Category: NHS-FPX6008

NHS FPX 6008 Assessment 4 Lobbying for Change Name Capella university NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Lobbying for Change October, 2024 Kate Gallego, Mayor Phoenix City Hall, 200 W. Washington Street, Phoenix, AZ 85003 Respected Mayor,  I am writing this letter to bring your attention to a critical healthcare financial problem of homelessness in Phoenix, Arizona. 7,419 individuals were homeless in 2020 in Phoenix, with 51% without shelter (Phoenix, 2020). Homeless individuals have threats of physical health issues, morbidity, fatality, and higher admissions. This problem causes overloaded emergency rooms due to complex conditions, lengthy waits, and high care expenses. Homeless patients spend an extra 2.32 days in hospitals and incur $1000 in expenses for each release (Franco et al., 2021). It is vital to address this issue as it results in severe community outcomes, putting economic pressure and harming public health.  Adopting actions to alleviate homelessness in Phoenix will have significant outcomes. It will enhance community health results, resolving homelessness leads to reduced HIV and other infection rates and a reduction of admission and emergency care usage. Offering adequate housing reduces health costs by 85%, $US28.98 monthly (Carnemolla & Skinner, 2021). If this problem is ignored, the Phoenix community could encounter increased health inequities, prolonged crowded emergency units, and rising financial demands. Such people have medical complications like hepatitis (36%) and chronic issues (61%) more than general people (Central Arizona Shelter Service, 2022). Ignorance will worsen medical inequities and the state’s costs. The problem has an immense effect on medical facilities, communities, and the state. Health systems face a greater need for emergency care because homeless people depend on them for health care, resulting in overcrowded emergency units and high expenses (Franco et al., 2021). At the community level, homelessness causes wellness problems as unhoused people have a higher rate of infections, raising the potential for infection spread (D’Souza & Mirza, 2022). At the state level, homelessness demands extra social and care services, utilizing resources of other crucial services leading to disparities. Integrated efforts are needed to resolve homelessness. Our multifaceted approach, based on offering preventive and primary care community initiatives with mobile health clinics, housing assistance, and an integrated cross-disciplinary approach, boosts health outcomes and fiscal stability. NHS FPX 6008 Assessment 4 Lobbying for Change According to Serchen et al. (2024), using an integrated care team approach can reduce homeless hospital stays by 35% and emergency demand by 19%. It aligns with the principle of justice by offering holistic services, reducing disparities, and meeting the health and social needs of homeless patients. Offering housing assistance services for secure housing will improve medical results and reduce costs (Carnemolla & Skinner, 2021). Offering primary and preventive care community programs aids in addressing the chronic and mental illnesses of homeless people, improving safety, and reducing emergency visits and costs. Primary care community programs cause $1.31 to $1.93 in revenue with $1.00 in spending (Arbour et al., 2024). It boosts homeless people’s health results by aligning with the nonmaleficence principle.  Professionally, I witnessed during the pandemic that when homelessness surged in Phoenix, the medical conditions worsened, led to longer waits, and increased stress among staff, creating an undesirable situation. As the emergency unit’s Nurse Manager, I have personally experienced the influx of unhoused patients that caused strain on staff, the assets, or emergency services, impeding patient care. In practical experience during COVID-19, I performed robust threat assessment strategies and fiscal planning by partnering with community groups to manage homeless people as it impacts the health system or community.  NHS FPX 6008 Assessment 4 Lobbying for Change Therefore, I urge you to prioritize funding for primary care efforts and partnerships with local groups for homeless management. Your role is vital to building a robust system for Phoenix’s homeless people.  Thank you for your consideration. Sincerely, Travisha References Arbour, M., Fico, P., Atwood, S., Yu, N., Hur, L., Srinivasan, M., & Gitomer, R. (2024). Primary care–based housing program reduced outpatient visits; patients reported mental and physical health benefits. Health Affairs, 43(2), 200–208. https://doi.org/10.1377/hlthaff.2023.01046 Carnemolla, P., & Skinner, V. (2021). Outcomes associated with providing secure, stable, and permanent housing for people who have been homeless: An international scoping review. Journal of Planning Literature, 36(4), 508-525. https://doi.org/10.1177/08854122211012911 Central Arizona Shelter Service. (2022). Homelessness as a health crisis. Central Arizona Shelter Services.org. https://www.cassaz.org/2022/02/homelessness-as-a-health-crisis/ D’Souza, M. S., & Mirza, N. A. (2022). Towards equitable health care access: Community participatory research exploring unmet health care needs of homeless individuals. Canadian Journal of Nursing Research, 54(4), 451-463. https://doi.org/10.1177/08445621211032136 NHS FPX 6008 Assessment 4 Lobbying for Change Franco, A., Meldrum, J., & Ngaruiya, C. (2021). Identifying homeless population needs in the emergency department using community-based participatory research. Bio Med Central Health Services Research, 21(1), 428. https://doi.org/10.1186/s12913-021-06426-z Phoenix. (2020). Strategies addressing homelessness. Phoenix.gov. https://www.phoenix.gov/humanservicessite/Documents/Final%20Report_Homeless%20Strategies_061820_52.pdf#search=data%20related%20to%20homelessness Serchen, J., Hilden, D. R., & Beachy, M. W. (2024). Meeting the health and social needs of America’s unhoused and housing-unstable populations: A position paper from the American college of physicians. Annals of Internal Medicine, 177(4), 514–517. https://doi.org/10.7326/m23-2795

NHS FPX 6008 Assessment 3 Business Case for Change Name Capella university NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Business Case for Change Homelessness at St. Joseph’s Hospital and Medical Center presents a significant healthcare economic issue, deeply affecting patient care, staff well-being, and organizational finances. The persistent challenges of managing chronic conditions among homeless patients increase operational costs and strain resources, contributing to staff burnout and reduced community access. This assessment explores the economic impact, feasibility, and cost-benefit of targeted interventions, emphasizing culturally sensitive and ethical solutions to improve patient outcomes and foster a sustainable healthcare model. Addressing this issue is critical for enhancing healthcare delivery and ensuring equity within the community. Problem and the Impact of Healthcare Economic Issues Homelessness at St. Joseph’s Hospital and Medical Center is a pressing healthcare economic issue impacting me, my colleagues, our organization, and the broader community. Immediate attention is needed to address its effects. Every day, my colleagues and I provide care to individuals experiencing homelessness, often facing complex medical conditions worsened by unstable housing. The lack of stable housing complicates our efforts to manage chronic conditions, follow up on treatment plans, and ensure medication adherence. These challenges extend beyond medical treatment as we navigate social determinants of health, leading to increased workloads and stress (Robinson et al., 2022). This situation is not just frustrating; it’s exhausting, contributing to burnout among many of us.  For our organization, the impact is equally significant. The emergency department, where homeless individuals often seek care, is overwhelmed. This overutilization leads to overcrowding and skyrocketing operational costs, threatening the financial health of our hospital.  Studies show that the mean cost increases for hospital admissions among homeless individuals can range from $6,990 for non-psychiatric cases to $7,012 for mental health cases (Wiens et al., 2021). These costs are unsustainable and divert resources from critical areas of care, affecting both those we serve and our colleagues. Physicians often feel frustrated, providing temporary fixes rather than long-term solutions, impacting their morale and professional satisfaction. NHS FPX 6008 Assessment 3 Business Case for Change The community we serve is also affected, as increased emergency service use by homeless individuals leads to wait times longer, reducing access for others. Studies show undomiciled patients experience longer emergency department wait times, averaging 53.4 minutes versus 38.9 minutes for domiciled patients (Ayala et al., 2021). This burdens the community and perpetuates a cycle of poverty and poor health outcomes across the population. This issue resonates deeply with me as a healthcare professional. I feel stuck in a system that fails to address the root causes of our problems. Current healthcare models are not designed to meet the unique needs of people experiencing homelessness, often failing to integrate responses to specific barriers like unstable housing (Carmichael et al., 2023). This disconnect exacerbates health disparities and places an unsustainable burden on our healthcare system.  As we look toward the future, it’s clear that we must develop specialized, adaptable healthcare models that address these unique needs. Doing so will not only improve the health outcomes of this vulnerable population but will also reduce the economic burden on our hospitals and healthcare professionals. Imagine a system where we’re not just putting out fires in the emergency room but are instead providing comprehensive, preventive care that keeps people healthier and reduces the need for emergency services. Research suggests that shifting from emergency to preventive care models could save up to 30% in costs (Vohra et al., 2022), freeing up resources to invest in other critical areas. Considering Feasibility and Cost-Benefit Analysis Addressing homelessness at St. Joseph’s Hospital and Medical Center is both feasible and economically advantageous. As the number of homeless individuals seeking emergency care increases, the hospital faces significant financial and operational pressures. Investing in targeted interventions such as preventive care and specialized outreach programs for homelessness can mitigate these pressures, leading to substantial cost savings and improved patient outcomes. Implementing preventive care for the homeless population offers notable cost benefits. Research indicates that preventive care is significantly more cost-effective than emergency services. For example, emergency department visits average $1,500, while preventive care costs about $500 per patient annually (Wiens et al., 2021). By transitioning 20% of emergency visits to preventive care, the hospital could save approximately $3 million annually, demonstrating a clear financial advantage. Additionally, improving resource utilization through specialized care teams and outreach programs can reduce overcrowding and operational costs. Overcrowding increases costs by 15% due to additional staffing and longer wait times (Ayala et al., 2021). Targeted interventions can alleviate these issues, potentially saving $2 million annually. NHS FPX 6008 Assessment 3 Business Case for Change Addressing homelessness effectively can enhance community relations and attract additional funding. Hospitals engaged in community health initiatives can secure up to 25% more in grants and donations. By successfully managing homelessness, St. Joseph’s Hospital could potentially increase its funding by $500,000 annually, bolstering its financial position and enabling further improvements in patient care. To mitigate financial risks, the hospital should diversify its funding sources. This involves seeking grants, forming partnerships with local nonprofits, and pursuing community donations, which can reduce dependence on a single revenue stream and enhance financial stability (Sykes & Ontario, 2022). Evidence suggests that hospitals with diversified funding experience 20% less financial volatility compared to those relying on traditional sources (Carmichael et al., 2023). Additionally, implementing cost-effective programs such as telehealth services and mobile clinics can lower operational costs while extending care to the homeless population. Telehealth services, for example, reduce healthcare costs by up to 15% while improving access to care (Gutwinski et al., 2021). Lastly, enhancing care coordination through electronic health records (EHRs) and integrated care teams for homelessness can streamline processes and reduce unnecessary expenditures. Effective care coordination can decrease healthcare costs by up to 10% and improve overall efficiency (Klamen et al., 2024). Addressing homelessness through targeted interventions is both feasible and economically beneficial for St. Joseph’s Hospital, leading to significant cost savings and enhanced community

NHS FPX 6008 Assessment 2 Needs Analysis for Change Name Capella university NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Summary of the Economic Issues of Nursing Staff Shortages The economic issue of nursing staff shortages significantly affects various facets of work, organization, colleagues, and the community. As a nursing student, I directly witness the consequences of staff shortages, including increased workloads, longer shifts, heightened stress levels, and challenges in providing comprehensive patient care. This results in fatigue and potential compromise in patient care quality, contributing to frustration and burnout among nursing staff, affecting their overall well-being and job satisfaction (Tamata & Mohammadnezhad, 2022). Nursing staff shortages also affect organizational operations by increasing turnover rates and recruitment difficulties, resulting in financial strain and potential penalties for non-compliance with staffing regulations. The impact extends to colleagues who experience higher workloads, burnout, and dissatisfaction, leading to decreased morale and potential compromises in patient care (Winter et al., 2020). In turn, the shortage affects the community, particularly in rural and underserved areas, by limiting access to timely healthcare services, exacerbating existing health inequities, and impeding efforts to improve community health (Shamsi & Peyravi, 2020). NHS FPX 6008 Assessment 2 Needs Analysis for Change Personal experiences, professional insights, and a commitment to equitable healthcare drive the rationale for pursuing this issue. Clinical observations, conversations with colleagues, and mentor discussions underscore the urgency of addressing staffing challenges. Ensuring every patient receives safe and high-quality care reinforces the importance of tackling these issues. One crucial gap contributing to nursing staff shortages is the mismatch between healthcare workforce demand and supply. Variability in daily staffing levels and nurse burnout exacerbate the issue. Addressing this gap requires investment in workforce development, training, and retention strategies tailored to meet evolving healthcare needs and demographics (Wyk & Nankoo, 2023). Analyzing the effects of financial and economic factors, nursing staff shortages lead to increased operational costs for healthcare organizations due to recruitment and retention challenges. Failure to comply with staffing regulations may result in financial penalties. Despite the economic or financial risks, investment in workforce development and retention strategies yields long-term benefits regarding improved patient outcomes and organizational efficiency. Thus, addressing nursing staff shortages is crucial for enhancing patient care, organizational sustainability, and community health (Winter et al., 2020). Diversity Disparities or Socioeconomic  The economic issue of nursing staff shortages exacerbates existing socioeconomic and diversity disparities, impacting vulnerable populations such as those in rural and underserved areas and minority communities. Due to staffing challenges, research indicates that rural hospitals and clinics need help recruiting and retaining nursing professionals. This shortage disproportionately affects rural and underserved populations, limiting their access to quality healthcare services (Hines et al., 2020). Minority communities, including African American, Hispanic, and Indigenous populations, are disproportionately affected by healthcare disparities. Minority nurses represent only a tiny percentage of the nursing workforce, exacerbating disparities in health outcomes and access to care for minority patients. The underrepresentation of minority nurses contributes to cultural and linguistic barriers that hinder effective care delivery, further widening disparities (Fowler, 2020). NHS FPX 6008 Assessment 2 Needs Analysis for Change Healthcare organizations must implement ethical and culturally equitable solutions to address these disparities. This could involve targeted recruitment efforts to attract nurses from diverse backgrounds to work in underserved areas. Implementing cultural competency training programs for healthcare providers has improved patient satisfaction and outcomes among minority populations. Additionally, offering financial incentives such as loan repayment programs or scholarships for nursing students from underrepresented communities can help address workforce shortages while promoting diversity in nursing (Esu et al., 2021). Moreover, organizations should prioritize community engagement and collaboration to tailor healthcare services to the unique needs of underserved populations. For example, community health worker programs have effectively improved healthcare access and outcomes among minority populations (Patel et al., 2024). By implementing these strategies, healthcare organizations can work towards mitigating socioeconomic and diversity disparities exacerbated by nursing staff shortages. Evidence-Based Sources Nursing Staff Shortages Addressing nursing staff shortages in healthcare settings is imperative due to its profound impact on patient care quality and safety. Research illustrates the correlation between staffing levels and patient outcomes. Their study found a significant increase in patient mortality rates associated with higher nurse-patient ratios in hospital units, highlighting the adverse effects of staffing shortages on patient health. Moreover, the study underscores the importance of adequate nurse staffing in ensuring optimal patient care and reducing adverse events (Assaye et al., 2020). Another investigation into staffing shortages in nursing homes reveals concerning findings regarding daily staffing levels. Their research indicates variability in staffing levels, often falling short of regulatory standards. This shortfall in staffing poses challenges in maintaining quality care and increases the likelihood of errors and adverse events, further underscoring the urgency of addressing staffing deficiencies. Furthermore, their study emphasizes the need for robust workforce management strategies to lessen the impact of staffing shortages on care quality and patient safety (Xu et al., 2020). NHS FPX 6008 Assessment 2 Needs Analysis for Change A systematic review, consistent with the 2018 NSSRN data, examines nurse burnout exacerbated by staffing shortages. It highlights adverse effects like high nurse-patient ratios and increased workloads on well-being and care quality, echoing concerns in the article. The review emphasizes the interconnectedness of staffing deficiencies, burnout, and compromised outcomes, aligning with NSSRN findings. Additionally, it underscores economic costs such as elevated turnover rates and diminished performance, as observed in nurses leaving due to burnout (Shah et al., 2021). Research on interventions for improving the attraction and retention of health workers in rural and underserved areas to mitigate staff shortage. Despite interventions such as educational programs, regulatory measures, and financial incentives, more evidence of their effectiveness is still needed, particularly in low- and middle-income countries. The studies highlight healthcare access and quality disparities due to staffing shortages in underserved communities. Moreover, the findings underscore the importance of community engagement and collaboration in developing sustainable solutions to nursing workforce challenges in rural areas. Addressing these challenges through targeted interventions

NHS FPX 6008 Assessment 1 Identifying a Local Health Care Economic Issue Name Capella university NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Identifying a Local Health Care Economic Issue Rehospitalization is a significant healthcare economic issue with far-reaching implications. These include cost implications, reimbursement penalties, and productivity loss.  This assessment entails a comprehensive discussion on rehospitalization in Florida and its impact on diverse stakeholders. Moreover, the paper will delve into the gap contributing to the need to address this vital economic issue. Healthcare Economic Issue and its Impact on the Population of Florida Rehospitalization refers to a patient’s readmission to the hospital shortly after discharge, often within 30 days, for the same or a related condition. In Florida, about 15% of patients with stroke were readmitted to hospital within 30 days from 2010 to 2013. Moreover, the study shares the result that within 30 days, 12% of stroke patients were readmitted due to vascular abnormalities and 3% due to recurrent stroke (Gardener et al., 2023).   Rehospitalization increases healthcare costs significantly as each readmission entails additional medical expenses, including hospital fees, physician fees, medications, and diagnostic tests. These costs can burden patients and Florida’s healthcare systems, mainly if frequent or preventable readmissions occur (Santiago et al., 2020). Moreover, it needs more healthcare resources that could be allocated to new patients and utilized instead for readmitted patients, potentially leading to delays in care for others. Thus, it impacts the quality of care and limits access to care for the general community of Florida. The Rationale for Choosing Rehospitalization as a Health Care Economic Issue Rehospitalization within 30 days of prior treatment can potentially increase healthcare costs, utilize limited resources, lead to further resource constraints, and impact the quality of care delivered (Santiago et al., 2020). Considering these implications, this issue is selected to focus in this assessment. Moreover, as a nurse at Tampa General Hospital, I witnessed firsthand the challenges patients faced upon discharge and the factors contributing to rehospitalization risk. Despite our best efforts to educate patients about their condition, most fail to adhere to treatment plans, resulting in hospital readmissions. Moreover, the personal values of compassion and social justice also informed me to choose the issue of rehospitalization as an economic healthcare issue so that every patient acquires high-quality care that prevents the need for hospital readmission, which burdens patients and the community of Florida. This is possible by implementing evidence-based care and promoting interdisciplinary collaboration. Impact of Rehospitalization on Work, Organization, Colleagues, and Community Rehospitalization has severely impacted my work, the organization, i.e., Tampa General Hospital, the work of my colleagues, and the overall Florida community. Rehospitalization directly affected the quality of care I provided to my patients. When patients were readmitted shortly after discharge, it was disheartening for both patients and healthcare providers, as it indicated that their health needs were not adequately addressed or managed during their initial hospitalization. The organization incurred higher costs due to escalating rates of hospital readmissions, leading to strained budgets and resources. High readmission rates contributed to increased workload and stress among healthcare professionals, leading to burnout and decreased job satisfaction. The hospital also faced staff shortages during readmission, ultimately impacting the quality of care delivered within the organization. In our diverse community of Florida, rehospitalization tends to have greater impacts on lower socioeconomic groups. Patients from underserved backgrounds often face barriers to accessing follow-up care, medications, and other essential resources after discharge. Limited health literacy, transportation issues, lack of social support, and financial constraints can all contribute to higher rates of rehospitalization among these populations.  Gap Identification Contributing to the Need to Address the Rehospitalization One significant gap contributing to the need to address the economic issue of rehospitalization is the lack of comprehensive care coordination. Studies have shown that effective discharge planning and post-discharge follow-up can significantly reduce the risk of rehospitalization, particularly for patients with chronic conditions (Al Sattouf et al., 2022). The gap in care coordination is particularly pronounced for vulnerable populations, such as those with limited access to healthcare services. These groups often face additional barriers to accessing follow-up care, obtaining medications, and navigating the healthcare system, increasing their risk of rehospitalization. Moreover, the gap due to inadequate transitional care intervention after discharge can be addressed using telemonitoring or telephone calls to prevent hospital readmissions (Al Sattouf et al., 2022). Conclusion Rehospitalization in Florida is a tremendous healthcare economic issue. This issue has led to escalating costs for healthcare systems and patients. The selection of this issue is based on the implications and personal reflections gained from relevant experience of confronting rehospitalization and its aftermaths. Moreover, it has impacted my work, organizational workflows, staff burnout and community at large. The identified gap of lack of coordinated care and proper transitional support during and post-discharge lead to higher rehospitalization. This gap must be addressed to resolve the issue of hospital readmissions. References Al Sattouf, A., Farahat, R., & Khatri, A. A. (2022). Effectiveness of transitional care interventions for heart failure patients: A systematic review with meta-analysis. Cureus, 14(9). https://doi.org/10.7759/cureus.29726  Gardener, H., Romano, J. G., Derias, T., Gutierrez, C., Asdaghi, N., Johnson, K., Gordon Perue, G., Marulanda, E., Brown, S. C., Foster, D., & Rundek, T. (2023). Early hospital readmission following stroke: The Florida stroke registry. Frontiers in Stroke, 2. https://doi.org/10.3389/fstro.2023.1238442  NHS FPX 6008 Assessment 1 Identifying a Local Health Care Economic Issue Santiago, M., Magro, F., Correia, L., Portela, F., Ministro, P., Lago, P., Trindade, E., & Dias, C. C. (2020). Rehospitalization rates, costs, and risk factors for inflammatory bowel disease: A 16-year nationwide study. Therapeutic Advances in Gastroenterology, 13, 175628482092383-175628482092383. https://doi.org/10.1177/1756284820923836