You are an Assistant Administrator at Best Start Health Care System. The organization is a mid-sized teaching
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You are an Assistant Administrator at Best Start Health Care System. The organization is a mid-sized teaching hospital with an affiliation to a regional medical school. Recently, you attended a meeting with the hospital's Chief Operating Officer (COO), the Director of Quality Management [your immediate manager], Director of Nursing Services, Manager of System Analytics, Assistant Director of Pharmacy, and the Chief Medical Officer to discuss a recent internal audit. This audit identified two key areas that significantly underperformed: ? Hospital - Acquired Infection Rates ? Medication Errors During the meeting it was revealed that the Best Start Health Care System has an anticipated accreditation inspection from Joint Commission within the next twelve to eighteen months. The Manager of System Analysis shares data associated with each of the two areas in question. The Chief Medical Officer states that each year in July new physician Fellows or Residents start yearly rotation, and the on-boarding new Fellows is resource consuming. The Director of Nursing Services voices their opinion that nursing staffing is a challenge during the Christmas Holidays, and as a result the usage of travelling nurses at the institution increases by 15% each December. Based upon the impending inspection it was noted a plan of action needed to be established. The group's decided the following action(s) needed to be taken: ? Meet in thirty days with a general plan of action. ? Assign a point person to develop a list of recommendations, and educate the team on the importance of Continuous Quality Improvement within a health system ? The Director of Quality Manager and his team will lead the effort Post-meeting, the Director of Quality Management and you huddle to discuss the actions that need to be taken. S/he designates you as project leader. As project leader you will generaye an approximate five-page executive summary (paper) with the following content considerations: ? ? Provide a summary of recommendations for next steps. ? Other Considerations: o Feel free to provide a timeline or supplemental slide deck (not required). o What questions would ask the stakeholders at the next meeting (i.e., support materials or resources)?
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