HCM 3070 Module 2 Planning and Decision Paper Example

What to Do With 5 North: A Structured Planning and Decision-Making Analysis for a Closed 20-Bed Unit

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B.S. in Healthcare Management, Thomas Edison State University

HCM-3070: Principles of Healthcare Management

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Month Day, Year

What to Do With 5 North: A Structured Planning and Decision-Making Analysis for a Closed 20-Bed Unit

Cedar Ridge Regional Medical Center, a composite 214-bed nonprofit hospital, closed its 20-bed 5 North unit eighteen months ago when it could not staff the beds. Since then, the emergency department has boarded admitted patients for an average of more than four hours on weekday afternoons, and the leadership team has asked managers to recommend what to do with the empty unit. This paper applies a structured planning and decision-making process to that question. It defines the problem, gathers evidence, generates alternatives, compares them against weighted criteria, recommends one and sets out an operational plan with measures, showing how management decisions can be made deliberately rather than by habit or by the loudest voice in the room.

Defining the Problem

Decisions go wrong most often at the first step, when the problem is defined too narrowly or as a solution in disguise. Nutt (1999), drawing on a large collection of organizational decisions, reported that about half failed and that failure was more likely when decision makers moved quickly to a favored idea instead of investigating the situation and searching for alternatives. The tempting definition at Cedar Ridge was "we need more inpatient beds." A closer look at the data showed a different problem. About a third of patients boarded in the emergency department were waiting for a bed to which they were admitted for less than two days, mostly for chest pain evaluations, dehydration, asthma flares and transient symptoms needing monitoring and tests. Many of them were placed in observation status after admission. The problem, restated, was that short-stay patients were occupying inpatient beds and emergency department space while waiting for care that a different setting might provide faster and more cheaply.

Restating the problem changed the set of solutions worth considering. More inpatient beds would treat the symptom; a better pathway for short-stay patients might treat the cause.

Gathering Evidence

Evidence for management decisions comes from the organization's own data, from published research and from the experience of comparable organizations. Walshe and Rundall (2001) argued that health care managers have been slower than clinicians to apply evidence to their own decisions, even though the same problems of underusing effective approaches and overusing ineffective ones occur in management, and that evidence-based practice must be translated to fit how managers decide rather than simply transferred. For this decision, the team combined twelve months of boarding and length-of-stay data with published research and site visits to two hospitals in the region that run observation units.

The research was encouraging. Baugh et al. (2012) estimated, using a literature review, national survey data and a simulation, that hospitals without dedicated observation units would spend about $1,572 less per patient and about $4.6 million a year each if they adopted such units for stays expected to last less than a day, largely through shorter stays and lower costs than short inpatient admissions. The estimates come from a model rather than a trial, but they matched what the regional hospitals reported.

Generating and Comparing Alternatives

The team considered three realistic alternatives. Alternative A converts 5 North into a 16-bed observation unit run by emergency medicine with protocols for common short-stay conditions. Alternative B reopens it as a 20-bed medical-surgical unit, which would require hiring about 22 registered nurses at a time when the hospital already has vacancies. Alternative C leases the space to outpatient services, such as an infusion center, generating rent and outpatient revenue but doing nothing for boarding.

The leadership team agreed on four weighted criteria before scoring, which kept anyone from tilting the weights toward a favorite once the scores were known. Each alternative was scored from 1 to 5 by the planning group, using the evidence gathered, and the scores were multiplied by the weights.

The Decision

Alternative A scored highest, 4.25 out of 5. It addresses the restated problem directly, needs fewer nurses than reopening the unit because observation patients have more predictable needs and protocol-driven care, and is supported by evidence on cost and length of stay. Its main weakness is staffing: the unit would still need about 12 registered nurses and emergency physician coverage. Alternative B scored lowest because the hospital cannot reliably staff the beds it already has. Alternative C would help the budget but leave the original problem unsolved.

A matrix does not make a decision by itself. It makes the reasoning visible, so that members of the leadership team can challenge a score or a weight rather than argue in general. In this case, the chief nursing officer questioned the staffing score for Alternative A, and the group lowered it from 4 to 3 before finalizing the result, which still left the observation unit clearly ahead.

Operational Plan

Planning turns a decision into action. The strategic plan already includes a goal of reducing emergency department boarding, so the observation unit becomes an initiative under that goal, with an operational plan that sets out what will happen, who is responsible and when. In the first quarter, the project lead, the emergency department director, will finalize protocols for the four most common conditions and recruit staff, with nursing positions offered first to current staff who want to transfer. In the second quarter, the unit will renovate minor fixtures, train staff and open with eight beds, rising to sixteen by the end of the third quarter. Measures include emergency department boarding time, observation length of stay, the share of observation patients later admitted, patient experience scores and the unit's cost per case. The leadership team will review results quarterly and decide at twelve months whether to expand, adjust or close the unit.

Conclusion

The decision about 5 North shows why structured planning and decision-making matter. Defining the problem carefully changed the answer, evidence from several sources narrowed the options, agreed criteria made the comparison fair, and an operational plan with measures made the decision accountable. The same steps apply to smaller decisions, and managers who use them consistently make choices they can explain.

References

Baugh, C. W., Venkatesh, A. K., Hilton, J. A., Samuel, P. A., Schuur, J. D., & Bohan, J. S. (2012). Making greater use of dedicated hospital observation units for many short-stay patients could save $3.1 billion a year. Health Affairs, 31(10), 2314-2323. https://doi.org/10.1377/hlthaff.2011.0926

Nutt, P. C. (1999). Surprising but true: Half the decisions in organizations fail. Academy of Management Executive, 13(4), 75-90. https://doi.org/10.5465/ame.1999.2570556

Walshe, K., & Rundall, T. G. (2001). Evidence-based management: From theory to practice in health care. The Milbank Quarterly, 79(3), 429-457. https://doi.org/10.1111/1468-0009.00214