Sample Brief Business Proposal on Armidale Hospital

Armidale Hospital is the main public healthcare facility in the city of Armidale, in the Hunter Local Health District of New England. The hospital provides a wide range of healthcare services including imaging, general surgery, allied health services, emergency medical services, visiting services (which includes cardiology), and general medical services that includes cardiology, arrhythmia, syncope and acute coronary symptoms (Hunter New England Health, 2020). The Armidale area is also associated with a relatively low socio-economic index, which means that most people in the area are unable to access healthcare from privately owned and managed facilities.

Currently, cardiology is the only service that the hospital does not offer, although the provision for cardiovascular services is available. The hospital has been unable to recruit a cardiologist since the retirement of the previous cardiologist as no suitable and willing replacement has been found. Considering the currently high burden of cardiovascular disease-related morbidity and mortality; the region has higher cardiovascular disese burden than the rest of New South Wales, hence the need for a cardiologist. Accessing cardiology services at the hospital is currently through the Armidale Private Hospital, which works with a consultant cardiologist. The only public healthcare facility that offers cardiology services to the members of the Armidale population is the Lismore Base Hospital, which is located within the Northern New South Wales Health District. The hospital is located nearly 350 km away, while the John Hunter Tertiary Hospital, which offers similar services, is located nearly 30 km away. Once Armidale Hospital begins the cardiology unit, it will be offering cardiology services to the public within the region.

Demographic Situation: Population, Education, Infrastructure

Armidale Hospital serves the entire Armidale City as the main public health facility. As at 2019, the region had an estimated population of approximately 30,779 people (Armidale Regional Council, 2020). More than 2.2% of the population comprised of individuals aged above 85 years. The percentage of the population that was above 70 years in 2018 was approximately 11.8%, which was slightly lower than the regional population of individuals aged over 70 years (14.1%) (ABS, 2019). The location of the University of New England within the area has been an advantage to the community, with nearly 30% of the population having attended a tertiary institution; while more than 25% of the populations above 15 years old have a minimum of a Bachelor’s degree (ABS, 2016). Most of the population (approximately 86%) is also employed either part-time or full-time, with educational institutions being the biggest employers (ABS, 2016). These demographics indicate that the most of the population would access healthcare services for cardiovascular diseases.

The hospital already has existing infrastructure for the provision of cardiology services and will only need to address the gaps that may have been caused with prolonged idleness. With existing and operational out-patient infrastructure for cardiology services in Armidale Health Centers, expanding the infrastructure will be much easier and may be less costly than setting up new cardiac departments.

Health Services and Workforce

From the public health reports shared on the region, it is evident that cardiovascular diseases (CVD) are the most common cause of morbidity in the region (HNECCPHN, 2018). In terms of the average risk factors for CVD, Armidale Region is not significantly different from other regions with risk factors such as sedentary lifestyles, obesity and smoking (AIHW, 2019). According to The WHO VC Risk Chart Working Group (2019), the use of effective models for the prediction of risk factors for cardiovascular diseases can help in developing systems that address those factors. As such, the evidence collected on the CVD risk factors in the Armidale Region will be essential towards effective system development. The region also has a higher percentage of aboriginals and islanders, who are more susceptible to heart diseases. Nearly 74 in every 100,000 people die from heart diseases annually in the Armidale region compared to 68 per 100,000 people, which is the national average (Heart Foundation, 2020). These statistics indicate the need to establish an operational cardiology unit in Armidale to serve the public.

The general workforce for the hospital is adequate. However, the cardiac unit has not working cardiologist. The hospital has also found it difficult to retain or recruit a new cardiologist because of its location as many of those found are not willing to stay. Once a cardiologist has been found, it will be possible for the hospital to work with the other healthcare staff that are already in the hospital.

Current Financial Status

As part of its strategic plan, Armidale intends to set up a fully-functional cardiac department at a cost of $ 10,000,000 which should cater for the set-up as well as for running the operations of the department for one year. These funds should be sufficient for the planned activities.

Current Services, Infrastructure, Resources, Personnel

Armidale Hospital has previously been providing cardiac services to its patients. However, the recent retirement of the single cardiologist that had been in the region 18 months ago has made it impossible to offer those services anymore. The region itself has a high burden of cardiovascular disease-related morbidity, and thus, there is imperative need to have a functional cardiac unit within the region (AIHW, 2019). As part of its strategic plan, the hospital will have to seek the services of a cardiologist, which has been difficult to accomplish since the retirement of the last one. Currently, investigations have been on-going on the different service models that can be used for cardiac patients. Some of the possible proposals include various technologies, partnerships with bordering LHDs, as well as the use of metropolitan tertiary cardiac services. Hiring a cardiologist would be cheaper than any of these options in spite of the current challenges.

Besides the previous services, Armidale also has the Armidale Private Hospital, which is a 30-bed facility that offers a variety of medical and surgical services. It has the support of allied health, radiology, pathology, and aged-care assessment, among others. The Armidale Community Health Service on the other hand, offers respiratory and cardiac rehabilitation in addition to the general medical services. The available facilities will be used collaboratively in the new facilities that will be introduced courtesy of the upcoming project.

Possible Risks/ Constraints/Issues

As Armidale intends to develop and run a public cardiology department, the hospital is bound to face various challenges, risks, and constraints in implementation. The most glaring constraint is that of specialist availability (Narang et al., 2016; Marine, 2010). According to Petch (2002), one of the sources of constraint and challenge in any healthcare program set-up is the availability of healthcare professionals for the department. Particularly, the recruitment of the cardiology team is described as one of the biggest challenges for any healthcare administrator (Abraham, 2012; Douglas et al., 2018). Further evidence shows that this has been a long-term challenge for healthcare administration (Fye, 2004). Credentialing, administration of a job description, employee insurance, conducting facility-based inductions, and employee privileging can all be a challenge to the process of cardiologist recruitment (Stuart, 2012). The experience gained over the last 18 months should be a tentative indication of what Armidale Hospital should expect in its bid to recruit a new cardiologist. As such, it is imperative that the hospital’s administration begins the recruitment process early enough.

Besides the risk of getting registered, credentialed healthcare practitioners, the hospital will also face the issue of resource availability. Van Baal, Morton, and Severens (2018) describe the impacts of resource constraints on healthcare facilities and on the growth of healthcare inputs. According to the authors, healthcare facilities may have the intention to implement certain changes from evidence-based practice and other research, which may be focused on facility upgrades or service improvement, but may be deterred by the lack of resources (Kumar, Khan, Inder, & Anu, 2014). The distance from the closest available public health facilities to Armidale Public Hospital indicates that the hospital will be incurring high costs to obtain resources further away from the point of use. It is also probable that the hospital will face resistance as a challenge to the implementation of the proposal as this is a common challenge in the implementation of change in public hospitals (Nilsen et al., 2019). Resistance could come from various stakeholders such as the employees of the hospitals, particularly when they are not made aware of the need for the unit. Jones and Van de Ven (2016) report that resistance to change is one of the challenges that all organizations face, and which have to be addressed by enhancing information-sharing among all those involved in the proposed change. To achieve this level of information sharing, actual data on deaths pertaining to cardiac issues will be shared as recommended by Edwards and Saltman (2017). One of the ways to successfully initiate the proposed change is to incorporate it as part of the patient-centered care model as described by Fiorio, Gorli, and Verzillo (2018). This will attract support from in-house healthcare providers as well as external professionals.

The other issue that could be faced is the incorporation of telehealth services as part of the cardiology practice to be initiated. In the contemporary times, the popularity of telehealth services has seen medical departments pursuing the competitive advantages associated with telehealth services such as the breakage of patient-provider communication barriers. For cardiovascular diseases, the available evidence shows that telehealth-based services can deliver value; however, this evidence is not sufficiently compelling (Wade & Stocks, 2017). The challenge in the implementation of telehealth services in cardiology is that they technology can be costly. The combination of the pressure to conform to the contemporary popularity of telehealth and the resource constraints at Armidale Hospital imply that the hospital may find it difficult to invest both in the human resources and the technology. The implementation of telehealth services in cardiology is also associated with several challenges and barriers including patient-related barriers such as low socio-economic status; physician-related issues such as lack of standardization, incentives, lack of infrastructure, and training barriers; legal and ethical issues in telehealth for cardiology such as privacy and confidentiality; and technology interoperability issues (Frederix et al., 2019). Addressing these barriers may be particularly challenging when the hospital decides to start implementing telehealth at the same time that cardiology services are being re-established.

Option/s – SWOT Analysis

Strengths

An already existing infrastructure that would support the development of the cardiac unit.

Management effectiveness and support.

A pre-tried system, which means there is a high probability of success.

Ready finances for the investment.

An operational out-patient department is already available for the cardiac unit in the Armidale Health Centers.

Weaknesses

Non-operational facilities and resources for cardiology services – which means that the operational status may not be well understood.

Human resource constraints – challenges in cardiologist hiring and retention.

No existing telehealth services for the cardiac unit.

 

Opportunities

A large underserved area that seriously needs a cardiac facility.

Improved technologies have expanded the available options for the establishment of the unit.

Telehealth as an approach to cardiology practice.

Threats

Other organizations also offering cardiac services may pose a threat through competition.

High competition among facilities for good cardiologists.

High costs of outsourcing cardiology personnel- can drive operational costs high.

Several barriers to telehealth implementation in cardiology services.

Conclusion and Recommendations

Establishing a cardiac unit is not an easy process for the Armidale Hospital. Furthermore, the main constraints to the hospitals plans are external to the hospital, which means that they could be potentially beyond the control of the hospital. The hospital is located in the general Armidale region, within which there is no public hospital that offers cardiac services. Armidale Health centers only offer respiratory and cardiac rehabilitation, both of which comprise of a limited percentage of the scope of cardiac services needed in the hospital.

The main recommendation for Armidale Hospital is to consider managing the establishment of the cardiology department as a conventional organizational change process. To do this effectively, the first step in achieving this will be to create awareness among existing staff, so that they are not only willing to support the revival of the department, but can also offer to be involved in its operation and recommend suitable cardiologists that can fill the vacant position. The best change management model to be used will be Kotler’s change model, which begins with unfreezing and concludes with refreezing. Additionally, the hospital should introduced telehealth services in the existing Armidale Health Centers where outpatient cardiology services are currently available before eventually rolling them out once the cardiology department has been completely set up. Effectively managing the implementation of telehealth in the cardiology department requires the hospital to barriers to implementation through approaches such as implementing patient and physician education programs and redesigning the workflow processes in preparation for the unit.

References

Abraham, S. (2012, March 6). Hospital administrators identify recruitment of cardiology team among biggest challenges. American College of Cardiology. Retrieved from https://www.acc.org/about-acc/press-releases/2012/03/06/15/03/hospitaladminrecruitment

ABS. (2019). 2016 Census quickstats. Australian Bureau of Statistics. Retrieved from https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/SSC10085?opendocument

AIHW. (2019, August 30). Cardiovascular disease. Australian Institute of Health and Welfare. Retrieved from https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/cardiovascular-health-compendium/contents/how-many-australians-have-cardiovascular-disease

Armidale Regional Council. (2020). Community profile. Retrieved from https://profile.id.com.au/armidale

Douglas, P. S., Rzeszut, A. K., Bairey Merz, C. N., Duvernoy, C. S., Lewis, S. J., Walsh, M. N., & Gillam, L. (2018). Career preferences and perceptions of cardiology among US internal medicine trainees: Factors influencing cardiology career choice. JAMA Cardiology, 3(8), 682-691. Retrieved from https://europepmc.org/article/pmc/pmc6143073

Edwards, N., & Saltman, R. P. (2017). Re-thinking barriers to organizational change in public hospitals. Israel Journal of Health Policy Research, 6(8). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357814/

Fiorio, C. V., Gorli, M., & Verzillo, S. (2018). Evaluating organizational change in healthcare: The patient-centered hospital model. BMC Health Services Research, 18(95). Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-2877-4

Frederix, I., Caiani, E.G., Dendale, P., Anker, S., Bax, J., Bohm, A., Cowie, M., et al. (2019). ESC e-Cardiology working group position paper: Overcoming challenges in digital health implementation in cardiovascular medicine. European Journal of Preventive Cardiology, 26(11), 1166-1177. Retrieved from https://journals.sagepub.com/doi/full/10.1177/2047487319832394

Fye, W. B. (2004). Cardiology’s workforce shortage. Circulation, 109(7), 813-816. Retrieved from https://www.ahajournals.org/doi/full/10.1161/01.CIR.0000118641.54694.4C

Heart Foundation. (2020). Australian heart maps. National Heart Foundation of Australia. Retrieved from https://www.heartfoundation.org.au/for-professionals/heart-maps/australian-heart-maps

HNECCPHN. (2018). Population health snapshot 2018: Armidale Regional LGA. Hunter New England and Central Coast. Retrieved from https://hneccphn.com.au/media/14562/armidale-regional-2018-lga-profile.pdf

Hunter New England Health. (2020). Armidale Hospital detailed services. Retrieved from http://www.hnehealth.nsw.gov.au/facilities/hospitals/Pages/Armidale-Hospital-detailed-services.aspx

Jones, S. L. & Van de Ven, A. H. (2016). The changing nature of change resistance: An examination of the moderating impact of time. The Journal of Applied Behavioral Science, 52(4), 482-506. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0021886316671409?journalCode=jaba

Kumar, P., Khan, A. M., Inder, D., & Anu. (2014). Provider’s constraints and difficulties in primary health care system. Journal of Family Medicine and Primary Care, 3(2), 102-106. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139987/

Marine, J. E. (2010). Cardiology workforce crisis: Shortage or surplus? Journal of the American College of Cardiology, 55(8). Retrieved from http://www.onlinejacc.org/content/55/8/838.1

Narang, A., Sinha, S. S., Rajagopalan, B., Ijioma, N. N., Jayaram, N., Kithcart, A. P., Tanguturi, V. K., et al. (2016). The supply and demand of the cardiovascular workforce: Striking the right balance. Journal of the American College of Cardiology, 68(15), 1689-1689. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351767/

Nilsen, P., Schildmeider, K., Ericsson, C., Seign, I., & Birken, S. (2019). Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses. Implementation Science, 14(51). Retrieved from https://implementationscience.biomedcentral.com/articles/10.1186/s13012-019-0902-6#citeas

Petch, M. C. (2002). Heart disease, guidelines, regulations, and the law. Heart, 87(5), 472-479. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767111/

Stuart, C. (2012, March 7). ACC survey: Recruiting cardiology staff is a major challenge. Cardiovascular Business. Retrieved from https://www.cardiovascularbusiness.com/topics/healthcare-economics/acc-survey-recruiting-cardiology-staff-major-challenge

The WHO VC Risk Chart Working Group. (2019). World Health Organization cardiovascular disease risk charts: Revised models to estimate risk in 21 global regions. Lancet Global Health. Retrieved from https://www.thelancet.com/action/showPdf?pii=S2214-109X%2819%2930318-3

Van Baal, P., Morton, A., & Severens, J. L. (2018). Health care input constraints and cost effectiveness analysis decision rules. Social Science & Medicine, 200, 59-64. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5906649/

Wade, V. & Stocks, N. (2017). The use of telehealth to reduce inequalities in cardiovascular outcomes in Australia and New Zealand: A critical review. Heart, Lung and Circulation, 26(4), 331-337. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1443950616316870