Managing in Today's Health Care Organizations
October 21, 2013
Decision-Making Case Study
Indiana as a whole is affected by the current grave state of the economy. Rural health is no stranger to budget cuts. In the status of working families in Indiana report it states “the number of Hoosiers living in poverty reached more than one million; unemployment in Indiana has remained above the national average for nearly a year; low wage jobs and income inequality are both on the rise, and; post‐secondary educational attainment continues to present challenges to high‐growth job creation”. (The Joyce Foundation, 2013, p. 12). Rural medicine is largely funded by Medicaid and Medicare. Nearly one in five patients who receive this assistance lives in rural communities.
Integrated health care homes are on the rise. Madison County Community Health Center (MCCHC) is one example, located in Anderson Indiana. The MCCHC is dealing with an additional 15% budget cut. Management will decide which services to eliminate or change while keeping the health care needs of the patient as their primary goal. Designing a care management program will assist the health center in reducing cost and waste throughout their system.
Utilizing the Informed Decisions Toolbox
The ID Toolbox does not attempt to make a decision or determine the right decision for a manager or policymaker. The six steps are:
1. Framing the question behind the decision.
2. Finding sources of information.
3. Assessing the accuracy of information.
4. Assessing the applicability of information.
5. Assessing the actionability of information.
6. Determining if the information is adequate. (Finding and Using Management Research Evidence , 2008, para. 3)
Step One: Framing the Question
As a manager we discover what information is needed to make the best decision. When investigating the needs of Medicaid clients and deciding which clinical services to change or eliminate, it is vital to research information regarding the various services used by these patients. The manager must ask several questions. Do inviduals enrolled in Medicaid have unique health needs that differ from the larger population? What are the services most utilized within MCCHC at any given time? In what ways will service cuts and elimination of resources affect the clients? What services can be outsourced to other facilities that accept Medicaid? Can the current physician staff be reduced, and the use of nurse practioners and physician’s assistants be implemented?
Step Two: Finding Sources of Information
After the questions are formulated, step two involves identifying credible sources of information to answer these questions. In an age of abundant technological resources, a large percentage of sources may be found on research-based websites, bibliographic databases, online academic and peer-reviewed journals, books or other publications, and government reports to name a few (The Informed Decision Toolbox, 2011, para. 2). It may also be helpful for the manager to locate internal information available within the clinic to taylor to the unique needs of the MCCHC. While the IDT mainly focuses on evidence-based sources of information, the manager may also utilize supportive colloquial knowledge from and opinions of colleagues, employees, patients, and other health care professionals.
Steps Three, Four, and Five
Steps three through five take the collected research and evaluate its accuracy and applicability. First, step three emphasizes the accuracy of the research presented. The manager must question if the research is of high-quality, originates from a credible source, presents complete and balanced viewpoints, and comprises reliable and valid measurements (The Informed Decision Toolbox, 2011, para. 4). Step four highlights the applicability of the research. The manager must ask if the research is relevant to his or her question