Executive Summary
For the continuous initiative of the Hospital Authority (HA) to improve the population growth, enhance the healthcare system sustainability, improve service of the quality of the service and the clinical governance, and build the capability of the human resource, the government provide fund since 2001. According to the annual plan of HA in 2006, the Government provided only 1% growth for the increase of the ageing population. In this case, HA is encountering financial problems due to the budget cut and to the SARS outbreak in 2003. The impact of the budget and problems in the manpower should be properly analyzed so that it can maintain the service quality. Furthermore, the HA had focus on the effort for the preparation to the disease outbreak and for the protective measures of the staffs for the past years (HA 2006). In relation this facts, I want to research and make an investigation regarding the direction of the HA.
For the current practices in the OT, a general anesthesia is needed by 70% of the patients. This is the reason why the there is in need to have a two pieces of suction tubing. The pneumonia and infection can also acquired trough the unclean suction tubing. After the operation, there are many staffs that is being needed for the cleansing and cleaning of the suction tubing that will be use for the next operation. Including in the staffs are the OT nurse, the operating theater assistant (OTA), and the General Service Assistant (GSA). This is vulnerable to the risk infection and ca lead to disease. The use of the disposable suction tubing is globally used that is why it is highly suggested. Then, I must investigate the use of the disposable suction tubing and its feasibility.
This investigation has a methodology of various analyses on the replacement of the reusable suction tubing to the disposable one. Every analysis in using the disposable suction tubing can decrease the number of the workload of the staffs, lessen the manpower and reduce the risk of infection.
The economic analysis also had been done so that it can come up to the comparison to the options, to the financial appraisal, to the analyzation on the criteria of benefits and its cost. This also includes subjective and objective data which will serve as the basis upon the proposal to the department.
The recommendation of the preferred options also been advice and some sort of evaluation and conclusion had been done in order to attain the project objectives.
Managing Finance in Health and Social Care Organizations
An Evaluating Report for a Business Case
Part I: Business Case
Project Title
To replace the existing reusable suction tubing with disposable one in Operating Theatre (OT) for the operation and the General Anesthesia procedure (GA). In order to comply with the infection controls measures and diminish reprocessing of reusable items to reduce staff workload and fully utilize the financial resources.
Introduction
The proposition of the business case is one of the important factors to present in the senior managers. This will impart the full blueprint that will give reason in order acquire the new item and a new idea which will be at the budgetary limit. It cannot be denied that HA is facing hindrances due to the budget cut every year. For the past five years HA had decreased for .5 billion while the GDP stayed low and compared to the other countries in the OECD or Organization for Economic Co-operation and Development (HA,2006). Furthermore, during the SARS outbreak in 2003 this made to be a great impact in the control measure of the infection. In this manner, the clinical procedures and the equipments needs to analyze so that there will be a betterment in the resources and in the utilization as the procedural area having which has high risk including Operating Theater (OT). The head manager should a wide knowledge and to think of the best and efficient way to gain productively so that the organization financial planning will enhance. This business case will then give practicable, effective, rational, and fair information analysis in order for the department to make a better decision in changing the existing practice of using the reusable suction tubing with the aide of the procurement, the financial adjustment, and the management of the human resource. Additionally, it also is emphasize the staff’s occupational risk and the control risk to the infections.
Project Objectives
One of the most common reasons for developing a business case is as a response to increasing workload or a need to introduce new methods into the service (Galloway, 2004). The objectives of the project are faced with two big directions: cost saving and infection control.
Ø To alleviate the manpower shortage problem
Ø To reduce the costing when using disposable items by eliminating the re-processing of the reusable items
Ø To improve standard of care by reducing the risk of cross infection when handling the soiled reusable items.
Ø To catch up the modern trend in using the single use item in operation.
Ø To minimize staff exposing to chemical disinfectant so as to enhance occupational safety.
Background
Current practice
In daily operation, all the patients going to the OT for operation and 70% of the patients need general anesthesia. Therefore one or two pieces of Suction tubing will be used for each case. Wound infection or pneumonia may be induced by the unclean suction tubing which may prolog patient’s hospital stay and increase the hospital expense for the prolong stay and the drug used . As a result, the disinfection of the soiled suction tubing is very important in order to diminish the risk of infection. After the operation, the OT nurse and the operating theatre assistant (OTA) will send the used and soiled suction tubing to the instrument washing room. They connect the suction tubing to the water tape and perform the preliminary rinsing and washing. Then, they will pass these tubings for the instrument nurse and the General Service Assistant (GSA) for further washing either by hand or the washer. As there are over 30 tubings used everyday, and the machine has only two outlets for the tubing washing, so over 80% of the tubing are washed by hand. The cleanliness depends on the handlers, there is no standard time for washing, and they just wash away the visible dirt such as blood or secretion. The concentration of the detergent is also hard to maintain for the manual washing. During re-processing, appropriate personal protective equipments (PPEs) must be worn to prevent cross infection. The workflow is shown on diagram 1.
Diagram 1: The workflow on the existing practice
4. Internal Analysis
Situational analysis
The use of the situational analysis will determine the first step in planning so that the department will determine the existing situation and also can forecast the future plans. In this manner, it can also refer the advantages and disadvantages, the implication, and influence of the suggested method. To show comparison on the use of the disposable and the reusable suction tubing, they are shown in the Table 1.
Table 1: Situational analysis of the two circuits
Current situation
(using reusable suction tubing)
Future situation
(using disposable suction tubing)
Service
Ø Purchase yearly
Ø Reprocessing is required
Ø Purchase yearly for each year’s stock
Ø No reprocessing is necessary
Patient
Ø Sometimes visible dirt found
Ø Foul smell from the tubing especially those tubings used for the intestinal obstruction
Ø Higher chance of infection
Ø Quality of tubing assured including the sterility, cleanliness and the odor free
Ø
Staff
Ø OT nurse
Ø OTA
Ø Instrument nurse
Ø GSA
Ø OT nurse
Ø OTA
Consumable
Ø Reusable suction tubing
Ø Plastic bags
Ø Sterilization indicators
Ø Personal protective equipment( PPEs)
Ø Disposable suction tubing
Estimated cost
(per year)
Ø Personnel involved:
Ø OT nurse
u 10% of the workload of OT Nurse~ HK,000
Ø Instrument nurse
u 10% of the workload of instrument Nurse~ HK,000
Ø OTA
u (10% of the workload of one staff ~ ,000)
u Instrument nurse
u GSA (10% of the workload of one staff ~ 00)
Ø Consumable involved:
Ø Reusable suction tubing
n 120 set per year
ÞHK per set
Þ cost HK$ 10,800/ year
n plastic bag
~HK$ 1,500per year
n Sterilization indicator~HK,500
n PPEs
~HK,000
n Machine ( Washer, sealing machine, Sterilizer maintenance fee ~HK,000
Ø Total costing per year: ~HK,700
Ø Personnel involved:
Ø OT nurse
u 5% of the workload of one staff ~ HK$ 12,000
Ø OTA
u (5% of the workload of one staff ~HK ,000
Ø Disposable suction tubing
n 8,000set per year
ÞHK.8 per set
Þ cost HK$ 78,400/ year
Ø Medical waste:
n ,000 per year
Total costing per year: ~HK,400
Health policy
Ø Infection risk on handling of soiled circuit
Ø Infection risk on the disinfection process
Ø Infection risk on handling of soiled circuit
Ø Infection risk on handling medical waste
Situational analysis suggests:
A. To diminish the costing through the elimination of the reusable suction tubing which is from HK,700 to HK83, 400 this can save up to HK6, 300 yearly.
B. There is no workload for the instrument nurse and there are no workloads in the General Service Assistant (GSA). In this manner they can do other work and services in the hospital. Generally, there is no need for the services of the Instrument nurse and to the GSA.
- There is a lesser infection risk because of the small percentage of handling the suction tube as well as handling the disinfectant
- Cleaning and cleansing is not applicable also
Nevertheless
- Additional item is needed and it is consumable
- The waste on the medical procedures can also become larger
- There is huge impact on the protection of the environment
Risk of infection
There is a risk of infection in the use of the disposable suction tubing due to the improper waste management. This can also be hazardous that will constitute an additional infection in handling and in the staff as well as to the environment for using the suction tubing (Ireland, 2006). In the way the staff handles the consumables, there is a high in need of using the Personal Protective Equipments (PPEs) for the protection and for the prevention to the infection. The basic yet the standard precaution are significantly recommended to the hospital procedure though the reusable process has no harmful records for the workers.
5. Strategic Analysis
I would like to use various analysis tools to examine the feasibilities of the new method of practice which includes:
A. Strength, Weakness, Opportunity and Threat (SWOT) analysis
B. Politics, Economic, Social, Technology, Legal, Environment, Information (PESTLEI) analysis
C. Stakeholders analysis
A. SWOT analysis
The SWOT Analysis is just a simple yet a powerful foundation for the analyzation to the organization. This helps then the organization on focusing to its strengths, to alleviate the threats and to take the highest possible opportunities which are available in the company. Therefore, this can assist the organization to choose and to recognize the best method to use, whether the reusable or the disposable suction tubing. Most of the change specialists as well are using this method for the application in the individual, in the organization level both for the external and in the internal process (Dulnik, 2007). There are ascertain opinions to the parties involved and reference to the HA policy. The analysis done is shown in the Table 2 which can be the assistance for the other people for them to understand the different matter and perspective involving the decision making.
Table 2: SWOT analysis on using disposable suction tubing
Strengths (internal)
Weaknesses (internal)
Quality products can acquire
Less Infection Risk to Staff, No need hold disinfectant which can save manpower, time as well as to minimize risk
Less Manpower Needed on the cleaning and cleansing, No need for the service of the GSA
There is a simplified procedure
The cost of initiation may be high
Infection risk in handling can occur
Requires Specific waste management (For the proper disposal)
Opportunities (external)
Maximize organizational revenues
Patients Loyalty to the organization
Maximize profit
The occupational risk can be minimize
There is a best support in the occupational health committee and in the infection control
There is a positive trend of using the disposable medical products due to its continuous demand
There is an encouragement on the strategic planning for the cost saving for the HA so that the standard can be maintained
Threats (external)
No assurance of having the same prices for the next years
Growth on the medical waste
Lesser supply due to the much demand
There is a great effect in the environmental protection
The SWOT analysis suggests:
- The adjustment on the instrument nurse and the GSA
- Development on the measures of infection control in the hospital
- Adjustment in the staff in the hospital
- In general, it can minimize cost
- There is a precise support in the committee of infection control
- These are all in connection to the policy of HA and in the global trend
Nevertheless
- There is demand in the budget planning and in the initial cost which are all required
- There is an irregular supplies in the consumables
- There are increase in the medical waste
- Hard time to implement the change in the practice
- There is huge effect in the environment
B. PESTELI analysis
The PESTELI analysis helps the managers of the organization to have a decision to its business in relation to the macro environment. It is important in this study due to the external factors that can affect the growth of the business as the political, economics, social, technological, environmental, legal, and information (Chapman, 2006). It is also important to comply in the HKHA policy because from the basic up to the general services of healthcare is needed by the public. The PESTELI analysis is written at Table 3.
Table 3: PESTELI analysis in using disposable suction tubing
Political
Ø Healthcare worker’s risk of infection is the big concerns.
Ø Labour Department will also assess varies types of occupational risks
Economics
Ø The HA is open for the projects which are cost saving as far as it can meet the standard care for the patient
Ø The Interest Rate might increase due to the demand of the disposable products
Social
Ø The maintenance of the care and the treatment which lessen the length of stay of the patient in the hospital
Ø The attitudes of the staff in the work can lessen the stress due to less workload
Ø The disposable products may become the major products when it comes to medicine
Technological
Ø New development of the suction tubing product
Ø Innovation of the suction tubing as the single items and huge demand may occur
Ø Disposable suction tubing can be out dated due to the continuous evaluation of the product when it comes to efficacy, the cost and its safety
Environmental
Ø Waste management increase
Ø Proper disposal also be the demand
Ø The product may be environment friendly whereas it can minimize the contamination to the environment as the washing procedure
Legal
Ø Product controlling can be done to minimize the helath risk
Ø Staff’s knowledge and training on the proper use of the disposal suction tubing
Ø The impact to the governments labor department
Information
Ø There is an effective flow of the work and it saves time
PESTELI analysis suggests:
- The use of the disposable suction tubing can alleviate the hazards on the occupations of the healthcare workers
- This can maintain the standard of the health care to the patient while minimizing the cost
Nevertheless
- The environmental factor is the key issue in the suggested practice due to the medical wastes though it can investigate it further
C. Stakeholder analysis
The people inside as well as outside of the organization are all connected in the organization and its activities that is it is much better have a stakeholders analysis to widen the perspective and to have a closer look to the players in the organization (Elearn, 2005). The stakeholder analysis is the method used for the assistance to the situation in the decision making whereas the certain stakeholders have resources limited, competing interest, and the needs appropriate balanced. This is important to determine the interest, the conflicts and the risks regarding the project of the organization. It also gives opportunities and encouragement on the participation of the stakeholders (Jamieson, 2006). The stakeholder’s analysis is written at Table 4.
Table 4: Stakeholders analysis
Stakeholder
Involvement in issue
Interest in issue
Influence / Power on outcome
Attitude of stakeholder
Impact on stakeholder
Patient
Low
He does not aware nor involve in the decision making
Low
He does not aware to the issue
Low
He is not a decision maker
Unclear
He has less understand on the impact of the issue
High
The guaranteed to the standard of care
OT Nurse
High
Deliver the full care
High
Exact interest
Medium
Gives the output and response
Positive
He little practice change
Medium
Workload is looks no different
Instrument nurse
High
He may lose his workload
High
He may lose workload
Medium
Gives opinion
Positive
Lesser workload
Medium
Minimize its workload
OTA
High
Care deliverer
High
He may lessen his workload
Medium
He can make its opinion and or feedback
Positive
He minimize its workload
Medium
He lessen his workload
GSA
High
He may lose his job
High
He may lose his job
low
He only wait for the decision though can make its opinion
Positive
Lose workload
Medium
Lessen his workload
Department
High
The decision for the change of practice and planning of budget
High
The decision for the new plan
High
The department is the one to make the final decision
Positive
It can increase for the production
High
Saves cost
Stakeholder analysis suggests:
- Majority of the stakeholders have different perception and acceptability in the propose practice
- Many of the stakeholder’s attitudes as well are all positive which only signifies that the use and the impact of the new practice is a little bit obvious
- The patient which are the new user has no involvement in the issue but the nurse has a positive impact and they are the one who knows the best for their patients that is why it signifies the best for their patients and for their past recovery
Summary of the analysis tools
To summarized the tools on the analysis, it has been determined that the use of the disposable suction tube is then important to the organization, to the patients and to the staff. It can also give justification on the objectives of the study of minimizing manpower and cost, as well as decrease the risk of infection while maintaining the same standard. This should also be lessening the nosocomial pneumonia by the further study to alleviate its effect on the environment and the risk it holds to the staffs. Though, there is an increase in the wastes, definite study should be made as recycling.
6. Economic Analysis on option appraisal
Benefit analysis
In order to quantify the benefits of different types of suction tubing, a benefits criteria score is established. Five critical elements are identified by the highly involved parties including manager, nursing officer, the OT nurse and the OTA. Each of these scores is obtained by considering in the context of their decision made. The benefits criteria scores are written below:
Table 5: Benefits criteria scores
Benefits
Measures
Importance
Quality of care
Maintenance of the care standard
Reduce the nosocomial infection risk by the lesser handling to the disinfectant
Patients compliance and comfort
40
Flexibility
No time for reusing the suction tube
The availability of the disposable suction tube are always open
15
Workload
No need for cleaning and cleansing of the used suction tubing
No need to disinfect the used suction tubing
30
Acceptability
The disposable suction tubing are always ready
5
Occupational risk
Lesser handling for the disinfectant for the used suction tubing
10
Option comparison
The existing reusable suction tubing and two disposable suction tubings from the two companies are being analyzed and shown in table 6.
Option A is the existing reusable suction tubing with inside diameter 7mm
Option B is a disposable circuit with the inside lumen 7mm diameter, same as the reusable suction tubing
Option C is a disposable circuit with smaller inside diameter of 6mm
Table 6: Option comparison
Option A
(Existing reusable suction tubing
Option B
(7mm diameter)
Option C
(6mm diameter)
Benefit
Weight
Score
Weight X score
Score
Weight X score
Score
Weight X score
Quality of care
40
6
240
9
360
9
360
Flexibility
15
6
70
9
135
7
105
Workload
30
6
180
9
270
9
270
Acceptability
5
5
25
10
50
10
50
Occupational risk
15
6
90
9
135
9
135
Totals
605
950
920
(Score are out of a maximum of 10, benefit criteria weights total 100)
7. Financial appraisal
In cooperative with the HA’s annual plan, an effective financial management is a necessary ingredient to ensure the financial resources are properly utilized. Front line managers should also have a financial awareness as their actions will also affect the finances of the organization. To review the costing of the three options, table 7 will show the overall running cost. The cost of the three options is shown in the Table 7.
Table 7: Running cost for the three options
Items
Option A
Option B
Option C
Manpower fee
HK,400
HK$ 21,000
HK,000
Consumable:
Ø Reusable suction tubing (HK/set, 120set/year)
Ø Plastic bag
Ø Sterilization indicator
Ø PPEs
Ø Machine maintenance fee:
HK$ 10,800
HK,500
HK,000
HK,000
HK,000
HK,400
(HK.8 /set,8,000set/year)
HK,000
(HK/set,8,000/year)
Medical waste
HK,000
HK,000
Total
HK,700
HK,400
HK,000
According to the Hong Kong Budget Plan (2005-06), the predicted inflation rate shows there will be a rise of 1.5% for the year. Table 8 will review the option cost analysis for the coming five years.
Table 8: Option cost analysis
Option
Year 1
Year 2
Year 3
Year 4
Year 5
Total
A
HK,045.5
HK,411.18
HK,797.35
HK,204.31
HK,632.31
HK9,090.71
B
HK,651
HK,920.77
HK,239.58
HK,578.17
HK,936.84
HK6,326.36
C
HK,185
HK,387.78
HK,608.60
HK,847.73
HK,105.45
HK3,134.56
There is a 1.5% increase yearly. In option A, the total amount for the upcoming 5 years is HK9,090.71 which is the higher among the other options. At the option B, it recorded a total HK6,326.36 for the 5 year in raw and finally, the option C records HK3,134.56 which is the lowest price among them.
Table 9: Cost benefit analysis
Option
Average Cost / Year
Benefit Weight
Benefit / Cost
Cost / Benefit
A
HK,700
605
0.6%
148.26
B
HK,400
950
1.1%
87.79
C
HK,000
920
1.1%
85.87
As shown in table 9, the preferred option should then be option B.
8. Preferred Option
The preferred option is the Option B. Based on the findings of the analyses it has been found out that the Option B has many relevance on the organization and to the staffs as the reducing the occupational risk. Though, option C has the lowest cost, it still not advisable because it has only 6mm in diameter and the Option B had been maintained or enhanced added to the global trend to the quality of the product and the benefits to the staff as well as its acceptability. To finalize, it has been difficult to lessen the nosocomial pneumonia calculation but looking at the brighter view it can save the life and money.
9. Recommendation
It had been highly recommended the use of the Option B or the disposable suction tubing because of its significance. It has met the objective of reducing the cost and the infection. Compare to the other options, the option B is has benefits to the staffs and to the department besides to its much cheaper. The use of the reusable method should not be use for the next years and introduce the disposable one but it should be evaluated as well so that it can evaluate the development and the use of the product. The Operating Theatre Assistant (OTA) should have a consistent record while using the disposable suction tubing for the process of evaluation and its effect to the patients.
Conclusion
Presenting a new product in the operation also accompanied challenges in the department. The disposable suction tubing is an ample and helpful product but requires much time before implanted. That is why the organization made analyses and therefore follows these for the betterment of its products and its services.
Part 2: Reflective Statement
Pre-module study experience
At the pre module preparation I am a little bit nervous for the result of this experience. In this manner, I made difficulties in the understanding as well to learning of the topic but I take it positively wherein I will better what I am expecting. I kept on reading for the course materials and the chapter topics made my learning process simple.
Learning experience during lecture
The language made my understanding on the topic easier. It also made the topic interesting as the students from the hospital undertake their point of views. I simply admire the lecturer that made my appreciation be great.
Learning experience when writing assignment
Writing this kind of business case is a little bit hard but with the effort of pursuing the goal and maintaining confidence, I made it. There are lessons I learned as the implementation process that needs precise time and keen analyzation. The decision making that requires much effort for comparison and contrast which will comply in the policy of HA. This will be sent to the ward manager so that they can use it for future.
Self reflection to learning
This module made me lot of troubles but through my optimistic view I turned out this material. I learned a lot from here that can bring it for the rest of my life.
11. References
Chapman, G 2006: Eastward Ho, London, United States of America: Manchester University Press
Dulnik, A 2007, Every Day Matters, Washington, United States of America: Dr. Agata Dulnik
Elearn, 2005, Business Environment, Virginia, United States of America: Elsevier
Ireland, R 2006, Clinical Textbook of Dental Hygiene and Therapy, Great Britain Blackwell Publishing
Jamieson, D 2006, The Facilitators Field Book, California United Sates of America: AMACOM Div American Mgmt Assn
Tricor Services Limited [2005], Hong Kong Budget Plan 2005-2006, Tech News, Volume 2, No. 2 page 3
Hospital Authority Annual Plan [2006] Towards sustainability hospital authority annual plan 2006-07. Hong Kong: Hospital Authority. Page 11
Credit:ivythesis.typepad.com
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