IN NEED OF IMPROVEMENT? You are an administrative staff specialist newly employed by the hospital to act as a management engineer and address a number of issues relating to operating efficiency. Your first assignment is to analyze work methods and staffing in the central sterile supply division of materials management. The department was singled out for study for the following reasons: The manager --- a registered nurse who has held the job for more than 25 years --- has requested two more processing aides, although her staff is already one person larger than that of another area hospital of equivalent size. There has been a recent, seemingly unexplainable, upturn in the consumption of disposables. A number of storage shelves appear to be stocked to overflowing with infrequently used items. The department issues frequent rush orders to obtain needed items that have completely run out. Observed conditions in the department include an overcrowded storage area, a seemingly inadequate decontamination area, and a grossly oversized processing area referred to by most employees as \"the ballroom.\" On your initial visit to the department, the first thing the manager says to you is, \"So you're the one who's going to tell us what we're doing wrong?\" Her tone is none too friendly. Instructions Develop a proposed approach to a complete study of the department, including the \"sales pitch\" you would use to try to win the manager's cooperation and support, specifying what should be done, why it should be done, and how you propose to address the inevitable resistance of both manager and staff. THE PATIENT PROTECTION AND AFFORTDABLE CARE ACT OF 2010 The major legislation known as the Patient Protection and Affordable Care Act of 2010 promises to affect the health care system at all levels. Middle managers will need to utilize all of the strategies described in the chapter to deal with the massive changes associated with this legislation focusing on the provision of affordable care and health care reform. They need to take into account the political aspects of the legislation's passage, which are likely to lead to further amendments, deletions, and changes in its implementation time frame. The federal mandates, in turn, will generate companion state-level legislation. More than 100 regulatory agencies, boards, and councils are empowered to issue guidelines and mandatory regulations. The designated time frame for the implementation of the federal law is from 2010 to 2018. Thus we face an almost decade-long period of sustained change. The middle manager who has a positive attitude will more easily respond to these challenges than one who is resistant. Flexibility, creativity, attentiveness to the unfolding mandates --- these traits will serve the manager well. A commitment to factual analysis will lead the manager to develop a system for monitoring the details of the new law. For guidance, the manager should turn to trusted sources, such as professional associations--- especially these organizations' legislative divisions, which monitor primary documents such as federal and state regulation publications. The manager might partner with several peers in the work setting to study the unfolding mandates and share insight about their impact. Following is a suggested template for use in tracking these changes. A few examples are included under the headings as a starter. Impact on the organizational setting Increase in community health centers Development of independence -at - home programs Creation of community- base transition programs for Medicare patients at high risk for readmission to acute care Phasing out of physician-owned specialty hospitals Patterns of Care Implementation of wellness programs and preventive care (e.g., smoking cessation counseling) Wellness care incentives Increased emphasis on coordination of care for all stages of care Creation of medical homes or health home programs (i.e., a decentralized coordinator of care) for chronic illness ( Note: The term \"homes\" is not used to denote a place to live; in this context, it means the primary caregiver who coordinates various aspects of care including referrals to specialists.) Practitioners Increased funding for training Increased utilization of physician assistants and nurse practitioners Increased roles for pharmacists in direct counseling of patients concerning medication management Clients Increased numbers as individuals come under new health insurance coverage Surge in demand for specific services as coverage for thee services unfolds (e.g., free annual physical exam) Increased need for client education about the details of coverage and the time frames associated with various benefits (e.g., preexisting conditions coverage starts in 2010 for children, but does not begin for adults until 2014) Increased need to capture eligibility data (e.g., income levels, prescription medication expenses for the benefit period, Medicare or Medicaid coverage) Increased sensitivity to patients' concerns about their coverage and their continued access to care Employees Need for timely information about changes in health insurance coverage, copayments, and deductibles Need for annual information (on W-2 forms) about the dollar value of the health insurance fringe benefit Concern for job security when the organizational setting changes Questions about job rotation (e.g., if mergers occur or if community-based programs are developed, will the employee be obliged to rotate among various geographic locations?) Need for more frequent continuing education (e.g., intake processing and health insurance questions) Specific System Impact Budget adjustments to include resources for more frequent continuing education Increase in fraud detection processes Increase in monitoring and reporting of elder abuse Increase in patient-centered outcomes standards research and studies Increase in monitoring of discharge planning, coordination of care, readmission rates, and supportive rationales