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Peer Responses

Peer Responses

Responding to Tracey Watson

Hello,

I appreciate your post and the proposed solution to address healthcare workforce shortages through APP residency programs and telehealth. Workforce development and technology innovation can enhance patient care and reduce employee burnout. Apart from your suggested solutions, another option is to use federal or state financial grant programs such as the Health Resources and Services Administration (HRSA) grants to help finance APP residency programs: Peer Responses.

Additionally, Bajwa et al. (2021) suggested the addition of artificial intelligence (AI) powered telehealth platforms to improve diagnostic precision, optimize patient monitoring, and lessen the burden on in-person providers. Maximizing the use of healthcare resources while increasing patient outcomes can also be achieved through extensions of telehealth services to remotely monitor patients with chronic conditions (RPM).

Certainly, recalling provider buy-in is challenging, as some physicians might not want to cede tasks to APPs. According to Wilsher et al. (2023), seamless integration would be ensured by formalized collaboration models, interdisciplinary training, and outcome-based evaluation. It is also important to align reimbursement models with growth in telehealth. This is a sound approach on how to manage the labor crisis without sacrificing quality care and efficiency.

References

Bajwa, J., Munir, U., Nori, A., & Williams, B. (2021). Artificial intelligence in healthcare: Transforming the practice of medicine. Future Healthcare Journal, 8(2), 188–194. NCBI. https://doi.org/10.7861/fhj.2021-0095

Wilsher, S. H., Gibbs, A., Reed, J., Baker, R., & Lindqvist, S. (2023). Patient care, integration and collaboration of physician associates in multiprofessional teams: A mixed methods study. Nursing Open, 10(6). https://doi.org/10.1002/nop2.1655

Responding to Holli Hammer

Hello,

I appreciate your insightful post on how you may narrow the housing center’s fiscal deficit. The strategy for hiring a business development (BD) representative has always been a proactive measure to increase patient admission and financial stability. Marketing and outreach are not essentially well used in healthcare settings, and your approach can fill this gap. For instance, partnering in such a way with local hospitals, community organizations, and court-mandated treatment programs could help not only direct referrals to the facility but also boost ADC (Average Daily Census) over BD representation.

According to Khatri et al. (2023), centers with community referral networks have greater patient involvement, continuity of care, and financial sustainability compared to centers with direct referrals. Other activities are internet marketing, as they are doing other internet marketing activities such as search engine optimization (SEO) to attract as many as possible and get more potential patients through internet marketing advertisements.

BD representatives need to measure their long-term performance in order to track a referral or a patient conversion rate as well as a patient retention rate. Langarizadeh et al. (2024) state that this strategy would greatly increase financial outcomes, access to care and investment in technologies less traditional than virtual reality colloidal tolerance building therapies. Generally, you have a good financial and operating improvement plan.

References

Khatri, R., Endalamaw, A., Erku, D., Wolka, E., Nigatu, F., Zewdie, A., & Assefa, Y. (2023). Continuity and care coordination of primary health care: A scoping review. BioMed Central Health Services Research, 23(1). https://doi.org/10.1186/s12913-023-09718-8

Langarizadeh, M., Fallahnezhad, M., & Vahabzadeh, A. (2024). Key performance indicators of hospital supply chain: A systematic review. BMC Health Services Research, 24(1). https://doi.org/10.1186/s12913-024-11954-5

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Question

Tracey Watson

Gap Identified:

My healthcare organization currently faces a significant shortage of healthcare providers, particularly primary care, behavioral health providers and nursing staff. This shortage has led to delays in patient care, prolonged patient wait times, increase workloads for current staff, increase burnout among current staff, decrease patient and staff satisfaction, and compromised quality of care.

Solution:
An effective solution is the implementation of telehealth services and a fellowship and residency program for APPs. This service will be combined with an advance practice provider (APP) model which includes nurse practitioners (NPs) and physician assistants (PAs) (Payerchin, 2023).

A fellowship and residency program for these APP can focus on recruitment, training, and retention, and telehealth services which will fill the gaps within the primary care and specialty practices by increasing patient access, especially for routine follow-ups and behavioral health consultation. This will alleviate pressure on in-person services (Home, n.d.).

The systems thinking approach involves:

The system thinking approach involves collaborating with local universities to create a steady influx of qualified NPs and PAs who enter directly into a supportive training environment. Develop a formal resident program which will enhance clinical skills, promote confidence, and prepare APPs to handle the complexities of patient care, which will improve patient outcomes and staff satisfaction (Juetten, n.d.).

Provide mentorship programs and professional growth opportunities that encourage long-term retention and decrease turnover rates. Telehealth services would decrease wait times and enhance continuity of care which will free up physicians.

Financial Impact & Budgetary Considerations:
The initial financial impact for establishing an APP residency program would include staff program would include staff recruitment, salary support for trainees, program administration, educational materials, and mentorship compensation.

However, these costs can be offset and financially justified through several factors such as reduce recruitment costs which will improve retention decrease repeated recruitment and onboarding expenses which in the long run will result in long term cost saving.

Enhanced productivity and revenue by having well-trained APPs which will increase patient volumes and overall organizational revenue. Finally reducing overtime and temporary staffing costs which will allow a stable and adequately staffed workforce minimizes reliance on costly temporary staffing agencies and overtime hours.

Reference:
Home. (n.d.). Husson University. https://www.husson.edu/online/blog/2024/10/nursepractitioners-and-telehealth

Juetten, A. (n.d.). Evaluation of an advanced practice provider residency program. DigitalCommons@CSB/SJU. https://digitalcommons.csbsju.edu/nursing_dnp/4

Payerchin, R. (2023, April 20). APPs may fill in gaps due to growing shortages of physicians, nurses. MedicalEconomics. https://www.medicaleconomics.com/view/apps-may-fill-ingaps-due-to-growing-shortages-of-physicians-nurses

HH Holli Hammer

In my healthcare facility, which is a residential treatment facility for the treatment of substance use disorders, there is a budget deficit related to the Average Daily Census (ADC) and Average Length of Stay (ALOS). This is a significant deficit that is impacting the business overall.

The facility has 80 beds but currently has an ADC of 10 and an ALOS of 12. This means that there are very few clients in the building and they are not staying as long as they should be, which, in turn, continuously contributes to the low census.

This impacts the business because hours have to be cut for hourly FTEs, and the facility cannot invest in additional treatment modalities such as virtual reality tolerance building. To address this need, I suggest hiring a business development representative.

This should help drive business by letting those in the community and other healthcare providers know that the facility is there and ready to provide treatment to clients. There is an initial up-front cost associated with onboarding a new staff member.

The BD rep will have to be trained and go through various classes that are required of all employees. The majority of the cost of the BD rep would be spread out over the course of the year in their salary. In return, the clients can be tracked and traced to see what client is admitted directly because of a referral from the BD rep.

Then, over the year, the facility could add the revenue generated by these direct referrals and compare it to the BD rep’s salary to see how effective the BD rep has been and if it is something worth continuing.

Maydelis Rodriguez

Gap within Healthcare Organization

One significant gap within our healthcare organization is the limited access to mental health services. We propose enhancing mental health services by integrating telehealth solutions to address this. Implementing a comprehensive telehealth platform that offers virtual consultations, therapy sessions, and mental health resources can bridge this gap.

This approach leverages systems thinking by considering the interconnectedness of technology, patient care, and healthcare delivery. The initial setup cost for the telehealth platform, including software, training, and equipment, is estimated at $200,000.

Ongoing costs for platform maintenance, additional staffing, and digital resources are projected at $50,000 annually. However, reduced need for physical infrastructure and in-person visits can save approximately $100,000 per year in facility and administrative costs. Increased patient reach and service utilization can generate an additional $150,000 annually.

By consulting with the finance counselor, we can manage the budgetary impacts effectively, balancing the initial investment with long-term savings and revenue growth.

Research supports the effectiveness of telehealth in improving access to mental health services. For instance, a study on the barriers and facilitators to implementing digital technologies in mental health systems highlights the importance of personcentered approaches and policy reforms to enhance access (Berardi et al., 2024).

Additionally, telemental health has been shown to be reliable and effective for clinical assessment and treatment, with its adoption accelerated during the COVID-19 pandemic (Sugarman & Busch, 2023). Furthermore, relaxed telehealth policies during the pandemic have positively impacted health equity in telehealth utilization and outcomes, demonstrating the benefits of telehealth in improving access to mental health services (Mohr et al., 2024).

References
Berardi, C., Antonini, M., Jordan, Z., Wechtler, H., Paolucci, F., & Hinwood, M. (2024). Barriers and facilitators to the implementation of digital technologies in mental health systems: A qualitative systematic review to inform a policy framework. BMC Health Services Research, 24, Article 243. https://doi.org/10.1186/s12913-023-10536-1

Mohr, N. M., Vakkalanka, J. P., Lavin, L., Ternes, S., Healy, H. S., Merchant, K. A. S., Gadag, K., & Ward, M. M. (2024). The role of relaxed telehealth policy on health equity in telehealth utilization and outcomes during the COVID-19 public health emergency: A living systematic review. Journal of General Internal Medicine. Retrieved from https://ruraltelehealth.org/briefs/RTRC_LSR4_Brief_Final_1207.pdf

Sugarman, D. E., & Busch, A. B. (2023). Telemental health for clinical assessment and treatment. BMJ, 380, e072398. https://doi.org/10.1136/bmj-2022-072398

Peer Responses

Peer Responses



MM Margaret Lawrence Moreland

As many of you are already aware, there has been an ongoing nursing shortage for many years, which was highlighted by the COVID-19 pandemic and continues to be an issue today. While this gap exists in all healthcare systems, it is particularly prevalent in cardiovascular intensive care units, where nearly half of newly hired nurses leave their positions within the first year (Vozzella & Hehman, 2023).

When there is high job dissatisfaction and high turnover rates, the culture of patient safety is called into question (Aiken et al., 2023).

Vozzella & Hehman (2023) described the relationship between nursing staffing and turnover as a loop system, explaining how poor unit RN staffing leads to increased RN workload, which leads to reduced job satisfaction and increased intent to leave, which causes an increased RN turnover and, ultimately, a chronically poorly staffed RN unit.

In the Surgical-Cardiovascular Intensive Care Unit (SCVICU) where I am employed, I believe that the staffing shortages and high turnover rates could be due to the lack of education for a highly specialized unit, and a potential solution to this gap in healthcare could be addressed by enhancing educational support.

Currently, many hospital systems hire unspecialized staff to reduce labor costs; however, this commonly leads to poorer patient outcomes and complications, which are financially costly (Padula et al.,2019).

Using a systems-based approach, it is my theory that supporting specialized nursing education for specific units (such as the SCVICU) would lead to improved patient outcomes, which would lead to higher nurse satisfaction at work, less burnout, less staff turnover, and an adequately staffed unit which would also improve patient outcomes.

My solution to RN staff shortages in specialized units has the potential to be financially burdensome, as most nurses would like to be compensated for the time they put towards such education.

Collaborating among nurse managers, nurse educators, the Chief Financial Officer, and financial executives of a hospital system would be imperative.

The nurse managers would determine where further education is needed based on their staff needs/opinions, and the nurse educators would create a plan based on this, determining the best method for teaching and the time needed.

From there, these two nursing resources would collaborate with the financial team to create a budget for such a project. It is unlikely that this plan would initially have financial gains, but over time, as staff retention improves, fewer new nurses will be on orientation.

Money will be saved by not having to pay two nurses (orientee & preceptor) for the duration of the orientation period.

References:
Aiken, L. H., Lasater, K. B., Sloane, D. M., Pogue, C. A., Fitzpatrick Rosenbaum, K. E., Muir, K. J., McHugh, M. D., Cleary, M., Ley, C., Borchardt, C. J., Brant, J. M., Turner, B. L., Leimberger, A. E., Kozlowski, K., Coleman, B. L., Albert, N. M., Stewart, C., Steele, D., Kaplow, R., … Whade, J. J. (2023). Physician and nurse well-being and preferred interventions to address burnout in hospital practice. JAMA Health Forum, 4(7). https://doi.org/10.1001/jamahealthforum.2023.1809

Padula, W. V., Nagarajan, M., Davidson, P. M., & Pronovost, P. J. (2019). Investing in skilled specialists to grow hospital infrastructure for Quality Improvement. Journal of Patient Safety, 17(1), 51–55. https://doi.org/10.1097/pts.0000000000000623

Vozzella, G. M., & Hehman, M. C. (2023). Cardiovascular Nursing Workforce Challenges: Transforming the model of care for the future. Methodist DeBakey Cardiovascular Journal, 19(2), 90–99. https://doi.org/10.14797/mdcvj.1188

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