NHS FPX 6004 Health Care Law and Policy Assessment 2 Policy Proposal KP

NHS FPX 6004 Health Care Law and Policy Assessment 2 Policy Proposal KP

Need For Creating a Policy

NHS FPX 6004 Health Care Law and Policy Assessment 2 Policy Proposal KP

All authority levels in the healthcare system, including the federal, state, and local authorities, provide various healthcare metrics benchmarks. For instance, the federal government requires that all patients who visit a health care facility have a medication reconciliation upon their admission (Al-Hashar et al., 2018). However, health facilities express significant shortfalls in meeting benchmark metrics prescribed by these authorities. Therefore, it is vital to have policies and practice guidelines to address these shortfalls in the various hospitals and other health care facilities. Most fundamentally, having these policies and practice guidelines benefits patients, healthcare facilities, and the healthcare system (Jung et al., 2020). They give protocols that prevent human error in the hospital, allowing for excellent healthcare outcomes. Indeed, these policies and practices help doctors and nurses deliver the best care to patients and use their knowledge to inform future policies in their practice.

           Mercy Medical Center currently experiences a significant shortfall in addressing hospital readmissions, where it has significant cases of rehospitalization. This shortfall exists predominantly with diabetes patients, wherein from 2019 through to 2020, the facility had a significant increase in diabetes patients. In 2020, the hospital registered a 16.13 readmission rate for diabetic patients, which is a high figure considering that reducing readmission rates is a benchmark in the federal government that hospitals in the US must strive to address (Warchol et al., 2019). This benchmark underperformance is detrimental to The Mercy Medical Center’s goal of providing quality health care services to its patients. Indeed, the sole purpose of this facility’s existence is to address health care challenges in Shakopee, Minnesota, by treating people in this region of their diseases, including diabetes. While diabetes remains one of the most prevalent chronic diseases, its treatment and management are possible (Raghupathi & Raghupathi, 2018). However, the readmission rates at the hospital indicate that it is failing in addressing the problem, and it has not managed to help patients manage diabetes. Secondly, the shortfall in the benchmark is consuming significant facility time. The hospital workers spend more time addressing the readmission cases than when they would spend addressing new cases. Hence, this creates congestion at the hospital and overexploitation of facility resources. These factors undermine the provision of quality health care services at the hospital.

NHS FPX 6004 Health Care Law and Policy Assessment 2 Policy Proposal KP

           Failure to make the necessary changes to this shortfall will have various repercussions. First, it will lead to poor patient outcomes. When patients keep revisiting the hospital for the same problem, it means they are not receiving the care they deserve (Bailey et al., 2019). Indeed, rehospitalization is an indication that the original care was inadequate, making the patient revisit the hospital for further services. Secondly, excessive readmissions can threaten the financial health of a hospital (Wadhera et al., 2021). This aspect happens mainly in a value-based reimbursement environment. If anything, the Agency for Healthcare Research and Quality (AHRQ) indicates that readmissions are the costliest episodes to treat (Lu et al., 2021). According to this agency, readmission hospital costs reach up to $41.3 billion for patients readmitted within one month of discharge. Lastly, readmissions will lead to the loss of Mercy Medical Center’s reputation. When diabetes patients continue to be readmitted to the hospital, people will conclude that this hospital offers substandard care, hence the many readmissions.

Recommendations (Ethical and Evidence-Based Practice Guidelines)

While hospitals experience many shortfalls in meeting health care benchmarks, evidence-based literature presents several strategies to improve performance on various benchmarks. More so, this literature suggests several strategies to reduce hospital readmissions, which is one of the most significant shortfalls in Mercy Medical Center. First, hospitals must practice care transitions (Brown, 2018). A hospital that does not provide quality care during and after hospitalization will increase the costs and rates of hospital readmissions. Often, physicians and clinical entities fail to coordinate patients’ healthcare across various settings for different providers. Therefore, hospitals must have a significant transition of care. This can happen by having transition coaches in hospitals. They must also have expressive care transition programs to manage post-discharge care. Secondly, hospitals must improve patient engagement and education (Sharma et al., 2018). Inadequate patient and practitioners communication is a barrier to readmissions reduction initiatives. Patients or their families receive unclear inadequate instructions, complicated medication instructions, and unclear follow-up care instructions. Research shows that involving patients and families in the discharge plan will help improve patient health and decrease hospital readmission rates. Therefore, hospitals must engage patients in their treatment during hospitalization and post-discharge care (Sharma et al., 2018). Moreover, they must train patients on various aspects like following medication prescriptions and discerning symptoms. Moreover, they must avoid making mistakes in their prescriptions to ensure patient treatment is effective.

These strategies could effectively ensure performance improvement or compliance with applicable local, state, or federal health care policy or the law. First, an effective transition of care would ensure that the hospital knows a patient’s history and previous hospitalizations. Optimizing care transition also ensures reduced communication breakdowns (Brown, 2018). This way, caregivers and patients can exchange information effectively. Indeed, after hospitalization, care transition optimization ensures that caregivers can guide patients to transit from the hospital to home settings of post-acute care settings. Improving patient engagement and education is one of the most effective strategies to prevent hospital readmissions. Research indicates that most patients who report not being engaged in their discharge process have a high potential of being readmitted to the hospital for the same problem (Brown, 2018). More so, patients who say they did not receive written instructions for their discharge care have a high likelihood of hospital readmission. Hence, hospitals can s drastically decrease hospital readmissions rates by caregiver and patient engagement through patient education about follow-up care. This strategy ensures that patients understand what they must do when they leave the hospital. For instance, they understand how and when to take their medication, the foods to avoid in the case of diabetes, and when to visit the hospital for subsequent check-ups.

  Mercy Medical Center can apply these strategies to reduce readmission rates that have been on the rise since 2019. Mostly, the hospital has been experiencing high readmissions of diabetes patients. Hence, to ensure it improves its performance and meets the readmissions reduction benchmark policy, it can apply these strategies in various ways. On optimizing transitions of care, the Mercy Medical Center must ensure that it has all the patient’s details and history if they come from a different facility and enroll for care at their facility. This will allow the hospital to continue the care offered by the previous hospital and make appropriate changes where necessary. Secondly, Mercy Medical Center must be very meticulous during the discharge process when transitioning patient care from hospital to home-care. Brown (2018) claims hospitals must have care transition programs with transition coaches to guide the discharge process. During discharge, the patient must receive all the information for their discharge, including medication prescriptions, follow-up dates, and how to evaluate their symptoms to discern when they can revisit the hospital.

Concerning improving patient education and engagement, Mercy Medical Center must always train the patient on their follow-up care, caregivers at the hospital must create time to answer patient questions during hospitalization. They must also explain treatment procedures treatment alternatives, among other essential information (Banerjee, 2021). This could happen in the information teach-back process, where the patient repeats to the caregiver what they have just told them. Also, the hospital can offer transport assistance and ensure that their patients reach their homes safely. 

NHS FPX 6004 Health Care Law and Policy Assessment 2 Policy Proposal KP

Reducing hospital readmissions must be a priority at Mercy Medical Center. Nevertheless, it must be culturally and ethically inclusive (Haddad & Geiger, 2018). Shakopee, Minnesota, is a demographically diverse region. Therefore, it is vital to ensure that all communities in the region are included in these strategies. First, the hospital must ensure that the hospital can communicate with them irrespective of a person’s language. Hence, when staffing the hospital, the management must strive to ensure it has workers from all the languages in the region. For instance, the recommended policies require patient training on post-discharge care. The caregivers must ensure they can educate patients in their respective languages. Also, Mercy Medical Center must ensure that only the patient and their immediate families at home understand the patient’s problem and how to attend to them (Haddad & Geiger, 2018). This factor will help in maintaining patient confidentiality and privacy.

Therefore, while the hospital strives to maintain equality, it must also adhere to the ethical principles of justice, accountability, and autonomy. Since other patient categories have not reported readmissions, it could imply that the hospital is not practicing justice with diabetic patients. Hence, fairness in distributing care will be a relevant ethical consideration to making the policy work and reduce readmissions of diabetic patients (DeCamp et al., 2018). Also, if doctors and nurses fail in dispensing their duties and or fail in their actions, they must accept full responsibility (DeCamp et al., 2018). These ethical principles must apply in implementing the new policy and practice guidelines. 

Potential Effects of the Environment on the Recommended Practices

Various environmental factors could affect these recommendations. First, there are regulatory considerations that challenge these recommendations. These recommendations deal with communication. Various regulations dictate and determine how patient communication must happen in a hospital setting (Haddad & Geiger, 2018). Invariably, the hospital must keep patient information private and confidential. However, some patients could be aged or have inadequate information and fail to understand some care information. As such, the hospital seeks a third party to explain the care plan. This could be a relative that the aged or uneducated patient has not consented to handle their health information. This becomes an ethical dilemma for the hospital. 

NHS FPX 6004 Health Care Law and Policy Assessment 2 Policy Proposal KP

           Also, resources considerations could affect these recommendations. For instance, patient training takes up organizational time and resources. Caregivers must spend extra time to ensure the patients understand their post-discharge care (Lu et al., 2021). They also use resources like charts that the hospital must procure for this endeavor. If the hospital decides to offer transport support to patients to ensure their safety and prevent readmissions caused by poor transportation, it will incur high transport costs. Lastly, it will have to consider its staffing, it that it employs workers from the local communities for effective communication with patients in their respective languages. 

If these policy and practice guidelines fail to address communication regulations in hospital settings, they would be working against various rules. This could deem them unlawful in hospital policies. However, a particular implementation of the policy would ensure it complies with hospital communication regulations. Also, the lack of resources of the scarcity thereof would lead to inadequate policy implementation. Its full and successful implementation is contingent upon resources availability. Like Campos & Reich (2019) observe, the lack of resources is a significant impediment to policy implementation in health care.

Stakeholder Involvement

The most important stakeholders in these recommendations are the hospital management and caregivers, including doctors and nurses. Engaging these stakeholders is vital for several reasons. First, the hospital management controls that facility’s daily practices and operations. It also engages in allocating funds in the hospital for various activities. The doctors and the nurses as practitioners are the responsible parties in implementing the policies because they are the frontline workers dealing with the patients. For instance, while the doctors recommend post-discharge care, it is the responsibility of nurses to communicate the care to patients (Kang et al., 2018). Also, while doctors recommend and prescribe medication regimens, nurses must ensure the patients follow them. These two groups, the management, and health care practitioners, are vital in implementing the recommended policies. While the management will provide the necessary support to enable the policies, practitioners, i.e., doctors and nurses, will implement and follow the policies.


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Brown, M. M. (2018). Transitions of care. In Chronic illness care (pp. 369-373). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-319-71812-5_30 

Campos, P. A., & Reich, M. R. (2019). Political analysis for health policy implementation. Health Systems & Reform, 5(3), 224-235. https://www.tandfonline.com/doi/abs/10.1080/23288604.2019.1625251

DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., Lehmann, L., … & Tilburt, J. (2018). Ethical issues in the design and implementation of population health programs. Journal of general internal medicine, 33(3), 370-375. https://link.springer.com/article/10.1007/s11606-017-4234-4

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Jung, D. H., DuGoff, E., Smith, M., Palta, M., Gilmore‐Bykovskyi, A., & Mullahy, J. (2020). Likelihood of hospital readmission in Medicare Advantage and Fee‐For‐Service within the same hospital. Health services research, 55(4), 587-595. https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13315

Kang, E., Gillespie, B. M., Tobiano, G., & Chaboyer, W. (2018). After-care education for surgical patients to increase recovery post-discharge. International journal of nursing studies, 87, 1-13. https://www.sciencedirect.com/science/article/pii/S0020748918301585

Lu, C. H., Clark, C. M., Tober, R., Allen, M., Gibson, W., Bednarczyk, E. M., … & Jacobs, D. M. (2021). Readmissions and costs for adults with certain diagnoses during hospital readmission reduction programs. BMC health services research, 21(1), 1-17. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06399-z

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NHS FPX 6004 Health Care Law and Policy Assessment 2 Policy Proposal KP

Sharma, A. E., Rivadeneira, N. A., Barr-Walker, J., Stern, R. J., Johnson, A. K., & Sarkar, U. (2018). Patient engagement in health care safety: an overview of mixed-quality evidence. Health Affairs, 37(11), 1813-1820. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.0716

Warchol, S. J., Monestime, J. P., Mayer, R. W., & Chien, W. W. (2019). Strategies to decrease hospital readmission rates in a non-Medicaid-expansion. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669363/Wadhera, R. K., Joynt Maddox, K. E., Desai, N. R., Landon, B. E., Md, M. V., Gilstrap, L. G., … & Yeh, R. W. (2021). Evaluation of hospital performance using the excess days in acute care measure in the hospital readmissions reduction program. Annals of internal medicine, 174(1), 86-92. https://www.acpjournals.org/doi/abs/10.7326/M20-3486

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