview
- Part 1: Defining the Health Problem and Identifying the Affected Population
- Part 2: Program Design
- Part 3: Program Finances
- Part 4: Organizational Structure
- Part 5: Program Proposal and Presentation
Part 1: Defining the Health Problem
Your task in this part of the project is to identify a public health issue in a locale of your choice based on an analysis of public health data for the demographic area. Based on your research, you will conceive of a program at the local hospital, health system, or clinic to improve health outcomes for the population.
Instructions
Use this project template to complete the requirements for Part 1 of your Capstone Project, detailed as follows:
- Use the data to identify 2 endemic health issues among populations in the county. Your project will focus on only 1 of the issues, but you will need to identify a second issue if your first choice is determined to be unfeasible for this project. Your instructor will assist you in making that determination. Since county-level health data in most states is more detailed than city-level data, it is recommended that you choose a county, rather than a city. You can locate health data from the following sources:
- County Health Rankings
- National Center for Health Statistics
- County Health Department websites
- State health dept
- Describe the conditions and the extent of these health problems and why you feel they warrant a program or service to address their impact on the population. Support the results of your analysis using charts or graphs that include demographic, morbidity, and mortality data.
- Provide and analyze demographic information on the county population including age, gender, income, employment and other relevant information for your program.
- Summarize the health issue you want to work on and explain your idea for a program to accomplish this objective.
Sources of Data
Cite using APA guidelines. Enter text below.
County and Health Profile
County and Hospital / Health System / Clinic
Select a county for the location of your project. County level data is kept by most states and is usually more detailed than city-level data. Include a rationale of why you selected the city, including if you have any prior experience or knowledge about the existing health care system in that city. (175-250 words) Enter text below.
Health Issue 1
Description and Analysis of Data
Explain the source(s) of your data and the types of analyses you conducted to reach your findings. For example, how does this data compare with other counties, states, or at the national level? (250-350 words) Enter text below.
Description of Condition(s) (primary interest)
Describe the condition(s) you have identified in your data analysis. Describe the extent of these health problems and why you feel they warrant a program or service to address their impact on the population. Provide demographic information on the county population including age, gender, income, employment and other relevant information for your program. (250-350 words) Enter text below.
Health Issue 2
Description and Analysis of Data
Explain the source(s) of your data and the types of analyses you conducted to reach your findings. For example, how does this data compare with other counties, states, or at the national level? (250-350 words) Enter text below.
Description of Condition(s)
Describe the condition(s) you have identified in your data analysis. Describe the extent of these health problems and why you feel they warrant a program or service to address their impact on the population. Provide demographic information on the county population including age, gender, income, employment and other relevant information for your program. (300-350 words) Enter text below.
Part 2: Program Design
In Part 1, you conducted research on health data of a population to identify an endemic public health issue and proposed a program to help improve health outcomes for this population.
In Part 2, further develop your program idea by researching existing programs that address to some degree the health problem you identified in this population.
Goals and Objectives
Develop a goal and 2 related objectives for your program. Enter text below.
Description of Program and Facility
Describe the facility and its services, including the target population and demographics. (300-350 words) Enter text below.
Impact on Marginalized Groups
Examine the impact of this program on uninsured, low-income populations. How will these groups of people get access to the services? (250-350 words) Enter text below.
Staffing and Support
Provide an initial estimate of the staff required to operate this facility, including physicians, nurses, receptionist, and other support staff. Apply standards on the ratio of clinical and support staff per physician. (250-350 words) Enter text below.
SWOT Analysis
Evaluate the potential strengths, weaknesses, opportunities, and threats that can impact the targeted outcome of this program. (250-350 words) Enter text below.
Internal
Strengths
Enter text below.
Weaknesses
Enter text below.
External
Opportunities
Enter text below.
Threats
Enter text below.
Policies, Procedures, Incentives
Describe policies, procedures, and incentives that would make the program a transformative work environment. (250-350 words) Enter text below.
Literature Review
Conduct a literature review and list at minimum 5 sources (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality) to identify programs that exist that address at least to some degree your identified health problem.
Part 3: Program Finances
Factors that determine the financial feasibility of a health care program include the cost of the facility, equipment, staff salaries, patient out-of-pocket expenses, and insurance reimbursement. Referring to the concepts practiced so far, work on the following:
- Determine how many physicians and supporting staff are needed to operate the clinic, applying the appropriate ratio of clinical and support staff per physician.
- Determine the direct costs of the program. Direct costs in this case are patient expenses, and they increase as the number of patients increase. These include:
- Physician and procedural support staff costs per patient/procedure
- Gloves, sutures, gowns, equipment, lab supplies, other supplies
- Determine the indirect costs of the program. Indirect costs are overhead costs that include but are not limited to:
- General support staff and related costs
- Electronic medical records
- Insurance and taxes
- Facility and administration
- Employee benefits such as health and life insurance, retirement plans, and fringe benefits
- Determine the equipment costs of the program. This includes items for the physician clinic that will be used for more than one year. This is in contrast to variable costs which occur per patient and include such items as gloves, syringes, needles, and gauze, and would include items such as:
- Examination tables
- Workstations
- Desks and chairs in the waiting room
- Other equipment of this nature
- Determine reimbursement for clinic services based on HCPCS/CPT codes with geographical adjustment.
- Determine net reimbursement after variable costs per patient.
- Determine how many patients the clinic will need to see (a) on average per day and (b) annually to break even on expenses.
Note: Refer to the health financial instructions and sample calculations document to help you with this part of the project.
Table 1. Staffing and Salaries
Complete Table 1 by adding the staff positions including physician specialty, nurses and support staff, and the number of positions in your clinic. Multiply the number of positions by average salary for those positions to obtain total salaries.
| Staff Position | Number of Positions | Average Salary | Total Salaries |
|---|---|---|---|
| Primary Care Physician | |||
| Nurse | |||
| Support Staff |
Total Salary:
Table 2. Fringe Benefits Expense and Total Salary Expense
These expenses have been established by the hospital system at 25% of salaries and added to salaries for Total Salary Expense.
| Factors | Dollar Amount |
|---|---|
| Total Salaries | |
| Fringe Benefit Expense 25% of Salaries |
Total Salary Expense w/ Fringe Benefits:
Table 3. Overhead (Indirect) Costs and Total Fixed Practice Costs
Begin with total salaries including fringe benefits. Multiply that amount by 40% (0.40) and combine the 2 numbers for total fixed practice costs. These costs do not vary based on the number of patients.
| Cost Factors | Dollar Amount |
|---|---|
| Total Salaries Expense | |
| Overhead Costs 40% of Total Salary Expense |
Total Overhead and Fixed Costs:
Table 4. Equipment Costs
These items will be used by the clinic for 5 years so the costs will be divided equally over 5 years (depreciation).
| Cost Factors | Dollar Amount |
|---|---|
| Total Equipment Cost | |
| Depreciated Equipment Cost (cost for year one) |
Total Clinic Costs (for year one including salaries, overhead, and equipment costs):
Table 5. RVU and Reimbursement Calculation
The cost of physician care varies in different locations, as do the cost of operating a practice and the rates of physician malpractice claims. In addition, each year Medicare adjusts the conversion rate either up or down.
| Category | RVU | GCI | Total RVU |
|---|---|---|---|
Totals
- RVU:
- GCI:
- Total RVU:
Table 6. Variable Costs and Net Reimbursement
To complete Table 6, multiply reimbursement per visit by 10% (0.10) and subtract this number from reimbursement to obtain net reimbursement per patient.
| Cost Factors | Dollar Amount |
|---|---|
| Reimbursement per visit | |
| Variable cost per patient 10% |
Net Reimbursement per patient:
7. Breakeven Analysis
To calculate the number of patients needed to break even, divide total practice costs by net reimbursement. To calculate the number of patients per day, divide the total number of patients for an annual breakeven number by the number of days the practice is open. Enter text below.
Part 4: Organizational Structure
Create an organizational chart that outlines the leadership structures and clinical departments at the facility you are planning. Include all positions that are required in your health care facility. Consider the organizational structure and roles that would shape the program and promote health care in a transformational way.
Summary
Summarize the clinic’s organizational structure and provide your rationale for these decisions. (350-525 words)
Part 5: SBAR Proposal and Video Presentation
As part of Competency 3, you submit an SBAR proposal that outlines all of the required supporting information to have your plan approved. You also present your proposal to the board and CEO as a 7- to 10-minute recorded video. Add your SBAR information below and submit your video to the Blackboard assignment.
Review the readings on writing SBAR proposals to help you with this assignment.
SBAR Proposal
(525-700 words)
Situation
Clearly and succinctly describe the situation or problem. Enter text below.
Background
What relevant factors led up to the described problem? Enter text below.
Assessment
What improvements would result from investing the resources to tackle the problem?
Recommendations
What action do you propose? How do you propose to make it happen?
Video Presentation
Record a 7- to 10-minute video in which you explain the following:
- Pitch your program plan for approval by hospital executives.
- Summarize and explain each part of your Capstone Project.
Submit your video to the Competency 3 – Summative Assessment: Capstone Project – Part 5: SBAR Proposal and Video Presentation.
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Question 
Capstone Project Leading the Organization Through Change
Part 1: Defining the Health Problem
Sources of Data
Centers for Disease Control and Prevention. (2024, May 13). National Diabetes Statistics Report. Diabetes. https://www.cdc.gov/diabetes/php/data-research/index.html
Ekwaru, J. P., Ohinmaa, A., & Veugelers, P. J. (2020). An Enhanced Approach for Economic Evaluation of Long-Term Benefits of School-Based Health Promotion Programs. Nutrients, 12(4), 1101. https://doi.org/10.3390/nu12041101
Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of Diabetes self-management Education (DSME) in Type 2 Diabetes Mellitus (T2DM) patients: Systematic Literature Review. Journal of Public Health Research, 10(2), 198–202. https://doi.org/10.4081/jphr.2021.2240
Gan, H., Hou, X., Zhu, Z., Xue, M., Zhang, T., Huang, Z., Cheng, Z. J., & Sun, B. (2022). Smoking: a leading factor for the death of chronic respiratory diseases derived from Global Burden of Disease Study 2019. BMC Pulmonary Medicine, 22(1). https://doi.org/10.1186/s12890-022-01944-w
Goodridge, D., Bandara, T., Marciniuk, D., Hutchinson, S., Crossman, L., Kachur, B., Higgins, D., & Bennett, A. (2019). Promoting chronic disease management in persons with complex social needs: A qualitative descriptive study. Chronic Respiratory Disease, 16(23), 147997311983202. https://doi.org/10.1177/1479973119832025
Gucciardi, E., Xu, C., Vitale, M., Lou, W., Horodezny, S., Dorado, L., Sidani, S., & Shah, B. R. (2020). Evaluating the impact of onsite diabetes education teams in primary care on clinical outcomes. BMC Family Practice, 21(1). https://doi.org/10.1186/s12875-020-01111-2
Haw, J. S., Shah, M., Turbow, S., Egeolu, M., & Umpierrez, G. (2021). Diabetes Complications in Racial and Ethnic Minority Populations in the USA. Current Diabetes Reports, 21(1). https://doi.org/10.1007/s11892-020-01369-x
Nguyen, K. H., Fields, J. D., Cemballi, A. G., Desai, R., Gopalan, A., Cruz, T., Shah, A., Akom, A., Brown, W., Sarkar, U., & Lyles, C. R. (2021). The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations. The Journal of the American Board of Family Medicine, 34(4), 698–708. https://doi.org/10.3122/jabfm.2021.04.200591
Rocha, V., Soares, S., Stringhini, S., & Fraga, S. (2019). Socioeconomic circumstances and respiratory function from childhood to early adulthood: a systematic review and meta-analysis. BMJ Open, 9(6), e027528. https://doi.org/10.1136/bmjopen-2018-027528
Soriano, J. B., Kendrick, P. J., Paulson, K. R., Gupta, V., Abrams, E. M., Adedoyin, R. A., Adhikari, T. B., Advani, S. M., Agrawal, A., Ahmadian, E., Alahdab, F., Aljunid, S. M., Altirkawi, K. A., Alvis-Guzman, N., Anber, N. H., Andrei, C. L., Anjomshoa, M., Ansari, F., Antó, J. M., & Arabloo, J. (2020). Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Respiratory Medicine, 8(6), 585–596. https://doi.org/10.1016/S2213-2600(20)30105-3
Taberna, M. (2020). The Multidisciplinary Team (MDT) Approach and Quality of Care. Frontiers in Oncology, 10(85), 1–16. PubMed. https://doi.org/10.3389/fonc.2020.00085
World Health Organization: WHO. (2019, July 15). Chronic respiratory diseases. Who.int; World Health Organization: WHO. https://www.who.int/health-topics/chronic-respiratory-diseases
County and Health Profile
County and Hospital / Health System / Clinic
For this project, the chosen county is Clark County in Nevada, where the City of Las Vegas is located. The decision is based on population size and demographics, as well as blocked and uninsured/ underinsured populations in the region. It is a popular tourist destination, and since many residents of Las Vegas are on the go, maintaining their health might be difficult. The primary cause of this population fluctuation is the ongoing influx of tourists, which necessitates adaptable and dynamic methods for the healthcare system to develop.
I have insight into how to tackle such issues since I worked in the health administration in a similar environment in Texas before transferring to the existing firm. I coordinated healthcare delivery in the context of high rates of mobility and dissimilar healthcare requirements in Texas and sought to implement creative approaches and optimize resources. Such a background has prepared me with the necessary skills to survive the complexity of healthcare services in Clark County, serving residents and other temporary populations. Based on this background, I want to work towards implementing sound healthcare solutions in Clark County to support sustainable healthcare initiatives.
Health Issue 1
Description and Analysis of Data
The leading health concern highlighted in Clark County is diabetes complications. Information collected using the County Health Rankings and the National Center for Health Statistics shows that Clark County has a higher prevalence of the disease when compared to both the state and the nation. Further, the data reveals that the prevalence of mental disorders in Clark County stands at 12%, which is higher compared to the 10% prevalence in the rest of the state and the 9% prevalence across the nation (Centers for Disease Control and Prevention, 2024).
This high prevalence rate of diabetes hints at the existence of a serious diabolic epidemic within that county. The effects were further explained by comparing the findings with those of other counties in Nevada and at the national level. According to the given data, Clark County deviates beyond the average figures throughout the state and creates a more significant gap when comparing the results with the national level. This pattern raises other questions as to why such occurrences may be more common, and they include socioeconomic status, behavioral and lifestyle, and healthcare accessibility.
Diabetes remains highly prevalent in Clark County, further stressing the importance of addressing the problem. The results indicate that expanding diabetes treatment services is an essential measure for addressing this growing health issue. Consistently, policies geared towards sensitization in preventing, diagnosing, and managing diabetes in the county are needed.
Description of Condition(s) (primary interest)
Diabetes in Clark County primarily impacts adults over 45 years of age, particularly Hispanics and African Americans (Haw et al., 2021). This is a long-term condition in which the body cannot use or cannot produce enough insulin to manage the glucose level in the blood. Diabetes is not just about high blood sugar, as it causes many other complications, which include heart disease, kidney failure, and amputations. These complications go a long way in raising morbidity and mortality among patients who are diabetic.
According to the demographic information, it is evident that about 30% of people in Clark County are below the poverty level. This socioeconomic factor is paramount in capturing the prevalence of diabetes in the region because people with low incomes will not be able to afford healthy foods, healthcare services, or the necessary diabetic products. Also, about 20% of the population is comprised of the uninsured, which adds to the issue. The absence of insurance means that patients are unable to afford essential medical services such as annual examinations, screenings, and the management of diabetes comorbidities.
Capstone Project Leading the Organization Through Change
All these aspects contribute to the enhancement of the rate of diabetes as well as complications in Clark County. Financial problems and unequal access to health insurance leave diabetic patients vulnerable when it comes to management and treatment. This is crucial in the prevention of the burden of the disease and the promotion of improved health among the minorities. Diabetes is a dangerous illness that is most prevalent among minorities, and apart from increasing access to affordable healthcare, providing community health education and eradicating social determinants of health is essential for averting a disaster.
Health Issue 2
Description and Analysis of Data
The second health concern that has been established in Clark County is the high prevalence of chronic respiratory diseases, which are disorders that cover asthma as well as COPD. Analyzing the information gathered from the State Health Department and health agencies of Clark County, it can be inferred that chronic respiratory diseases constitute 10% approximately. This rate is higher when compared to the state average rate of 8% as well as the national average rate of 7%, according to Soriano et al. (2020).
To understand the context of this data, which is provided below, it is necessary to compare the situation in the region with other metropolitan areas with similar demographic profiles and living standards. The above finding could suggest that other factors related to Clark County are to blame for this disparity. Such aspects may include air pollution indicators such as particulate matter and ground-level ozone, which are detrimental to respiratory illnesses. Also, climatic conditions within regions could be dry, and they cause high concentrations of suspended dust and other allergens.
Further, healthcare access and socioeconomic status, which are potential moderators of the management of chronic respiratory disease, were also included in the analysis, as pointed out by Rocha et al. (2019). Those in communities with low income, limited health care access, and other risk factors likely to develop chronic diseases may not manage chronic diseases well and may also suffer from higher levels of respiratory disease. As earlier described, while taking CC and other metropolitan areas with similar environmental and demographic characteristics, it was realized that local factors, for instance, pollution levels and healthcare facilities, play a lot in accounting for the high incidences of chronic respiratory diseases. Solving these problems requires an integrated approach – changes in environmental conditions, an increased focus on effective public health measures, and better availability of medical care and auxiliary products to manage chronic respiratory diseases.
Description of Condition(s)
Asthma and chronic obstructive pulmonary disease or COPD, which is a major classification of chronic respiratory diseases, affect both children and older adults in Clark County. These conditions involve chronic respiratory manifestations and reduced lung ventilation, affecting breathing and overall health (World Health Organization: WHO, 2019). Several factors predispose the inhabitants of this county to these diseases; these include high levels of smoking, poor quality of air, and occupational dangers in the service sector.
Smoking continues to be endemic in chronic respiratory diseases, especially in Clark County, due to socio-economic factors and lifestyle (Gan et al., 2022). Further to this, pollution from local environmental nuisances and regional trends also poses a major threat to respiratory health. The weather in this region is quite dry, meaning that the air is filled with dust and other allergens that will cause further discomfort to patients suffering from chest problems.
Occupational risks are also crucial as they can also be fatal, especially in the service industry, which is widespread in Clark County due to the developed tourist industry. This group of employees may be subjected to chemicals in the environment that may cause or worsen respiratory illnesses.
Official demographic statistics found that people with low incomes and living in crowded households are more likely to suffer from chronic respiratory diseases. They may have challenges in getting preventive and follow-up care because of various reasons, making it difficult to control and improve their health. They are unable to gain adequate access to health care services and add on socio-economic factors that make the problem worse.
Eradicating chronic respiratory diseases in Clark County is one approach to enhancing the overall well-being of people in the region. Interventions should incorporate ways of minimizing people’s exposure to pollutants in the environment, discouraging tobacco use and exposure to second-hand smoke, improving workplace safety, and increasing accessibility to primary and continuing care for such populations.
Part 2: Program Design
Goals and Objectives
The primary objective of the program is to decrease the occurrences and the related adverse effects of diabetes in Clark County. The two related objectives are:
- To expand the reach of diabetes education and preventive services by 30 percent in the first year
- To enhance the management of diabetes among diagnosed patients, decreasing hospitalization by 15 percent in two years
Description of Program and Facility
The proposed facility is a specialized outpatient clinic exclusively for diabetes care that aims to cater to the needs of Clark County. Patients attending this clinic will receive regular diabetes-related services such as check-ups, education, dietary advice, and diabetes complications treatment. Primary care will be targeted at adults over 45 years old, especially Hispanics and blacks, who constitute the main population that suffers from diabetes in the region. Since both age and ethnicity are risk factors for diabetes, the clinic focuses on offering culturally appropriate and comprehensive medical and social support to these groups.
Services offered at the clinic will include:
- Routine Check-ups: Monitoring of blood glucose levels, HbA1c tests, and general health check-ups to evaluate diabetic control and modify therapeutic strategies periodically.
- Diabetes Education: Diabetes education services include information given to patients on how to control the disease, check blood glucose levels, take their medications, and make necessary changes to their diet.
- Nutritional Counseling: This involves individualized counselling aimed at making appropriate food choices to assist patients with diabetes in managing their carbohydrate intake and chronic condition.
- Management of Complications: This will target patients with other associated complications such as neuropathy, retinopathy and cardiovascular diseases.
Low-income and uninsured people will be able to access the clinic since it will be situated in a central area that is easily accessible by public transport. This location is selected so that travelling to the clinic can be as easy as possible for people who may have problems with getting access to healthcare services. Through the innovative and patient-centered model of diabetes care, the facility seeks to enhance the health status of the diabetic population that is disproportionately affected in Clark County.
Impact on Marginalized Groups
The proposed diabetes care clinic is bound to have a positive effect on Clark County’s uninsured and low-income population since the services to be provided will be either free or very affordable. Given these groups’ financial restraints, the clinic will guarantee affordable, quality diabetes care for those who are unable to undergo the procedure on their own.
For this purpose, the clinic will collaborate with local non-profit organizations and government offices that offer discounts and flexible payment options. These partnerships will assist in helping the uninsured and other poor patients access services at an affordable price and ensure they receive the necessary services. By so doing, the clinic will guarantee that all the economic consequences of the care and treatment of diabetes are achieved.
However, a major part of the initiative will be to offer other forms of assistance apart from monetary support in the form of outreach programs. These programs will be utilized to raise awareness in the community on the services available, where to access them, and the importance of compliance with diabetes appointments. Other means of community mobilization shall include organizing seminars and fairs and engaging other community-based organizations to relay the required information.
This community mobilization will ensure that the minority population is informed of various services available and where they can access them from the different health facilities. Thus, the program is an effort to exercise a positive influence on the health of the uninsured and low-income populace in addition to tackling concerns in relation to equity in education and health.
Staffing and Support
To provide an adequate and encompassing approach in the proposed clinic for diabetes, it is required to involve several specialists. Consequently, the human resource management plan of the clinic will aim to ensure that all the clients receive sufficient care that is both medical and emotional. The core team will include:
- 3 Primary Care Physicians: They will be the main primary care physicians for their patients, the ones with the overall responsibility for their health, diabetes care, and communication with other specialists. They will frequently be engaged in physical examination, prescribing and dispensing of medicines, and managing complications that arise.
- 2 Endocrinologists: Endocrinologists studying hormonal and metabolic disorders will focus on the details of diabetes management, modifications of insulin therapy, and the management of the complications of diabetes.
- 5 Registered Nurses: Nurses will administer patient education, blood glucose measurements, and primary clinical processes. They will also help facilitate care plans and be involved in the continuation of the patient’s care.
- 3 Dietitians: These specialists will give diabetes management counseling about food, eating plans, nutrients, food and diet changes, and guidelines on improving blood sugar control.
- 2 Administrative Support Staff: Administrative personnel will include receptionists, secretaries, and other personnel who will deal with organizing the clinic’s appointments, admitting patients, and other related services.
The ratio of the physician to the total staff will be kept constant at 1:4, as this provides physicians with adequate support while not compromising the quality of patient care. This ratio allows enough time to be spent on each patient visit, the development of individual patient care plans, and effective evaluation. This will make it easier for the clinic to provide a one-stop full spectrum of care for diabetes, from medical intervention to change of behavior.
Implementing this structured staffing model will further enhance the clinic’s ability to provide quality and efficient care, thereby improving patient health and the general well-being of the community.
SWOT Analysis
Internal
Strengths
The clinic receives significant backing from both local health and community-related organizations that offer useful resources and improve service provision. Also, the services of experienced healthcare professionals, focusing only on diabetes treatment, guarantee a high quality of treatment. Having a strong community support and professional team increases the clinic’s capability to provide comprehensive and efficient diabetes care and services to the community.
Weaknesses
The clinic needs more initial capital, which could limit the available services and resources initially offered. However, there can be a problem with the coverage of all the disadvantaged groups because some of them might be located in remote or difficult to reach regions. Such financial and logistical difficulties explain why the clinic cannot serve all intended populations and close all the gaps that demand attention.
External
Opportunities
Individuals are now more aware and receptive to chronic disease management initiatives, including increasing community involvement and awareness of programs. Moreover, one can obtain additional finances from federal and state health grants; this would further enhance the clinic equipment and diversify the services offered. It is possible that realizing these opportunities can help strengthen the clinic’s capacity for addressing diabetes and other health issues effectively.
Threats
The financial insecurity may impact the resources and funding and, therefore, may impact the clinic’s ability to stay open and offer more services. Also, the high turnover of healthcare professionals in that area could exacerbate the fragmentation of patient care and destabilize the clinic’s staffing. All these aspects present formidable threats to the clinic’s sustainable impact and organizational sustainability.
Policies, Procedures, Incentives
A broad perspective of policies and procedures and incentives will be established to bring the desired change to the clinic workplace. These elements are intended to foster ongoing competency, interdisciplinary collaboration, and quality, patient-centered services.
Policies
- Continuous Professional Development: The clinic will ensure that all nursing personnel engage in continuing education and training. From time to time, workshops, seminars, and certification courses will be held to update healthcare professionals on the current trends in the management of diabetes.
- Team-Based Care: It will be mandatory to implement policies that will help the members of the multidisciplinary team to work effectively, as stated by Taberna (2020). Team-taught meetings and patient care plans will be required to guarantee joint patient management and improve cooperation among various caregivers.
Procedures
- Patient-Centered Care: It will be ensured that patient-centered processes will be developed. These will involve developing individual care plans, detailed patient information, and daily feedback to attend to patients’ needs and preferences.
- There shall also be a provision of Continuous Quality Improvement (CQI). Service delivery will be closely checked and improved through the Clinic CQI procedures. The status of clinical outcomes, patient satisfaction, and feedback will be evaluated periodically to assess areas that require enhancement and improvement in compliance with best practices in patient care.
Incentives
- Performance Bonuses: Clinic employees will be awarded performance bonuses depending on the level of patient improvement, clinic compliance, and general performance.
- Career Advancement Opportunities: The clinic will establish well-defined career ladders and promotion plans to retain qualified personnel. This will include promotions, leadership assignments, and positions to head specific projects.
Literature Review
The systematic literature review by Ernawati et al. (2021) focused on the effectiveness of Diabetes Self-Management Education (DSME) for patients with Type 2 Diabetes Mellitus (T2DM). As highlighted by the review, DSME helps improve patients’ glycemic control, knowledge of the condition, and self-management strategies. Therefore, it emphasizes the significance of structured educational programs for better management outcomes and suggests integrating the DSME into the usual treatment process to increase the level of patient care and health status.
Capstone Project Leading the Organization Through Change
Following this, Gucciardi et al. (2020) also measured the impact of onsite diabetes education teams for primary care on clinical outcomes. In detail, the research found that direct staffing of diabetes education teams positively influenced the patient’s clinical characteristics and diabetes status within the offices of primary care, especially concerning blood glucose regulation and complications. These teams ensured that patient care was delivered with a higher degree of focus and better outcomes than before the implementation.
Moreover, in order to examine the self-management of chronic illnesses in clients with multiple and complex needs, Goodridge et al. (2019) carried out a qualitative descriptive study. There is a need to embrace social determinants such as poverty, housing, and health in the management of chronic diseases. It calls for improvement of the function of social support systems, self-management plans as well as community activities in order to improve the health of the targeted group.
Further, in their study, Nguyen et al. (2021) aimed to determine CBOs’ roles in enhancing chronic care for safety-net consumers. The study established that CBOs have major roles in managing inequality in health services and improving the management of chronic diseases among at-risk groups. Consequently, expanding traditional healthcare services, patient education, outreach services, and care coordination will enhance health outcomes and patients’ involvement in safety-net CBOs.
Additionally, Ekwaru et al. (2020) described an improved method for assessing the cost-effectiveness of programs for school health promotion. It also stresses the benefits of adopting a long-term perspective on the costs and benefits of economic evaluations related to health care. Thus, by including these long-term goals, the approach offers a better assessment of the worth and effectiveness of HP programs in schools, contributing to further promotion and financing of their application.
Part 3: Program Finances
Factors that determine the financial feasibility of a health care program include the cost of the facility, equipment, staff salaries, patient out-of-pocket expenses, and insurance reimbursement. Referring to the concepts practiced so far, work on the following:
Table 1. Staffing and Salaries
|
Table 2. Fringe Benefits Expense and Total Salary Expense
| Factors | Dollar Amount |
| Total Salaries | $1,770,000 |
| Fringe Benefit Expense 25% of Salaries | $442,500 |
Total Salary Expense w/ Fringe Benefits: $2,212,500
Table 3. Overhead (Indirect) Costs and Total Fixed Practice Costs
| Cost Factors | Dollar Amount |
| Total Salaries Expense | $2,212,500 |
| Overhead Costs 40% of Total Salary Expense | $885,000 |
Total Overhead and Fixed Costs: $3,097,500
Table 4. Equipment Costs
| Cost Factors | Dollar Amount |
| Total Equipment Cost | $200,000 |
| Depreciated Equipment Cost (cost for year one) | $40,000 (Divided over 5 years) |
Total Clinic Costs (for year one including salaries, overhead, and equipment costs): $3,137,500
Table 5. RVU and Reimbursement Calculation
| Category | RVU | GCI | Total RVU |
| Work | 2.60 | 1.000 | 2.600 |
| Fully Implemented Facility PE | 2.20 | 1.000 | 2.20 |
| MP | 0.17 | 0.844 | 0.1435 |
Totals
- RVU: 2.60 + 2.20 + 0.17 = 4.97
- GCI: 1.000 + 1.000 + 0.844 = 2.844
- Total RVU: 4.9435 × $32.74 = $161.85
Table 6. Variable Costs and Net Reimbursement
| Cost Factors | Dollar Amount |
| Reimbursement per visit | $161.85 |
| Variable cost per patient 10% | $16.185 |
Net Reimbursement per patient: $145.665
7. Breakeven Analysis
To calculate the number of patients needed to break even:
- Total Practice Costs: $3,137,500
- Net Reimbursement per Patient: $145.665
Number of Patients to Break Even = Net Reimbursement per Patient/Total Practice Costs = 3,137,500/90 = 21,539 patients annually
Assuming the clinic operates 250 days a year:
Number of Patients per Day = 21,539/250 = 86 patients per day
Part 4: Organizational Structure
Create an organizational chart that outlines the leadership structures and clinical departments at the facility you are planning. Include all positions that are required in your health care facility. Consider the organizational structure and roles that would shape the program and promote health care in a transformational way.
Summary
A good organizational structure provides efficient management and delivery of specialized diabetes care with distinct lines of authority. At the apex of the structure is the Medical Director, who is responsible for the overall running of the clinic and answers to the hospital’s board of directors. This position is very important as it involves ensuring the clinic meets the general hospital goals and compliance with medical protocols.
Below the Medical Director, the structure is divided into three main departments: These are Clinical Services, Administrative Services, and Community Outreach Services. Every department is managed by a department head who usually specializes in their field of departments.
Clinical Services is comprised of primary care, endocrinology, nursing, and dietitian services. These services are coordinated by a lead physician or senior nurse in charge of patient care, staff management, and quality service delivery. This structure also promotes focused care for diabetic clients through direct supervision in the clinical areas for better results.
Administrative Services, on the other hand, provide important operational activities like reception, record-keeping, and billing. They are necessary to keep the clinic’s operations running smoothly and address patient interactions, record-keeping, and billing issues. Hence, efficient management of these services is imperative for operational effectiveness and improved patient experience.
Subsequently, education and partnership are central to Community Outreach. This department is also involved in promoting diabetes care information, public relations, and partnerships with other organizations in this community. Through this strategy, the clinic will be able to help even more people and target those whose needs are greater.
Such an organizational structure is meant to provide effective and efficient patient-centered diabetes care. This way, the clinic can ensure that roles are clearly defined and assigned and that services are delivered in the most efficient and patient-centered manner.
Part 5: SBAR Proposal and Video Presentation
SBAR Proposal
Situation
Clark County, more specifically, Las Vegas, is struggling to face a critical problem of public health in terms of increased rates of diabetes and chronic respiratory disorders. These problems are compounded by a range of socio-economic factors that include high levels of poverty, high uninsured populations, and the presence of many temporary residents due to factors such as tourism.
Background
Diabetes is a major health concern in Clark County, and the statistics present reveal that a large part of the population is affected by the disease – 12%, which is higher than the state average of 10% or the national average of 9%. This increased rate points out a significant health challenge that must be tackled. Similarly, 10% of the county’s population can be attributed to chronic illnesses like as respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD). This rate also dwarfs the state and national average rates, thus pointing to an inflated disease burden.
Poor people and ethnic minorities are the worst hit; these people are bound to face many problems in accessing quality, reliable, and cheap healthcare services. These barriers are compounded by the existing poor health systems which are already overwhelmed and without functional outpatient departments to provide optimal care for such chronic ailments. The absence of such services widens the health disparities and underlines the necessity of concentrated and specialized facilities.
Assessment
The new program will also see the development of an outpatient clinic specializing in the management of diabetes and chronic respiratory conditions. Basic and speciality services in the clinic will include annual physical examination, diabetes self-management, education regarding nutrition and counseling, and management of diabetes mellitus and chronic respiratory diseases. The goal is to improve care services, which will focus more on the clients in vulnerable populations with an aim of improving the healthcare experience in the system.
Of all the target populations, the clinic services will be useful for low-income and uninsured patients since they are likely to have poor access to health facilities. Therefore, the clinic’s development implies partnerships with other community organizations and agencies to advance the accessibility of the clinic’s services for the target population. These partnerships will also help reduce the expenses of operations and enhance the clinic’s capacity to attend to more clients.
Capstone Project Leading the Organization Through Change
Recommendations
To tackle these short-term health concerns, it is suggested that the clinic be situated in a prime location in Clark County. This strategic location will enable many people to access the clinic easily, especially those in low-income and densely populated areas. The initial funding comprises personnel, overheads, equipment, and operations.
The clinic will therefore employ personnel from various fields to ensure that every aspect of the patient is well attended to. This team will comprise of, general physicians, endocrinologist, registered nurses, dietician and other support staff. Each of them contributes to a patient-centered and comprehensive care from diabetes management to education and other clerical responsibilities.
Furthermore, there will be a functional organizational structure implemented to ensure that the facility operates optimally and also provides top-notch services. Also, outreach programs in the community will play central roles in the formation of a clinic. There will be programs focused on diabetes and respiratory diseases, and they will cover topics like awareness, prevention, and available resources. This will not only improve disease management but also amplify lifestyle changes and, therefore, decrease future healthcare costs.
Video Presentation
Hello and Welcome to this video presentation in which I will present my program plan to get approved by hospital executives and briefly describe each part of my Capstone Project. My name is Constance Petronella, and the program that I have developed will be able to respond to the needs of Clark County residents, most of whom are diagnosed with diabetes and chronic respiratory disorders, by creating an outpatient clinic with a focus on the overall management of these diseases.
Problem Identification
This is a significant public health concern in Clark County, more so in Las Vegas, since there has been a rise in cases of diabetes and chronic respiratory illnesses. At the same time, diabetes prevalence of 12% is considerably higher than that of the state and national average. Among all chronic disorders, respiratory diseases such as asthma and COPD are found to be prevalent in 10 % of the population. The report clearly brings out the fact that low-income earners, together with ethnic minorities, experience considerable barriers to quality, reliable, and affordable care. All these barriers explain why there is a need to have special centers focused on the issue.
Transformative Work Environment
To make a transformative work environment, our clinic will implement numerous policies, procedures, and incentives:
Policies
Continuous Professional Development
All nursing personnel will participate in continuing education and training, including but not limited to workshops, seminars, and certification courses.
Team-Based Care
Special emphasis will be placed on teamwork, with regular meetings and the formulation of patient care plans across various disciplines.
Procedures
Patient-Centered Care
We will assist in creating individual care plans and offering the patient clinical information with updates on a daily basis.
We will also provide Continuous Quality Improvement (CQI) where we shall integrate an evaluation of the effectiveness of service delivery by measuring the clinical results, customer opinions and patient satisfaction.
Incentives
Performance Bonuses
This will be done in accordance with patient progress, adherence to clinic schedules, and clinic results.
Career Advancement Opportunities
Promotion structures and career tracks will be developed to ensure qualified and talented staff remain with the organization.
Program Finances
As shown in the financial analysis section, our estimates of clinic costs for the first year of operation, including the salaries, fringe benefits, overheads, and equipment costs, total $3,137,500. Thus, considering the clinic works 250 days a year, we need to treat around 140 patients a day to make the net reimbursement of $90. This is possible given the fact that the prevalence rate of diabetes is high in the region.
Organizational Structure
The clinic’s organizational structure guarantees well-organized management and delivery of specialized care.
Organizational Chart:
Patient Story – Maria Lopez
I will now proceed with the case of Maria Lopez, our patient.
Maria Lopez is a 50-year-old woman from a rural place in Clark County. The woman has had a history of type 2 diabetes for the past ten years. Her risk factors are a family history of diabetes, obesity, and hypertension. Maria resides in a rural area, which makes it difficult for her to access proper diabetes management as the nearest clinic is more than fifty miles away. Indirectly, she struggles with limited transport capacity and the general absence of specialized medical services to help her address her difficulties properly.
In order to mitigate these challenges, my proposed clinic shall have a telehealth system in place. This will mean that Maria and other patients like her will be able to benefit from routine teleconsultations, continuous remote blood pressure and blood sugar monitoring, and extensive diabetes education from the comfort of their homes. These approaches will include providing patients such as Maria with evidence-based power to take control of their health, hence improving their diabetes and overall health.
SBAR Proposal – Evidence-Based Care Plan for Maria Lopez
A telehealth program will be recommended in Maria Lopez’s case to overcome the challenges of transportation and distance. These services will offer routine examinations, follow-ups, home blood pressure checks, and other ways of managing the heart. This has an evidence base since existing literature supports the idea that telehealth can enhance patients’ health and self-management.
Recommendations
To make this program a reality, we propose the following action steps:
- Launch the Physician-Led Outpatient Clinic by assembling a competent care team.
- Expand and enhance diabetes education and support.
- Partner with existing healthcare institutions and other community stakeholders.
- Embrace the use of telemedicine and digital health interventions.
- Come up with community and health education campaigns.
- Ongoing scrutiny and enhancement of quality.
In conclusion, I will design a program that will greatly change diabetes management in Clark County. Thus, employing the principles of evidence-based practice, patient-centered care, and interprofessional collaboration, we strive to enhance the quality of health, eliminate disparities within the needy population, and promote a healthier society. As such, I solicit the endorsement and sponsorship of hospital executives to actualize this important undertaking.
Thank you for taking the time to consider this proposal. If you have any questions or require any further information, please do not hesitate to contact me. As one, let us work to improve the quality of life of diabetic individuals in our society.
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