A Decline in The Quality of Health Services Remedies Case Study Questions

When a large regional medical center became part of an integrated delivery system that had a central board of directors, the medical center’s board began to struggle with its revised role. The new organizational environment included several outpatient clinics, multispecialty physician practices, and an insurance entity. Many of the current board members had served the organization since the medical center was built, and board activities always had been performed in a certain way. The administration rigidly controlled board meetings. Board members did not ask questions and routinely approved committee reports. The reports covered topics such as the organization’s financial status and future financial plans, physician credentialing, care quality monitoring, new policies, and plans for a new hospital.

A new board member with a healthcare background was appointed after extensive screening and a personal interview with the executive committee. She was not part of the local business power structure, and the administration was concerned that her appointment might not be a wise move. During her first board meeting, two very interesting reports were given. One report detailed some reengineering projects. One of these involved redesigning nursing staffing patterns. This redesign decreased the number of registered nurses (RNs), and replaced them with licensed practical nurses (LPNs) and certified nursing assistants (CNAs). The current quality report documented a very high quality of care and positive patient satisfaction surverys. Data excerpted from this report can be seen in the “1st Quarter” column of table 15.1 (found on page 326). Given that this was her first board meeting, the new board member remained silent and did not ask questions.

Within four months, the new nursing staffing pattern had been launched. Data excerpted from the quality indicators report presented to the board can be seen in the “2nd Quarter” column of table 15.1 (found on page 326). After reviewing the data presented by the nurse administrator, the new board member was very concerned and decided to ask if the values in the quality report, which show a negative trend, were for the nursing units with the new nursing staffing patterns. The administrator reported that there was a direct correlation. This answer initiated discussion among other board members who were accustomed to using quality indicators in their businesses. This was the first substantive board-level discussion that the new board members had seen. One board member wanted to know whether any data had been gathered from patient focus groups. Another board member ask whether the average length-of-stay data had increased, and someone else asked about a cost-benefit analysis of the new staffing patterns. Following the usual process, the chair called for approval of the report and presentation of the next item on the agenda.

Case study questions

1. What changes or patterns do you see in the data? Determine what remedies d you might be suggested for any problems?

2. Has the CEO carried out his or her responsibility for educating the board? Justify you answer.

3. Depending on the answer to question 2, what strategies would you recommend at this point?

4. What quality data would you recommend to be reported and utilized by this board of directors?

5. Given this administration’s style and leadership approach, do you think the minutes of the board meeting reflect actual board meeting discussions?

Expert Solution Preview


The case study presents an example of the challenges faced when a large regional medical center becomes part of an integrated healthcare system. The medical center’s board struggles to adapt to its revised role and new organizational environment. The case study highlights the importance of effective communication, data analysis, and board engagement in improving healthcare outcomes.

Answer to question 1:
The data in Table 15.1 shows a negative trend in several quality indicators, including pressure ulcers and falls. The launch of the new staffing pattern, which decreased the number of RNs and replaced them with LPNs and CNAs, appears to have had a direct correlation with the negative trends. To remedy this problem, the medical center’s board should consider revising the nursing staffing pattern to increase the number of RNs. Additionally, the board should request a cost-benefit analysis of the new staffing pattern to see if the changes are cost-effective.

Answer to question 2:
Based on the information in the case study, it is unclear whether the CEO has carried out their responsibility for educating the board. The administration seemed to rigidly control board meetings, limiting board members’ ability to ask questions and routinely approving committee reports.

Answer to question 3:
If the CEO has not effectively educated the board, the board should request additional training on healthcare quality indicators, data analysis, and effective board engagement. The board could also consider hiring an external healthcare consultant to provide guidance and support.

Answer to question 4:
The board should request the following quality data: patient satisfaction surveys, data on nursing staffing patterns, pressure ulcer and fall rates, average length-of-stay data, and cost-benefit analyses of new policies or programs.

Answer to question 5:
Given the administration’s style and leadership approach, it is unlikely that the minutes of the board meeting reflect actual board meeting discussions. The case study highlights the need for open communication and effective engagement among board members to improve healthcare outcomes.

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