Moreno Medical Center Issues in Managed Care

Week 5 Case Study 1 NUR/492 Version 8 University of Phoenix Material

Week 5 Case Study

Moreno Medical Center – Issues in Managed Care

Moreno Medical Center (MMC) is a 600-bed, full-service acute care facility located in the Northwest Kelse y community. The hospital is a physician-owned, for-profit hospital that takes pride in the provider-patient relationship. With recent changes in managed care, every dollar, process, and interest of the patient serv es as a common ground for making an organization more efficient.

To remain competitive in the marketplace, the management team at MMC decided to take a look at variou s processes within the hospital and noted that the overall patient experience in the outpatient surgical clini c was less than satisfactory. The main problem seems to focus on long delays throughout the entire admi ssion to discharge process. If the hospital wants to maintain its competitive position, the administration wil l have to redesign the current process to improve patient satisfaction.

The hospital administration appointed an internal quality consultant to facilitate the planning process. The quality consultant for this new organizational role is an experienced intensive care RN with a business de gree. She understands that health care is a personal encounter and that patients and families expect to h ave their priority needs met when experiencing a health care issue.

The quality consultant decided to work closely with the surgical department RN administrator who would b e a powerful change agent in leading the improvement process. During the review of the surgical departm ent processes, the administrator and consultant identified several major issues:

 Surgeons delaying surgery times causing backlog of surgery schedule  Other hospital departments (e.g., admitting, finance, lab) conducting separate encounters with sur gical patients without regard to the surgery schedule  Long wait times for patient transportation from surgical area to recovery room  Ancillary staff providing patient discharge instructions when nurses are busy  Nursing staff displaying a culture that the procedure, not the patient, is the priority

The surgical department RN administrator acknowledges that changes need to occur and the new proces s must be guided by what is in the best interest of the patient. He developed a new vision statement for th e department with its first priority to provide a patient and family focused quality care culture.