https://doi.org/10.1111/poms.13830

Fønss Rasmussen, L., Grode, L. B., Lange, J., Barat, I., & Gregersen, M. (2021). Impact of transitional care interventions on hospital readmissions in older medical patients: A systematic review. BMJ Open, 11(1), e040057. https://doi.org/10.1136/bmjopen-2020-040057

Kangovi, S., Mitra, N., Grande, D., Long, J. A., & Asch, D. A. (2020). Evidence-based community health worker program addresses unmet social needs and generates positive return on investment. Health Affairs, 39(2), 207–213. https://doi.org/10.1377/hlthaff.2019.00981

Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., O’Brien, E. C., & Kansagara, D. (2018). Impact of patient-centered medical homes on healthcare utilization. American journal of managed care, 24(5), 237-243.

M., S., & Chacko, A. M. (2021, January 1). 2 – Interoperability issues in EHR systems: Research directions (K. C. Lee, S. S. Roy, P. Samui, & V. Kumar, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/pii/B9780128193143000021

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In addition to these regulatory initiatives, outcome measures such as patient satisfaction, clinical quality measures, and healthcare utilization can be employed to monitor the effectiveness of the care coordination process at Sacred Heart Hospital. By tracking these measures, the hospital can identify areas for improvement and adjust its care coordination processes accordingly. For example, if patient satisfaction scores are low, the hospital may need to improve communication between care providers and patients or provide additional resources to support patients after discharge. Therefore, Sacred Heart Hospital can achieve the Triple Aim and provide high-quality, cost-effective care to its patients by continuously monitoring and improving the care coordination process.

Process Improvement Recommendations to Stakeholders

Sacred Heart Hospital must improve its care coordination process to achieve Triple Aim outcomes for the community. The existing care coordination process is inefficient and leads to suboptimal patient experience, poor health outcomes, and increased per capita cost of healthcare.

Stakeholders

The stakeholders in this case include the hospital administration, healthcare providers, patients, caregivers, and representatives from Vila Health.

Anticipated Needs and Concerns of Stakeholder Group

The stakeholders will want to understand why updating the care coordination process is necessary and how it aligns with the Triple Aim objectives. They will also want to know the specific strategies SHH will employ to achieve the Triple Aim outcomes.

Questions and Objections Likely to be Raised

The stakeholders might question the resources required to update the care coordination process and how it will impact their work. They might also object to the timeline for implementing these changes, citing that it is too short.

Response to Questions and Objections

In response to questions about resources, SHH should explain that updating the care coordination process requires minimal additional resources and is necessary to improve patient outcomes. Moreover, to address concerns about the timeline, SHH should assure stakeholders that the timeline is reasonable and that the hospital will provide adequate support to enable everyone to make the necessary changes efficiently.

References

Bravo, F., Levi, R., Perakis, G., & Romero, G. (2022). Care coordination for healthcare referrals under a shared‐savings program. Production and Operations Management. https://doi.org/10.1111/poms.13830

Fønss Rasmussen, L., Grode, L. B., Lange, J., Barat, I., & Gregersen, M. (2021). Impact of transitional care interventions on hospital readmissions in older medical patients: A systematic review. BMJ Open, 11(1), e040057. https://doi.org/10.1136/bmjopen-2020-040057

Kangovi, S., Mitra, N., Grande, D., Long, J. A., & Asch, D. A. (2020). Evidence-based community health worker program addresses unmet social needs and generates positive return on investment. Health Affairs, 39(2), 207–213. https://doi.org/10.1377/hlthaff.2019.00981

Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., O’Brien, E. C., & Kansagara, D. (2018). Impact of patient-centered medical homes on healthcare utilization. American journal of managed care, 24(5), 237-243.

M., S., & Chacko, A. M. (2021, January 1). 2 – Interoperability issues in EHR systems: Research directions (K. C. Lee, S. S. Roy, P. Samui, & V. Kumar, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/pii/B9780128193143000021


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