Orange County Pediatric Medical Center (OCPMC) had acquired three physician prac

Question

Orange County Pediatric Medical Center (OCPMC) had acquired three physician practices in its service area to broaden its ability to provide primary care. Based on its evaluation of the HR and business practices of the three practices, OCPMC was confident that it could reduce the costs of operations at these practices by consolidating and centralizing business activities. The business activities include accounting and finance, HR, billing, purchasing and materials management, and facilities maintenance. Additionally, the center would be able to spread the general costs of administration over the three facilities. After nearly six months of operating the three new acquisitions, OCPMC’s financial analysis found that very poor budgetary results had occurred. All three practices were over budget by more than 10 percent, and projections were for even larger financial losses. The most significant budgetary issue was labor costs. In further analyzing the problem, the main issue appeared to be the staffing mix of MDs, RNs, and assistive (nonlicensed) personnel. When the practices were acquired, the staffing mix was a simple combination of MDs and nonlicensed medical assistants. When OCPMC took over the practices, it changed the staffing mix to include RNs. This was consistent with the staffing model at the medical center and the other clinics OCPMC currently owned and operated. The budgetary problem was directly related to the increased expense of the RNs’ wages. OCPMC decided to evaluate the care delivery processes and the skill sets necessary at these clinics to determine if the staffing mix could be changed. The HR department was requested to undertake a job analysis, consider alternative job designs, and make recommendations.

Questions

1. Outline the steps that should be taken to evaluate the work at the practices to determine the appropriate staffing mix.

2. What methods of job analysis would be most effective for this assignm

Explanation / Answer

Answer:1:The steps that can be taken to evaluate the work at the practices to determine the appropriate staffing mix are as follows:

- identify the baseline staffing mix for MDs, RN and non licensed nurses as per regulatory norms and as per industry standards

-Indentify and analyse the allocation and efffort estimation for MDs, RNs and non licensed nurses for inpatient, ambulatory and home services.

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-Clearly define the roles and responsibilities for MD,RN and non licensed nurses and also determine KPIs to measure/verify them objectively

-Look into the options of spreading the services of the nurses across hospital in patient ,ambulatory and home care services

- Split the weekly work hours to increase the number of working days reducing the working hours per day.

- look into the flexibility of shifts and schedules

-Explore the possibilities of reducing the ratio of RN to licensed nurses by training RNs to take up more supervisory and management tasks and training the non licensed so that they can get more involved and be responsible for patient's direct care.This calls for review of assigned roles and responsibilities

-Skill upgradation of RNs to act as advance practice nurse . This would result in the change of mix of personnel interacting with the patients

-Evaluate and redesign nursing care delivery and skillsets needed for each practice

-Implement ABC (Activity based costing ) method for the overhead cost allocation and evaluate the impact

-Link and analyse RN numbers to patient's quality of care, mortality rate, length of stay etc

Answer 2:

-Task Analysis: The frequency of occurence of task, the requisite skillsets

-As-Is-State: Establish and link patient care quality to staffing ratio and skill ratio

-To-Be state and fit gap analysis: Anticipate and predict future revenue potential and scale up across different staff categories .

-Re-engineering nurse care delivery system: Take cognizance of curent vs future mix, skillsets, tasks/activities

-Interview the person: Detailed interview and inclusion of critical incident technique

-Brainstorming/workshop/Group discussion:Identify issies pertaining to staff nursing changes,skillset upgradations etc.

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