Introduction

 Although a lot of developments are taking place in the field of medical science, still a lot needs to be done in the field of cardiac tests. Proper facilities are not available at the hospital, an addition, if some hospitals are providing such services; they have very less resources due to which they are not able to serve customers. There is long waiting for the diagnostics of cardiac problems. Further, the referral to treatment time is as long as eighteen weeks. All these are because of lack of resources. In addition to this, most of the hospitals are not following the guidelines related to the CRM device clinic follow up set by the Heart Rhythm UK and European Heart Rhythm.

Due to lack of resources, hospitals are not able to deliver proper services to their inpatients, as most of their employees are engaged in providing services to the outpatients. In addition to this, the Device CRM clinic provides home monitoring facilities to the customers, so that customers can download the information and then can send it to the hospital. But, due to lack of manpower, the hospital is not able to entertain them.

This business plan is about buying another hospital Princess Royal University Hospital by the King’s hospital. By acquiring this hospital, the management can allocate the existing staff of this hospital to the earlier hospital and thus can solve the problem of manpower to a certain extent. In addition to this, the hospital will also recruit some of the staff to meet the demand of customers. Apart from this, the hospital will increase the efficiency of the diagnostic rooms in Suit 6 during office hours, and to serve more customers, it will extend the working hours and will also launch some satellite clinics. It will help in expanding services as well as to increase the capacity.

Background

Increased work pressure, unhealthy eating habits and improper lifestyle have resulted in the rise in patients suffering from different cardiac diseases. Cardiac Physiologists are proving a boon for such patients. Cardiac physiologists not only perform complex diagnostics and therapies related to congenital heart diseases, but also help in investigating and diagnosing the acquired and congenital heart disease. The importance of Cardiac Physiologists are many, such as:

  • They carry out critical and complex therapies and operations related to different heart diseases.  
  • They study the physiology of the heart to find out whether it is functioning well or not.
  • They are trained to perform and interpret ECGs.
  • They are expert in pacemakers and have complete technical knowledge about its functioning.
  • They perform stress test and to check the blood pressure of the patients.
  • They monitor abnormal rhythms of the heart.
  • They treat patients by implanting cardiac devices that help the heart to work normally.
  • Therefore, Cardiac Physiologists are important part of medical science since they monitor the most important organ of the human body.       
  • Develop Home monitoring importance in CRM Devices

The earlier patients suffering from various heart diseases or those who were implanted with implantable defibrillator and pacemakers have to periodically visit the hospitals for their regular treatment. According to the doctors, it is mandatory for the patients visiting the clinic once in three months, but patients were not able to visit the hospital more than two times a year. In order to overcome this problem and to keep a close look at the patient’s health, most of the companies invested home monitoring systems; it enables ICDs and pacemaker patients to consult doctors through wireless telephone technology. And, thus helps significantly in the safety of the patients and reduces pacing clinic visits

In recent year, a rise in the demand of Cardiac diagnostics has seen in the UK due to the aging population of the UK. In such circumstances Tertiary cardiac center such as King’s will significantly help in increasing the implant rate and this will boost the CRM clinic referrals. Further, with the addition of the new cardiac catheter and cardiac bed in the hospital will add more IP and OP referrals to the cardiac diagnostics.

A huge variation has been seen in the number of patients admitted in the hospital and number of patients discharged from it. The main reason behind this is the management of the services such as inpatient tests, ward round, pharmacy, etc. Due to all these reason, it is very difficult to predict the length of stay of the patients, even if two patients are suffering from the same disease. In most cases, patients are discharged on the weekends, that is, Friday, Saturday and Sunday.

This has made the situation worse for the King’s hospitals, since, it admits patients all the seven days of the week but, discharges only on the weekends. This is the main reason behind the variation of length of stay of the patients, and in order to overcome from this problem, the hospital has to manage and control its discharge process. By planning and controlling the discharge process, hospitals can increase the capacity in the system, but for this, it will have to adopt proactive discharge planning. The hospital can achieve this by designing a proper flow model and better pathway of care for all the different conditions. For example, take the case of hip replacement, by properly designing the care pathway, hospitals can estimate the date of discharge and thus can attain capacity planning. Further, imparting proper information to the patients about their admission and discharge, the hospital can make its capacity planning more effective.

 Strategic Fit - identify key relevant external and internal strategic drivers (e.g. NSF’s IOG’s care group priorities, KPI’s and how the bid supports their delivery. How it fits in with departmental and corporate (e.g. IT) strategies .

This business plan is basically about increasing the capacity of the King’s hospital and to reduce the waiting time of the patients. Thus, raising funds for this business plan will enable the King’s hospital to attain its aim and objective. By better planning and control of the admission and discharge of the patients, the management can improve the capacity and can reduce the waiting time of its inpatients checks and remote home monitoring. In addition to this, the new business plan proposes new 4th lab/cardiac beds; this will generate extra work for the CRM Device Clinic. It will enable the hospital to serve more inpatients, outpatients and remote monitoring.

Further, it will also help the management of the hospital to meet and comply with the key national performance targets set by the government and regulating bodies such as target of 18 week referral to treatment time (RTT), effectively implementing all elements of the Coronary Heart Disease National Service Framework (CHD NSF) and CHD NSF Chapter on Arrhythmias. Further, it will also enable the hospital to shorten the length of stay of the patients as employing new staff and better management will make sure that patients are admitted and discharge on all the seven days of the week. Moreover, the acquisition of the Princess Royal University Hospital of the King’s will solve the problem of manpower, as now King’s hospital can allocate the existing staff of the  Princess Royal University Hospital in the King’s hospital to meet the demands of the patients. Apart from this, by going for the bid, the hospital can enhance the efficiency of the diagnostic rooms in Suit 6and can launch some satellite clinics to serve more customer, to expand its service reach and to increase the capacity.

Define objectives – identify the key objectives which the bid seeks to deliver, making these ‘SMART’

The objective of the proposed business plan is:

  • To restructure and increase the organization of CRM service in CRM device.
  • To increase the capacity of the inpatients checks and remote home monitoring services
  • To procure some of the latest medical equipments

By investing in the proposed, the King’s hospital will increase the capacity within Suite 6 in CRM device.  Therefore, the hospital will able to serve more inpatients and remote home monitoring service. Further, the bid will also add to the competitive attractiveness of the cardiac diagnostics among the commissioning group. Further, by investing in the proposal, the hospital is forecast to increase the inpatient CRM Device checks by at least 40 patients per week. In addition, the hospital is expecting a rise of at least 60 more remote home monitoring appointments per week. All these measures will enable the king’s hospital to reduce the waiting time for the diagnostic for the inpatients, outpatients and the GP referrals. By stretching the office hours and by effectively using clinical rooms, the hospital can overcome the problem of long waiting lines.

In addition to this, the staff can extend the working days for such patients who are diagnosed with minor disease. Presently, the hospital’s capacity is far below than the required capacity to meet the demands of the patients; both for inpatients and the remote house monitoring, thus, by implementing the above measures as soon as possible, the management can overcome from all the problems. Finally,

The hospital has decided to implement this plan in September 2013; therefore, it will have to plan accordingly so that it can meet the desired deadline. Moreover, for this, the hospital will have to start its recruitment process by October 2013 so as to carry out all the operations smoothly.

There are two options available to the hospital to capitalize or address the problem or opportunity, these are stated below:

Option 1 - Do nothing   
The first option available with the hospital is to do nothing. That is, the hospital will not acquire new hospital nor it will recruit new staff. By working on this option, the hospital will not be able to reduce the waiting time of the inpatients. Further, by just adding more beds in the cardiac section, the hospital can only increase the patient referrals for the cardiac diagnostics. This will further increase the waiting time of the inpatients for the diagnostic tests and echo. Doctors will keep performing all the unnecessary tasks such as attending calls, rescheduling, paperwork, etc. and thus, will not be able to consult more patients. The CRM Device Cardiac Physiologist developed for the inpatients and the home monitoring will go waste as the Device CRM clinic will not be able to increase its capacity and thus, the hospital will not be able to serve more patients. Further, the hospital would not be able to capitalize the improvement on the tariff of diagnostic tests and this will not enable the King’s hospital to remain competitive in the medical industry.

Option 2 - Implement changes in staffing.
On the other hand, if the King’s hospital implements changes, that is, it acquires the Princess Royal University Hospital and recruit some more staff, in that case, the hospital will be able to reduce the waiting time of the inpatients, outpatients and remote home monitoring. Further, if the hospital will recruit more staff, cardiac psychologists will be able to focus more on their main work and thus will be able to attain more patients as now they don’t have to waste time on calling, rescheduling, paper work, etc. Therefore, by attending more patients, the hospital will be able to reduce the waiting time significantly. Trough this, King’s will remain abide by the Do RRT guidelines. All these measures will result in enhancing the attractiveness of CRM.

 Preferred option –
Based on non-financial and financial appraisal the preferred option is option 2 since it will help the hospital both financially and non financially in the following manner: 


Financial: 

Financially, the business plan will significantly help the hospital in generating more revenue and thus, more profits. Since, it is a trust and currently does not gross charge from the patients for the cardiac diagnostics and other operations related to the cardiac problems. But after implementing the measures, it will be able to abide by the 18 week pathway, and therefore, there will be no negative effect on the hospital financially. In addition, at present the patients referred by the general practitioners for cardiac diagnostics and other consultancy were not funded at the cost. But with the implementation of the new contract, the trust will be able to generate a higher amount of revenue through the diagnostic tests referred by the general practitioners. This will indirectly add to the income of the hospital. Moreover, since the waiting time will be reduced and capacity will be increased, the hospital will be served more patients and thus will earn more revenue and profit.

Non financial:

By recruiting more staff and procuring latest and modern medical equipments, the hospital can implement changes in its functioning. It will make sure that the hospital is meeting all the guidelines set by the government and other regulatory bodies. The hospital will meet the standard set by the regulator to provide the treatment within 18 months of referral time and will match the non invasive diagnostic pathway of six weeks. In addition, the appropriate number of staff and latest medical equipments will help it to reduce the waiting time of inpatient remote house monitoring service and will increase its capacity. Further, the doctors will be able to concentrate only on the consultancy as other works such as sailing, rescheduling, paper work etc. will be performed by other employees. It will also help in increasing the capacity.

Risk Assessment – describe any risks with any of the options (including clinical risk, risk of loss of activity / income, loss of reputation – and risk to business continuity)

If option two is not approved then different kinds of risk are associated with the proposal. The first and the fore most is the clinical risk. If there will be inadequate staff in the hospital, this will result in long waiting lines of the inpatients and out patients. Further, hospital will not be able to serve the remote home monitoring patients. This will increase the chances of casualty as due to insufficient staff, doctor will not be able to serve the patients on time. This will impact the image of the hospital as well and the hospital will find it difficult to survive in the competitive market.

Further, as the image of the hospital will deteriorate people will try to avoid consulting their and therefore, there will be loss of revenue and profit. Moreover, since the medical market is very competitive in the UK due to open NHS, long waits will further impact the business of the hospital. This will not only affect the perceptions of the patients but may also impact the existing staff of the hospital. In the absence of sufficient staff, the doctors will feel lot of pressure as they not only have to attend the patients, but also have to do calling, paper work, rescheduling, etc. so, there are possibilities that they may also switch to some other reputed hospital. In this case the hospital will lose its existing staff and due to its poor image amid the patients, it may also not be able to attract new talent. So, these are the possible risks that King’s hospital may have to face in case it is not able to implement the second option

Equality Impact Assessment – describe any positive or negative impact the proposal may have on service users and staff (complete EIA form and attach where necessary)

There are both positives and negatives of the proposed proposal. If the hospital implements the changes stated in the option two, it will be able to attain the standards set by the government and the regulating bodies. Apart from this, the waiting time will be reduced considerable for the inpatients, outpatients and the remote home monitoring and thus, the doctor will be able to serve more people. Patients will also benefit from this, they will receive the medical facilities and service instantly. This will reduce the death rate due to sudden cardiac arrest of the patients. Apart from this, the hospital will be able to overcome all kind of clinical risks, that is, there will be availability of the appropriate staff of in the hospital. Doctor will be able to mainly focus on consulting the patients rather than wasting their time in the unproductive activities.

The image of the hospital will enhance in the mind of customers and more and more customers will get attracted towards the hospital. This will help the hospital in increasing its revenue and thus, the overall profit. But, on the other hand, there are some negative also attached with the proposed proposal. The first and the foremost negative is the increase in the consultancy fees and the cost of treatment. As the hospital will install new medical equipments, it will have to recover it cost, which it can achieve by raising its consultancy fees and the cost of operations. Apart from this, with the rise in the number of staff, there are greater chances that conflicts may occur between the staff members. This may affect the working environment of the hospital. Finally, there are chances that due to improvement in its services, lot of patients visit the hospital for their treatment, and in that case the existing staff finds it difficult to serve all patients.

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