Final Project: Management of Industrial and Mission Critical Facilities
Background
A resilient infrastructure is required in a mission critical facility to ensure that there is continued service, which enables business, operations and systems to operate efficiently. In order to manage and maintain these facilities experience, expertise and total commitment to the work are required (Taneja, Akinci and Garrett 235). The facility targeted by this proposal is St. Thomas Midtown Hospital in Nashville, Tennessee. This hospital is the largest not for profit hospital in the center of Tennessee. It covers an area of almost 2 million square feet, has a capacity of 683 acute and rehab beds (Sthealth.com par 1). the mission of the hospital entails the provision of health services to all persons in the vicinity, with special attention being given to the poor and vulnerable in the community. The vision of the hospital is to have trusted personal relationship with the people in the community and through it guide them towards living healthier lives. The researcher interviewed the director of the hospital in order to determines the needs of the hospital so that the services would be made more efficient and satisfactory for the patients and other persons or entities that have a relationship the hospital.
Interview
The researcher interviewed the director of the hospital in order to establish the requirements of the hospital in order to increase its efficiency and reliability in the provision of health services to the clients. These requirements were also needed to ensure that the employees and other stakeholders in the hospital felt appreciated for the contributions made to the hospital in terms of finances, services and voluntary efforts as well. The director was quick to point out the world is now in the advanced information age, and that the hospital required a better infrastructure to handle the data collected from the patients and other entities within the hospital and also from outside. The analysis this data would help in the establishment of the expectations and needs of various parties in the hospital and assist in their fulfilment in time. The director emphasized that the hospital has grown significantly in the past decade, and this has been accompanied by expansion of the healthcare services portfolio, sophistication of treatment procedures, growth of the population served and ageing. These factors have contributed in making the provision of healthcare services in the hospital a complex affair.
Data and information is key in the improvement of the services in the hospital. The hospital collects massive volumes of data from patients and visitors in the hospital, and there is a need to have an infrastructure in place that will enable the hospital officials to analyze the data and come up with effective measures that can improve the efficiency in provision of health services. Such a system will make it possible to avail information to the interested parties in the hospital at request. Of importance, the system should be integrated to all of the nodes in the hospital and have a capacity to get updated from any of these points in the hospital by persons that have the security clearance and authority to do that. This hospital is already digitized, but there is still more that needs to be done about its information system in order to achieve better levels of efficiency in the provision of health services. The data that is fed in this system comes from heterogenous sources, and this makes the quality of the data to become compromised. In order to improve the data quality, the hospital is often forced to contract an engineer. This often costs the hospital a lot, and it would be best to come up with a method of ensuring that the staff in the hospital can access data, clean it and analyze it autonomously. This has to be done while ensuring that data protection laws are adhered to and also handle the corporate and personnel data with deserved discretion. Since this system is connected to all the departments and activities of the hospital, it will be much easier to set goals and monitor the performance of the hospital towards the said goals on a continuous basis.
The second requirement that the researcher was able to gather from the director of the hospital was on the need to change and respond to the external and internal environments of the hospital. When probed further, the director stated that the external environment of the hospital often happens to be a barrier to the achievement of efficiency and reliability. There are also different operation and performance standards between this hospital and others in the vicinity, and this makes it impossible for the services provided to patients in this community at different health facilities. With regards to the internal environment of the hospital, the director touched on the need for the senior of the company to provide adequate support for the juniors in the hospital; aligning the financial objectives of the hospital with the action of the workers; having a just culture; and aligning with the business case. Another requirement that the director identified is planning and implementation of improvement initiatives that would help in increasing the efficiency and reliability of the hospital. In order for this to work, there are three aspects of the hospital that will have to be considered. These include the processes of the hospital, people and resources at the disposal of the hospital. The other challenge that the director felt needed addressing before the hospital could become more efficient and reliable had to do with measurement of the progress of the hospital towards efficiency in its service delivery.
Proposed changes
Having determined the requirements of the hospital from the interview with the director of St. Thomas Midtown Hospital, Nashville, the researcher was in in a position to propose the changes that should take place in order for the requirements for efficiency and reliability to be fulfilled. The first requirement of having a better infrastructure to deal with the data of the clients of the hospital and other stakeholders is easier to fulfil, given that the hospital is already digitized. The first requirement of having a better infrastructure to deal with the data of the clients of the hospital and other stakeholders is easier to fulfil, given that the hospital is already digitized. What it will need in the moment is to have the systems upgraded in terms of the hardware used for faster speeds and also into the latest versions of the ERP software used by the hospital. The information system used by the hospital has to be made compatible with a variety of devices that have in the present been optimized to make use of such systems. Such system should not only be limited to the desktops used in the hospital, but also be functional on the mobile devices used by the doctors, nurses and other essential personnel in the facility. Having data and information available to the hospital staff will help in efficient coordination of activities in the hospital and also lessen the time taken for the patients in the hospital to get the services that they seek.
The hospital staff will be required to be autonomous in the handling of the data captured in the system as opposed to having an IT department or inviting a software engineer to do analytics for the hospital. The presence of an IT department or an engineer specialized in the hospital system gives the workers in hospital no incentive to know how to deal with the data in the system to solve present problems or decide how the efficiency of services provided can be improved. Hence, these will have to be taken out of the equation to motivate the workers in becoming familiar with the system and also to cut on operation costs of the facility. The workers need to be prepared for this by having training sessions on the workings of the new system and also on how they may troubleshoot the problems that they are likely to encounter when handling the data collected in the hospital. These training sessions should then be followed by assessments to determine how the employees have understood the system. This process will be preceded by first of all approaching the employees and informing them of the intention of the hospital regarding the running of the information system. Input from the employees will then be gathered, and this will help in the design of the training program for the workers of the hospital.
The second requirement that was identified from the interview was to have a change in the way that the hospital management responds to the external and internal environment. It was established that the external environment that largely consists of the regulatory authorities and the legislature play a role in creating a barrier to the achievement of efficiency and reliability for the hospital. In addressing the external environment barriers, it is proposed that the hospital collaborates with other health centers to push and lobby for policies in the legislature and the administration to have policies in place that promote the efficiency and reliability of the hospital. The collaboration of the hospitals in the elimination of the external environmental barriers will also achieve another objective of achieving cross-hospital standardization. This includes the sharing of the workforce among hospitals, standardization of the forms and processes across the institutions to prevent unnecessary errors or rework (Bagnara, Parlangeli and Tartaglia 713-718). This further standardizes the measuring and reporting of quality issues. The various health facilities should come together and not compete on the patient safety, as that would derail the collaboration efforts. It is important for the various facility management teams to realize that not much formality is needed in the formation of an alliance, but rather should begin doing so on an informal state and with conversations that are devoid of commitments. This makes it possible to know the desires and expectations from each of the participants in the collaboration.
A restructuring of the board responsible for the administration of the hospital can constitute as one of the ways in which the blockade caused by the internal environment of the hospital can be overcome. A good way of reconstituting the board is by inclusion of the Chief financial officer so that he may advise the board on how to best allocate the resources of the hospital such that the business case of the hospital aligns with the case for quality in the services offered by the health facility. Still on the internal environment factors, the leadership of the organization has to offer support to the staff by demonstrating a will to change the organizational culture so that the provision of services in the hospital can be improved in the form of reliability and efficiency. There is no need to introduce interventions if they are not in line with policies of the hospital and have rewards attached to their performance (Christianson et al. 314). This helps in the linkage of behavior with the desired outcomes where there is a need to improve the quality of the services offered to the clients of the hospital. When the bonuses of the employees are tied to the improvements made in the provision of the services to the clients, then the workers are motivated to continued giving high quality services, which is likely to translate in better reliability and efficiency of the hospital as a whole (Bagnara, Parlangeli and Tartaglia 713-718).
The management has to ensure that the quality issues applied in the hospital are carefully linked to the operational issues of the facility. Operational and improvement planners will have to coordinated their efforts so that the goals and successes of the are synchronized. For the quality of services provided by this hospital to be improved, there is a need for just culture to be inculcated into the workforce. This enables them to report mistakes, errors or waste without any fear of reprisal or personal risk on their part. On the requirement of planning and implementing improvement initiatives, success is made possible for the introduction of innovations for a system if it is prepared for them. Some of the preconditions for success include that an improvement needs to be integrated into the ongoing process for it to be successful. If it cannot be integrated, then the initiative or process will not be successful (Christianson et al. 314). In order to make it possible for policies to be adhered to by the employees, it is important to simplify them for them. Having done this simplification, then it is possible to add new procedures and processes without the employees seeing the new things as a burden. Initiatives should be rolled out incrementally the non-punitive ones taking precedence.
The use of people in the improvement of processes in the hospital entails the involvement of the physicians in the planning for improvements. This is because they are the ones that will be expected to alter the way they carry out their duties in order to implement the intended improvement. Involvement of the physicians in the planning stage ensures that they are receptive to the change, and most of them will not mind changing their practices if it will result in them increasing their efficiency and reliability in their work. Provision of resources to physicians and expertise as well to drive the improvement of the service delivery is also important. The planning process should involve persons from multiple shifts and work units. The quality improvement staff should not carry out its activities without the input of the operation staff. In terms of resource allocations, there is a need for the hospital to replace the workers that have been actively involved in the planning process.
Reliability
in terms of reliability, the improved information system will make it easier for the personnel in the hospital to access the medical records and exchange them effectively and on time. This will assist in ensuring that the patients get quality services in the hospital. The collaboration of the physicians in this hospital and those from other institutions will assist in the improvement of healthcare provision not only in this hospital, but in the entire health system in the state.
Redundancy
The redundant roles of the IT department will be eliminated by having all the hospital workers acquaint themselves with the new information system. This will free up resources that can be used for other improvement plans.
Security
Having an information system that is operated and controlled by the employees will require them to have varying levels of clearance in order to ensure that the system assists them in accomplishing their tasks efficiently. thus, information gathered from the patients will be kept safe. The upgraded information system will also be integrated in the security department to the hospital in order to have a comprehensive record of the persons coming into and leaving the hospital. This will contribute to physical security of the hospital.
Protection
It is a requirement by law to have the medical records of patients kept confidential by the medical personnel. The upgraded information system will be designed in a manner such that the personnel in the hospital cannot access more than is necessary concerning their client, and also in line with their responsibilities in the hospital.
Design Approaches
in order for the information system upgrade to take place effectively, there is a need for passive and non-passive activities. The passivity and non-passivity of the activities is from the perspective of the employees and the part they will play in the implementation of the changes. The installation of the new hardware and upgrade of the information system software will entail the passive activities, as they will not require the direct input of the employees. However, the training part will require the employees to get involved mentally and physically and this will entail the non-passive activities or stage in the implementation of the new systems to handle hospital data. The lobbying for better laws and regulations that will make it easier for the hospital and others with the same objectives to improve efficiency and their reliability will have to be a non-passive approach, as is the planning and implementation of the improvement initiatives that will require the input of the physicians and other medical personnel.
Distributed generation/storage potential
Given the nature of the activities taking place in this hospital and the services provided, there is no way of having offsite production and availing of the services. The implementation of the changes that are geared towards improving the quality of services provided will take place within the premises of the hospital.
Phasing
Phasing is done in order to prevent the interruption of services in the hospital. For the implementation of the new information system, it will be installed in place and all of its requirements made available while the present system is still in operation. After the new system has been fully set, the data in the old system will be imported into the new system at night, when there is slow flow of clients into the hospital. The involvement of the medical personnel in the implementation of the other changes will entail having them participate in the initiative only when they are not on active shifts as this will afford them the time required to give credible input.
In the case of improving the hospital information system, the first phase should entail collection of data from the various stakeholders in the hospital. These include the management, the employees and a portion of the clients that receive services from the hospital. The reason for this is ensure that the shortcomings in the present system are identified and considered in the design of the upgraded system. Having collected the data and analyzed it, it will be followed by presenting these findings to the management of the hospital for approval and also for budgeting purposes. This hospital has various departments, and the implementation of the new information system cannot be done in all of these departments at a go. This will require the parties responsible for this to identify the various departments of the hospital and assign phases for the implementation in each department.
The various departments in the hospital include: patient management, financial management, materials management, human resource, ancillary management and management information. The requirements regarding the information system upgrade will be categorized in according with the departments that they fall in. This will make it easier for the implementers of this system to work on the specific coding and in a timely manner. The patient management department will be the one handled in the first phase, as there is a need to have the clients feel the change and improvements in the system as soon as possible. As there are six departments in the hospital, they require six more phases in addition to the first phase of collection of data on the needs of the hospital in terms of information system. Each of the phases is projected to take six months. This will translate into 3.5 years for an upgrade of the hospital information management system to be completed.
Cost estimates
The requirements and changes required for hospital to improve efficiency will require the use of expert consultants in computer science and also in service provision processes. Hence, the bulk of the costs for these changes will be directed towards the payment of the consultants. The expected cost for the new system is $250,000. While the cost to pay the consultants for effecting the other changes is estimated at $200,000. The cost of tangible requirements for the upgraded system is $500,000.
Applicable codes and regulations
Some of the codes and regulations that will be adhered to in the implementation of the upgrade of the hospital information system include:
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009- This Act provides HHS with the responsibility of establishing programs that will inprove the provision of healthcare quality, safety and efficiency through the use of IT. It promotes the creation of electronic health records and a secure exchange of the same
Section 618 of the Food and Drug Administration Safety and Innovation Act (FDASIA) of 2012– This Act contains proposed recommendations and strategy; risk based regulatory framework for health IT; and mobile applications, all of which are geared towards promoting innovation, safety and the avoidance of regulatory duplication.
Operations and maintenance
Having effected the changes that are required in the hospital in order to improve efficiency and reliability, there is a need to put in place processes and procedures that will ensure that the changes continue to produce the intended results. The employees will be trained on how to use the new system effectively, and this will contribute to smooth operation of the same. For maintenance, however, the employees of the hospital are not expected to carry it out, but rather, a specialist will be invited periodically to check the system for any anomalies at a onetime fee, as opposed to a whole IT department that would cost the hospital much more.
Appendix
A Transcript of The Interview
For the purposes of brevity and quick understanding of the interview that took place between the researcher and the hospital director, the researcher will be referred to as ‘R’ and the hospital director as ‘HD’
R: hello, it’s good to have you. I would like to know how you intend to improve the reliability and efficiency of the services provided in this hospital.
HD: Hello, Thank you for that question. At this hospital, we have strived to provide our clients with the best services possible, though there is still room for improvement. It is a part of my job description to come up with means and strategies that can be used to improve the reliability and efficiency of our services.
R: Could please mention some of the ways in which the service delivery in this institution can be improved?
HD: Certainly. One of the major things that need to be done at this facility is an overhaul and upgrading of the information system. We are in the information age, and it is best that we use these tools that have at our disposal, thanks to technology. The information system that the hospital currently uses maybe considered as a rudimentary one, compared to the best practices in the market. I envision an information system that is driven and controlled by the personnel. I find the IT department in this hospital a liability, as it costs us a lot and continues to have minimal workload. Having the employees trained on how to handle data collected from the clients and analyze it competently will help in elimination of this department. I tend to feel that the presence of such a department makes the employees reluctant in learning about the system.
R: in addition to the upgrade of the information system, what other measures do you think can be taken to improve service efficiency and reliability?
HD: There is a need for the management of the hospital to have some control over the environment in which the hospital operates. As you know, this hospital has both external and internal factors that influence its operations. The internal factors can easily be manipulated by the management, and therefore offer a relatively minor challenge. The external factors such as regulations, legislations and different approaches in medical interventions in various medical facilities remains a big hindrance to the provision of efficient and reliable services. Due to that, the management teams of various hospitals in this state are in discussions to come up standard procedures of medical interventions and also coming up with a strong lobby group that will further the interests of the physicians in the legislature and other regulatory organs. This will help in the standardization of services and in the secure and efficient sharing of medical information among physicians in the state and possibly the whole country.
R: Thank you very much for the insight given on how you intend to improve services in this facility.
HR: It was a pleasure talking to you, have a nice day and live healthy.
Works cited
Bagnara, Sebastiano, Oronzo Parlangeli, and Riccardo Tartaglia. “Are Hospitals Becoming High Reliability Organizations?”. Applied Ergonomics 41.5 (2010): 713-718. Web.
Christianson, Marlys K et al. “Becoming A High Reliability Organization”. Critical Care 15.6 (2011): 314. Web.
Sthealth.com,. “About Us | Saint Thomas Health”. Sthealth.com. N.p., 2016. Web. 13 Nov. 2016.
Taneja, S., B. Akinci, and J. Garrett. “Requirements Identification For A BIM-GIS Integrated Platform To Support Facility Management Activities”. Gerontechnology 11.2 (2012): n. pag. Web.