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). While cardiology is listed as part of the general medicine services provided at the hospital, the actual delivery of cardiology related services has been ineffective and inadequate due to the absence of an in-house cardiologist. For now, cardiology is the only service that the hospital does not offer, and in which a patient has unnecessarily been lost in recent times. The previous cardiologist retired and there has been no replacement yet. Considering the demographics of the area served by the hospital and the history of the hospital with regards here is undeniable need for a cardiologist at 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.
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 those who were above 85. The percentage of the population that was above 70 years in 2018 was approximately 11.8%, which was slightly lower that the regional population of those who are over 70 years (14.1%) (ABS, 2019). The people are of various socio-economic characteristics. From the public health reports shared on the region, it has been shown 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.
Preliminary cardiology review services can currently be accessed in the entire Armidale region from the privately owned Armidale Private Hospital, which has a private consultant who practices locally. However, the private hospital may not be suitable for all populations due to financial constraints. 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.
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 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, something that 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 and also 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 in combination to 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 certain challenges, risks, constraints and issues 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 administration begins the recruitment process early enough such that
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, may be hampered due to 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 probably be incurring high costs to obtain resources from further away from 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 ensuring there is complete 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.
Option/s – SWOT Analysis
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.
Lack of facilities and resources dedicated specifically to the cardiac unit.
A large underserved area that seriously needs a cardiac facility.
Improved technologies have expanded the available options for the establishment of the unit.
Other organizations also offering cardiac services may pose a competition.
Challenges in recruiting good cardiologists and high costs of outsourcing cardiology services.
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. Through the implementation of the plan as laid down, it is expected that the cardiac unit will be laid down effectively and will be operational as planned.
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