Final Pocahontas Memorial Hospital Clinic Report

Running head: POCAHONTAS MEMORIAL HOSPITAL CLINIC REPORT 1

Pocahontas Memorial Hospital Clinic Report

Chelsey Bertram

HCM 580 – Organizational Management Strategy and Execution

Colorado State University – Global Campus

April 19, 2016

Dr. Bradley Beavais

POCAHONTAS MEMORIAL HOSPITAL CLINIC REPORT 2

Pocahontas Memorial Hospital Clinic Report

Pocahontas Memorial Hospital (PMH) in Pocahontas County, West Virginia, has decided

to look into the feasibility of building a satellite clinic as part of the annual strategic planning

process. The clinic would be to help expand care to the over 9,000 residents of this over 900

square mile rural county (Capstone Project Case Study Information, n.d.). This report was

conducted to asses if this was a possible along with any recommendations for this project’s

feasibility.

PMH is a hospital with core values and a mission statement focused on improving

healthcare through education, compassion, best practices, and a positive culture within the

organization (Pocahontas Memorial Hospital, n.d.). The hospital already runs a clinic within the

hospital that provides laboratory services, vaccinations, and monthly clinic focused on different

diseases. The rural population of Pocahontas County faces many challenges in obtaining much

needed healthcare. There are financial challenges; many people live in poverty, making it

difficult to pay for healthcare or have no health insurance. They also face transportation

challenges, little to no public transportation and challenging roadways, making it difficult to get

to appointments or get to care when needed (US Department of Health and Human Services,

2013). The mission of PMH is to provide care and a satellite clinic would provide healthcare to

residents not living in close enough proximity of the hospital.

Assessment of Satellite Clinic

To determine if this satellite clinic is possible there needs to be an assessment looking at

various parts. The internal and external stakeholders will need to be identified, as well as,

foreseeable challenges. A market analysis and a SWOT (Strengths, Weaknesses, Opportunities,


and Threats) analysis will be conducted to look at other important areas that will influence this

project.

Stakeholders: Internal and External

Stakeholders are people who have an interest in the organization. They can be within the

organization or people outside the organization, the important detail is that these people are those

that care about the organization and are affected by any changes. The stakeholders are those that

should be involved with any strategic changes, perhaps not each individual person in large

organizations, but their opinion should be registered (Ginter, Duncan, & Swayne, 2013).

Internal Stakeholders. Internal stakeholders are those people that work or are affected

by changes directly within the hospital. For PMH there are four groups of internal stakeholders:

employees, patients, families of patients, and the Executive Board or Board of Directors.

Employees for PMH will be the one of the first affected by the satellite clinic. Some employees

may be able to work closer to home if they are able to transfer. Others will notice the anticipated

workload change, becoming lighter. But all level of employees from orderlies and cafeteria staff

to physicians will notice the change (Ginter, et all, 2013).

The current patients will see changes as well. These patients may be able to receive care

closer to their home, making it more encouraging to receive the care they need. Others that are

closer to the hospital and the current clinic could see less of a wait time, since there would be

fewer patients using the same facility. This could encourage patients to seek care, as it doesn’t

take as long to receive care.

The families of patients are also stakeholders. This is because the families assist with care

at home in many cases, thus if a person can receive care easier and quicker than before, the care


at home can be supported. Also since many families in rural American communities share or

have limited vehicles for transportation, there would be less drive time with the satellite clinic,

thus limiting interference with other family member’s work and school schedules (Cook & Hoas,

2008).

The Executive Board or Board of Directors has a vested interest in the potential satellite

clinic since they make most of the decisions regarding strategic planning. The Board would want

to know and be assured that this change would continue to support the mission statement of the

organization and fund the hospital. For many healthcare organizations funding is a large concern

(Healthcare Financial Management, 2013).

External Stakeholders. Stakeholders outside the organization also need

acknowledgment since the change influences them and they can influence the change. For an

organization like PMH the community of the whole county is a stakeholders, as well as, potential

donors or investors for the clinic. The community will more than likely be full of patients or

potential patients, but as a whole they can influence the decision. Research supports the idea that

the community be involved in the decisions about clinics and healthcare support, especially in

rural communities. Town hall type meetings or other open forums allow the members to speak

up on either side of the decision (Farmer & Nimegeer, 2014).

The potential donors or investors are the people who ultimately make the clinic happen,

since without funds the clinic couldn’t happen. They want to be assured that they would get a

return on their investment or the donation will be used in a way they approve. Thus proposals

would need to be presented and potentially adjusted to suite all involved with the clinic (Ginter,

et all, 2013).


Environmental Challenges

For a project like this proposed satellite clinic for PMH, there needs to be a realization

about the challenges that are currently being faced and those that can be face at this new clinic.

Staffing challenges such as work load and equipment that is out of date, funding challenge and

community involvement are the biggest challenges. These will impact the already struggling

staffing problem.

Staffing Challenges. Many people who work in healthcare do report that since there is a

shortage of staff, the work load is extremely difficult to handle. PMH has a patient to doctor

tratio of 8,508 to 1, meaning there are about two physicians in the county. This ratio is higher

than the overall nationwide ratio (Capstone Project Case Study Information, n.d.). There is no

current data for PMH on the ratio of nursing staff and other members of a healthcare team to

make a full assessment of workload. But to follow the trend nationwide, there is shortage is all

levels of healthcare staff. The lack of employees creates more work for those that are employed

at the hospital. This overload leads to low retention rates, mental health illnesses including

depression and anxiety for staff, and poor work habits (Darkwa, Newman, Kawakab, &

Chowdhury, 2015).

The staff many times deals with old equipment or inadequate equipment, this too affect

workload. If the machines designed to help with testing don’t work properly or isn’t available in

the center, then staff may wait for the machinery to be fixed or develop another test that may not

be as accurate. This increases workload. Many healthcare personal who work in rural

environments report that having inadequate equipment is one of the hardest parts of working in

the environment because it adds to their already large workloads (Darkwa, et all, 2015).


Funding. Many rural healthcare organizations do not typically acquire large enough

revenue to support expansion or updating much of the equipment. The organizations support a

smaller population that usually has government funded healthcare, verse counterparts in urban

areas that have a larger population that can be insured through a private insurance company thus

larger revenues. This is especially challenging as healthcare has been moving towards the focus

of better quality care for lower costs (Solving the rural healthcare revenue conundrum, 2013).

Community Involvement. The typical rural community is very close and doesn’t like

change; they also have fear about healthcare because of the cost associated with it. The satellite

clinic will need community members to use it, to make it worthwhile. The community may be

more aware of what exactly the clinic should provide, since the community members may be

more in tune with challenges that they themselves or neighbors deal with in regards to healthcare

such as substance abuse or diabetes (Farmer & Nimegeer, 2014).

Market Analysis

As Pocahontas Memorial Hospital is looking at creating a new rural healthcare clinic in

the county it is important to look at the market and create a full analysis to make a decision. A

market analysis is made up of five different parts: an overview of the industry, target market,

competition, projections, and any regulations related to the market.

Overview of Industry. The healthcare industry has been going through many changes

due to new laws or acts and increased public interest. But it continues to be an industry of

growth. That is because the United States continues to increase spending on healthcare while

underperforming when compared to other developed countries. The United States fails to achieve

better health outcomes than countries like the United Kingdom, Switzerland, and Australia. In


four editions of a report by The Commonwealth Fund, the Untitled States finished last or near

last in many categories like access to care, efficiency and equity of healthcare (2014). The

United States spends $4,197 per capita on healthcare, more than double for the Organization for

Economic Co-Operation Development (OECD) average (OECD, 2015). The passing of the

Patient Protection and Affordable Care Act (PPACA) is expected in decrease cost for both

individuals and the government overall, while increasing quality of care, leading to an increase in

quality of life (The Commonwealth Fund, 2014). That can be part of the motivation of

Pocahontas Memorial Hospital’s interest in creating a clinic.

Target Market. For PMH is the only hospital in the whole county for 9,131 residents,

according to the 2010 Census. Thus the market is the residents of this small rural county in West

Virginia. The population is majority Caucasian with limited/lower income levels – the median

income is $26,401 per household (Capstone Project Case Study Information, n.d).

Analysis of Competition. PMH is the only hospital in the county, but it does not mean

there is no competition. The six counties surrounding Pocahontas County all have county

hospitals, which many be more convenient for the residents living at the opposite end of the

county to travel to. A cursory look at the hospitals it appears that the other hospitals are all of

similar (small) size with similar challenges regarding market. There also appears to be no private

practices in the county for additional competition (County Health Roadmaps & Rankings, n.d.).

But that does not mean that the hospital needs to become lax about care or competition, a

hospital still needs to strive to improve health while overcoming their challenges.

Projections. Healthcare is in a period of change, especially with the PPACA requiring

residents to have health insurance or face stiff penalties from the federal government, thus


meaning healthcare organizations will see an increase in patients (The Commonwealth Fund,

2014). The idea of reaching Pocahontas County residents, who do not live in the direct area of

Pocahontas Memorial Hospital, would increase the number of patients seen. The healthcare

industry is expected to continue to grow in the future, even with the projections of staffing

shortages in most areas, including the United States (The Commonwealth Fund, 2014).

Regulations. The healthcare industry has many regulations protecting patients in many

aspects of their care, but the operation of a rural clinic has its own regulations. The Centers for

Medicare and Medicaid Services (CMS) has a long list of regulations that must be followed in

order to receive payment from Medicare and/or Medicaid. The regulations require compliance

with any and all federal, state, and local laws that affect healthcare, the location, the building, the

responsibilities of staff, even how the clinic is evaluated. In recent edits the staff of a rural clinic

or center needs to be compromised of at least on physician and one physician’s assistant or nurse

practitioner, plus the option to have a social worker and a certified mid-wife (Centers for

Medicare and Medicaid Services, 2015).

SWOT Analysis

A SWOT analysis looks at various aspects both within an organization and the external

environment. SWOT breaks down to: Strengths, Weaknesses, Opportunities, and Threats to the

Organization. This is one of many analyses an organization can conduct on themselves when

preparing for a strategic change (Ginter, et all 2013).

Strengths. For PMH there are three strengths for the hospital, they are all points coming

from within the organization. The first is the focus the organization has on creating a healthy

lifestyle. It is a part of the mission statement for PMH (Pocahontas Memorial Hospital, n.d.).


Another strength is how the hospital already has the clinic within the hospital providing many

different items such as laboratory services, rotating clinics, and immunizations (Capstone Project

Case Study Information, n.d.). This shows how, the proposed satellite clinic would have an

example to follow. The final strength is how the ratio of physicians to patients is higher than the

national average, showing that the hospital has a positive reputation within a medical community

and the Pocahontas County (Capstone Case Study Information, n.d.)

Weaknesses. Even with the great strengths, there are weaknesses there too. The first is

the small size of the hospital; it is only 25 bed and low trauma level – level 4 (Capstone Case

Study Information, n.d.). If there was any form of large scale tragedy the hospital may not be

able to handle the situation. The next two are weaknesses from the environment that directly

weaken the hospital. The rural environment makes transportation a challenge for residents to

attend appointments (U.S. Department of Health & Human Services, 2013). This makes it

difficult for the hospital to maintain full schedules, supporting the revenue (Capstone Case Study

Information, n.d.). The last is the already apparent national shortage of healthcare professionals,

which is even more challenged in a rural environment. (U.S. Department of Health & Human

Services, 2013).

Opportunity. PMH does also have areas that can be beneficial. The first being how

PPACA is expanding Medicaid benefits to more people, which would increase the number of

potential patients to the hospital, even with the low reimbursement rate, could increase revenue

(U.S. Department of Health & Human Services, 2013). There are also federally based

organizations that provide funds for rural communities to help focus on healthcare which can

help with the expansion of the satellite clinic (U.S. Department of Health & Human Services,

2013).


Threats to the Organization. All organizations can be threatened by external forces.

PMH is not without threats. The first is the average income for Pocahontas County of $26,401 a

year (Capstone Case Study Information, n.d.). The lack of means to cover the cost of healthcare

threatens the organizations ability to have a sufficient budget. There are many times that

hospitals have to absorb the cost of care when insurance or an individual cannot pay for it, there

is a higher risk of this when the average population is of a lower socioeconomic status. The other

threat is the strictness of the CMS regulations for rural healthcare clinics. It is highly important

for any healthcare organization to follow these rules to be reimbursed by Medicare and/or

Medicaid (Centers of Medicare and Medicaid Service, 2015).

Recommendations and Implementation

In order to decide if this clinic will work, there needs to be solutions created to overcome

challenges such as those discussed above, as wells as recommendations for value adding

support, plans for implementation – both short and long term, and suggested evaluations and

benchmarks for this project.

Strategies for Potential Weaknesses or Threats. The first weakness is the small size of

the PMH. The current size of the hospital is 25 beds (Capstone Case Study Information, n.d.).

One way that the hospital is looking at overcoming that weakness is the proposed satellite clinic,

which would increase the number of patients the hospital system can care for. The second

location would help patients located in other regions of the county; PMH is located in the

southeast region (Capstone Case Study Information, n.d.). But with the current plan of expanding

via the satellite clinic there is little chance of expanding the current hospital’s capacity.


The second threat is the strict regulation from the CMS on rural health clinics. The

document on describing all details of the clinic must be followed in order to receive

reimbursement for care of patients with Medicare and/or Medicaid (Centers of Medicare and

Medicaid Services, 2015). The best way to overcome this challenge is to review the most current

version of the document and follow the regulations step by step.

The third weakness or challenge is the rural environment of Pocahontas County. The

rural area compromises patients ability to receive any form of care (emergency or regular care)

(U.S. Department of Health & Human Services, 2013). The proposed satellite clinic would help

those patients living in areas far away from PMH, as long as this clinic becomes a reality. If the

clinic doesn’t happen, one way to assist with this challenge would be to provide phone or email

appointments for questions or care that doesn’t require physical testing or examination.

One more threat or weakness is the lower socioeconomic statues of the county. This lack

of funds of the population affects the budget of the hospital. If the hospital overall budget does

not provide funds to build a clinic that will be a challenge. But there are some ways to assist the

organization reach its goal. The key is to work with the community to make it be a part of the

new clinic. Some hospitals have reach out to local banks to process the loan with success. Others

reach out to large volunteer organizations (like Rotary Club) that have chapters nerby, with the

ability to donate a larger sum of money from the organization as a whole (Nayak, 2013). It may

take a combination of these and other tools to help raise the funds needed to start on this

endeavor.

The last treat or weakness is the shortage of healthcare employees, even though PMH’s

physician to patient ratio is above that of the nation, there is no statement of the number of other


healthcare providers like nurses, technicians, and therapists (Capstone Case Study Information,

n.d.). The rural environment of Pocahontas County adds to the challenge; there is a lower rate of

retention for rural environments for healthcare professions. The biggest complaints from

healthcare workers in rural environments steam from higher workloads, inadequate equipment,

and culture. Some ways of encouraging employees to stay include pay and/or benefits package

and having equipment that is of good quality that would be higher or in line with those seen in an

urban area. The equipment at bare minimum must pass the same level of quality assurance and

control when tested by an outside facility (Olusegn, 2012).

Financially based incentives aren’t the only items that work and do not always work,

especially since many rural environments have limited budgets. One of the best ways to attract or

retain employees is to recruit employees from a similar rural background. The employees that

come from a similar background have an understanding of the culture and the challenges that are

a part of a rural community, thus there will be less of a “culture shock” (Darkwa, Newman,

Kawkab, & Chowdhry, 2015).

Feasibility for Development of the Satellite Clinic. The feasibility of this project is

very dependent on two large details: funding and staffing. The research supports the various

ways presented to reach this goal, so yes the hospital could happen, if those two details are

completed. There are of course other important details like following the CMS regulations that

need to be followed, but following regulations is an easier challenge then finding staff and initial

sources of money for the clinic.

Value-Adding Strategies. Value-adding strategies are a way of going “above and

beyond” the requirements or standard practices. They can be done pre-appointment, at the


appointment, and post-appointment (Ginter, Duncan, & Swyane, 2013). Pre-appointment

strategies should include the option to make appointments through an online calendar, slots of

time saved for patients who need an appointment the next day or walk it, and the ability to

collect basic information before the appointment to easy traffic and make it more convenient.

During the appointment using a timing or computer system that minimizes wait times for patients

in either the waiting room or in the actual office, comfortable and sanitary wait rooms, and space

for parents, spouses or family members to be in the appointment room if the patient needs or

wants someone there with them, all would add value to the clinic. Finally, after the appointment

staff can call after a set number of days to remind of any follow up appointments and schedule,

answer any questions the patient may have, or follow up about taking medications either

currently being used or recently taken. There can even be an email account for the clinic or

individual providers so patients can email regarding small questions after the appointment.

Strategic Initiatives. The strategic initiative of PMH is to help increase the availability

of care to the members of the county through the proposed satellite clinic. This strategic decision

allows the organization to focus on strengths such as high ratio of physicians to patient and the

desire to help create health lifestyles for their patients. Then use that edge and continue forward

to help overcome the previous mentioned weaknesses or threats. The clinic supports all

stakeholders by providing care to community members, provides job security to employees, and

helps the community overcome the health challenges the community faces.

Short-term plans for implementation. In order for the plan to be successful, there are

some items that need to be addressed. Funding needs to be secured from any and all sources that

have already been discussed. The community needs to be informed and allowed to speak, town

hall meetings have been suggested as a way to do both items at once (Farmer & Nimgeer, 2015).


There needs to be a decision about location and type of clinic: mobile versus stationary, done by

the board or the team selected for this project. This decision would affect the number of

employees, type of employees, and equipment needed. If the decision is for the clinic to be

freestanding, then a contractor would be needed for the building or the renovation of location.

These are all items that are needed to be successful for the satellite clinic.

Long-term plans for implementation. Once the short term plans have been

implemented and decisions made, the success of the organization and project depends on other

items. The first will be a plan on how to recruit employees for the clinic; this will probably be a

plan that needs to be constantly running to avoid shortages in staffing. Another plan needs to be

the marketing plan, showing the county that the clinic is open and the various options available

like the other clinic. There also need to be contracts with insurance companies, even though the

population is low-income, qualifying for Medicaid, with ACA there are other insurance

companies available to residents.

Evaluations and benchmarks. Every project needs places and ways to make sure the

project is preforming to standards and allow for changes to reach those marks. For the satellite

clinic there needs to be a timeline established keeping the team(s) on track with the end result of

opening. Items to be included would be funding, purchasing land, securing equipment, hiring

employees, and a timeline just for building the clinic. Once the clinic is running there needs to

ways to make sure this project is up to PMH standards of care by comparing it to the current

standards of hospital and its clinic. One would be patient satisfaction ratings through mailed

surveys. This option is low cost, but allows for the organization to receive feedback. An

important detail is the need to write the questions so they are easy to understand by majority of

the patients (Berkowitz, 2011). Another benchmark would be to prove the clinic is being used.


This can be done with a computer system marking out appointments and rooms (Joshi, Ransom,

Nash, & Ransom, 2014). Finally, a comparison of lab testing needs to be done, by comparing

turnaround time to the other clinic, other clinics in the area. There also needs to be a quality

assurance that the test results are correct, by using an outside party to verity results regularly

(Olusegun, 2012).

Conclusion

After conducting research on PMH, the business environment, and potential challenges

there were some items that needed to be addressed in order for the satellite clinic to be feasible.

The challenges can be overcome with work, which makes this projected clinic feasible. There do

need to be plans set in place for both short and long term implementation as well as benchmarks

to prove the benefits of the satellite clinic in Pocahontas County.


References

Berkowitz, E.N. (2011). Essentials of health care marketing. Jones and Bartlett Learning.

Cook, A.F. Hoas, H. (2008). Ethics and rural healthcare: What really happens? What might help?

American Journal of Bioethics, 8(4), 52-56. Doi:10.1080/15265160802166009

Capstone Project Case Study Information [Word]. (n.d.).

Centers of Medicare and Medicaid Services (2015). Retrieved from

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/

GuidanceforLawsAndRegulations/RHC.html

County Health Roadmaps & Rankings. (n.d.) Retrieved from

http://www.countyhealthrankings.org/

Darkwa, E., Newman, M.S., Kawkab, M., & Chowdhury, M.E. (2015). A qualitative study of

factors influencing retention of doctors and nurses at rural healthcare facilities in

Bangladesh. BMC Health Services Research. 15(1), 1-12.

Farmer, J. & Nimgeer, A. (2015). Community participation to design healthcare services. BMC

Health Services Research, 14(1), 130-139. Doi:10.1186/1472-16963-14-130

Ginter, P. M. (2013). The Strategic Management of Health Care Organizations (7th Ed.). San

Francisco, CA: Jossey-Bass.

Joshi, M., Ransom, R., Nash., Ransom, S.,(2014) The Healthcare Quality Book: Vision, Strategy,

and Tools (3rd ed.). Chicago, Illinois: Health Administration Press

http://www.countyhealthrankings.org/

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/RHC.html

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/RHC.html


No Author (2015) Compare your country. OECD. Retrieved from

http://www.compareyourcountry.org/health?cr=oecd&lg=en

No Author. (2014). Mirror, Mirror on the Wall, 2014 Update: how the U.S. healthcare system

compares internationally. The Commonwealth Fund. Retrieved from

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

Olusegun, A.P. (2012). Improving lab services and workforce in rural health facilities. Journal of

Pakistan Medical Students 2(3), 103-108

Pocahontas Memorial Hospital (no date). Retrieved from www.pmhwv.org

Solving the rural healthcare revenue conundrum. (2013). Healthcare Financial Management,

67(1), 132-3. Retrieved from https://csuglobal.idm.oclc.org/login?

url=http:search.proquest.com.csuglobal.idm.oclc.org/docview/1282582598?

accountid=38569

U.S. Department of Health & Human Services. (2013). The affordable care act: What it means

for rural America. Retrieved from

http://www.hhs.gov/healthcare/facts/factsheets/2013/09/rural09202013.html

http://www.hhs.gov/healthcare/facts/factsheets/2013/09/rural09202013.html

https://csuglobal.idm.oclc.org/login?url=http:search.proquest.com.csuglobal.idm.oclc.org/docview/1282582598?accountid=38569



http://www.pmhwv.org/

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

http://www.compareyourcountry.org/health?cr=oecd&lg=en

Final Pocahontas Memorial Hospital Clinic Report

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Transcript of Final Pocahontas Memorial Hospital Clinic Report