Write a 3-4 page paper; APA format; minimum of 3 references:

The younger generation, those 18 to 35 years of age, have said they want to be led, not managed.

How do you think that leadership would be different for a person who leads only persons between 18 and 35 and a person whose followers are mainly over the age of 40? What strategies would you recommend for a person who becomes the leader of a mixed group?

Please read pages 692- 716 (Case 14) of the course textbook Strategic Management in Health Care Organizations. Create a 5 or more page report in Microsoft Word document that answers the following questions.

1. What are the unique problems with delivering health care to and indigent population?
2. What is the purpose and structure of the Community Care Plan?
3. What are the factors that point to the need for change by Cooper Green Hospital?
4. What factors constrain the hospital’s flexibility – its ability to adapt to changes in the external environment?
5. What are the strengths and weaknesses of Cooper Green Hospital?
6. What the strengths and weaknesses of the Community Care Plan?
7. Develop a strategic plan for Cooper Green and the Community Care Plan.

Guidelines

• Clearly define the problem to be solved or identify symptoms the suggest an underlying problem
• Who are the stakeholders in this situation and how are they involved or impacted by this problem?
• What alternatives should be considered in solving this problem? Please quantify where possible.
• Indicate which alternative you would recommend and why?
• How do you expect that each of the stakeholders will react to your recommendation?
• Indicate the potential risks if this recommendation turns out to be wrong.
• Justified ideas and responses by using appropriate examples and references from texts, websites, and other references or personal experience.

Requirement:

Length: 5 or more pages

References: 5 or more

APA format

CASE 14 Cooper Green Hospital and the Community Care Plan*

An Overworked CEO

There are certain days when life seems unbearable. For Max Michael, MD, it had been one of those days. He had the difficult responsibility of balancing costs with access to care, of rationing procedures with policy, and of juggling personnel with budgets, performance, and demand. Dr. Michael, a former chief of staff at the hospital and now its chief executive officer (CEO), had spent the better part of his day fighting a losing battle in an understaffed, understocked, overflowing outpatient clinic. It was there, on the front lines, where he had first encountered the nature of the health care problem and developed his vision for its solution. As Dr. Michael left the clinic that evening, he mulled over a looming decision he was going to have to make. It was his last patient that reminded him of the importance of that decision.

Martha James Spent Her Day at Cooper Green Hospital

It was the second day in a row that Martha James missed work because she was running a fever and ached all over. She dared not miss another day for fear of losing the job she had with a small local business that paid above minimum wage but offered no health insurance. Her husband also was employed full time but did not receive any insurance benefits. Money was very tight for the couple and their two children, yet, based on federal guidelines, they were not eligible for financial assistance from the Aid to Families and Dependent Children (AFDC) welfare program; nor were they eligible for state Medicaid benefits. With no money to spare, the cost of a visit to a physician’s office was a luxury Martha felt she could not afford. She did the only thing she knew to do: she headed for the emergency room at Cooper Green Hospital.

It was nearly 9:00 A.M. when Martha arrived after a 45-minute bus ride. She waited for more than two hours before her name was finally called. The nurse asked her about her symptoms. Barely even looking up, the nurse said Martha would have to be seen over at the Outpatient Clinic because her case was not truly an “emergency.” She was told to sign in at the Clinic desk and they would try to “work her in.”

After more than four hours of sitting in the overcrowded waiting room, Martha finally heard her name called again. The doctor who took her case was a silver-haired man with sharp eyes and a concerned demeanor. Dr. Michael quickly determined the problem: a respiratory tract infection that had been “going around” for weeks. When asked, she admitted she had been coughing for more than a week, but had hoped the severe cough would go away on its own. “Besides,” she said, “I can’t afford to take a day off work to go to the doctor for just a cold.”

“The problem,” Dr. Michael explained, “is the infection is now affecting your lungs, which requires more intensive treatment than if you had come for help a week ago.”

Glancing at her chart, he realized she lived near Lawson State College, the location of one of the hospital’s Community Care Plan (CCP) clinics. He asked, “Martha, are you aware of the Community Care Plan clinics and the services they offer? They have medical office visits with much shorter waiting times.”

She replied, “I have heard something about them, but don’t really know what it is about or how it could help me.”

Martha still had to stop by the hospital pharmacy to pick up two medications and it was nearly 5:30 P.M. She knew she could get them much faster at a local drug store, but they would be several times as expensive. Instead, she settled in for another wait. By the time she headed back to the bus stop–some nine hours after she left home–Dr. Michael was wrapping up his afternoon in the clinic.

* This case was written by Alice Adams and Peter M. Ginter, University of Alabama at Birmingham, and Linda E. Swayne, The University of North Carolina at Charlotte. It is intended as a basis for classroom discussion rather than to illustrate either effective or ineffective handling of an administrative situation. Used with permission from Alice Adams.

Dr. Michael Wraps up His Day

As Dr. Michael entered his office, Martha James was still on his mind. It had been nearly four years since he launched the Community Care Plan, but in many ways it was still struggling. In his heart, he still believed it was a good model to provide access to preventive and routine medical services to the population traditionally served by Cooper Green Hospital: the poor and uninsured of Jefferson County. It placed small outpatient clinics within local neighborhoods. They were staffed by physician assistants or nurse practitioners, who were supervised by a physician. For a quarterly fee, members could receive routine medical care at the CCP clinics. When needed, they also received care from specialists, and even inpatient hospital care at Cooper Green. To Dr. Michael it made perfect sense; the CCP offered better access to services, less waiting time, less travel time, and a better atmosphere.

But the numbers did not agree. Although some of the CCP clinics established a reasonably sized patient base, others were struggling to attract members. If Martha James had been a CCP member, she could have been seen and received treatment before the infection had migrated to her lungs and she would not have had such a long waiting time. “For her, and thousands more like her,” Dr. Michael thought, “it’s important to keep the CCP running–if at all possible.” But few people knew about the CCP and even fewer had joined.

The five-year funding that enabled the hospital to launch the CCP was about to run out. Dr. Michael knew he was facing a critical decision: should he push forward with expansion plans for the CCP, maintain the clinics that existed, or fold the program altogether?

Cooper Green Hospital

In 1998, Cooper Green Hospital (CGH) was the current incarnation of Mercy Hospital. Built in 1972 with Alabama State and Hill-Burton funding, Mercy Hospital served the vision of the Alabama legislature to provide care for the indigent population of Jefferson County. Despite numerous organizational, structure, and name changes, the mission of the facility remained essentially the same: to provide quality medical care to the residents of Jefferson County, regardless of their ability to pay.

Mercy Hospital opened with 319 inpatient beds–a number based on an epidemiological study using the number of indigent cases reported in county hospitals during the mid-1960s. The study projected that the hospital would operate near 80 percent capacity. Occupancy never reached the initial projections.

The highest average census for the hospital was 186.3 in fiscal year 1974. The numbers of inpatient admissions, discharges, and length of stay for 1998 are shown in Exhibit 14/1.

Exhibit 14/1: Inpatient Statistics for Cooper Green Hospital, Fiscal Year 1998

The role CGH played in the community faced constant scrutiny from a county commission with increasing budget pressures. Media and public challenges about the quality of care provided by CGH limited its ability to attract patients with private insurance. For the first two decades of the hospital’s operations, cost overruns were common, as the county’s indigent population grew and medical costs soared. Facing increasing costs, Dr. Michael and the administrative staff initiated a stringent budget-cutting program that included personnel lay-offs, taking beds out of service, postponing most capital improvements, and eliminating some services. The hospital’s financial statements for the fiscal years 1993–1998 are included in Exhibits 14/2 and 14/3.

Early in his tenure as CEO, Dr. Michael initiated a strategic planning program for the hospital. Mission, vision, and value statements were developed (see Exhibit 14/4), strategic goals were outlined, and plans for meeting them were created. Each year, the strategic goals for the upcoming fiscal year were developed by the “management group” (consisting of the CEO, COO, CFO, Medical Chief of Staff, and Nursing Administrator) and distributed to all departmental supervisors.

As a result of ongoing strategic planning, Dr. Michael took the initial steps to transform Cooper Green Hospital into the Jefferson Health System (JHS) in 1998. JHS consisted of CGH (the inpatient facility) and Jefferson Outpatient Care (comprised of the outpatient clinics located in the hospital and six satellite clinics of CCP). JHS provided services to patients through two plans: HealthFirst, a traditional fee-for-service plan, and the Community Care Plan (CCP), a pre-paid membership plan.

Part of the motive for the transformation and expansion of CGH was to enhance its ability to generate external revenue, including attracting patients with private insurance. If CGH could attract paying patients on the basis of quality and satisfaction, it could mold itself from a provider of last resort into a true competitor in the market.

Exhibit 14/2: Cooper Green Hospital/Jefferson Health System Sources of Revenue

HealthFirst

Charges for services under the HealthFirst plan were determined by a sliding-fee scale that was based on federal poverty guidelines. Depending on the number of people in the family and the family’s income, patients were assigned to one of eight financial support categories. At the lowest level, patients paid as little as $2 for an office visit. At the highest level, patients paid full price for services (approximately $50 for an office visit). The HealthFirst financial support categories are shown in Exhibit 14/5. Initially, HealthFirst patients could only be seen at the outpatient clinic located at the hospital. However, in 1998 these regulations were relaxed, allowing HealthFirst patients to be seen at any of the satellite (CCP) clinics.

Exhibit 14/3: Cooper Green Hospital/Jefferson Health System Statements of Revenue and Expense