Case study on "Audit for Business Analysis".
Founded in 2006, Netherlands, Buurtzorg tends to be one of the unique district nursing system that has been able garn international claim for being a nurse led and cost effective health system (Buurtzorg, 2015). Hence, this point has led to a particular interest in UK, where there is an enormous challenge of meeting the needs of the ageing population that is growing susceptibly and developing complex conditions (Marshall, 2016). Therefore, Buurtzorg has been able to transform the home based health care into a system that creates an innovative method for nursing care homes. Buurtzorg success comes as a result of them being connected to competent nurses and clients who develop a positive and proactive approach to solutions that tend to be effective, sustainable and holistic (Buurtzorg Inc, 2015). Organized in a small team of 12 nurses located in the neighborhood size, Buurtzorg nurses have been able to bring a ground breaking synergy and expertise in direction and connection of the relationship between care givers and clients (Buurtzorg Inc, 2015). Buurtzorg has also drown success of reducing the administrative burden for the nurses, they have also led to the improvement of quality care and maintained high satisfaction of their employees. Buurtzorg success tends to be reinforced by the innovative IT systems and their ability to work without the management structure. It would be of significance if we could look at the background of the organization and clearly outline the model in Buurtzorg.
In Netherland, the home care issue tends to be a national benefit that’s funded by the tax revenues. Therefore, in the 1980s the Dutch community nurses decided to consider the autonomy to work closely with patients and their families. But due to marketing incentives there was the introduction of reduced costs, home care became highly regulated by the government, and the reimbursement was tied to an individual nurse action and services (Ironside, 2015). Hence, this led to the fragmentation of care, there was more paper work and less time was spent on patients care.
Therefore, the growth of dissatisfaction among the home care nurses created an opportunity for the introduction of new methods of delivering care. Jos de Blok, a home care nurse who had some experience in management and some background of business administration, had for long carried a vision of a new care system that nurses would apply in the provision of community care based on self-directed teams (Buurtzorg Inc, 2015). There was also the support of infrastructure that could enable the new technology and reduce the administrative oversight.
The Best Practice Model in Buurtzorg
After years of him planning and establishing the financial model that would work best in this system of care. De Blok and his partners created the first team known as Buurtzorg team. Gonnie and Ard, were the people responsible in developing the lean technology, thus they were able to administer their system and operate the organization intranet and the clinical document platform known as the Buurtzorgweb (Buurtzorg Inc, 2015). The first two pioneer nurses for Buurtzorg nurses were Edith and De Blok.
Analysis carried by government surveyor’s show that Buurtzorg patients tend to be highly satisfied. Further survey by them also show that employees workforce have been able to satisfy the organization compared to any Dutch company with over 1,000 employees (Iyamu & Tatnall, 2016). The model has also led to savings in the country. According to Netherlands insurers pay, the Buurtzorg nurses have been able to meet patients demand more than any other organization offering health care.
We can conclude our background analysis that Buurtzorg organization strategy has contributed to their extraordinary success. Consider their starting point where they had one team in the outcast of Almelo in 2007, Buurtzorg has been able to expand its territory to the national level as of 2015, with over 8,000 nurses and 700 teams. Statistics show that as of 2014 they had taken care of 65,000 patients (Buurtzorg Inc, 2015). Therefore, the Buurtzorg strategy has become global and some countries are adapting this strategy. Hence, the Buurtzorg model tends to create a new management approach that is simple, and there is a wide organizational structure that offers them a wide range of services that is enhanced by the technology available (Fleming, 2014).
Home care services in Netherlands are often offered to patients needing temporary health care services after being discharged from a hospital. Some of these patients may be suffering from chronic conditions which require critical medical services, other have dementia, and individual who need end of life care (Buurtzorg Inc, 2015). The home care organizations that are in contract with the government funded insurance firms must offer 10 different home care services. Hence, the number of authority hours depends on a patient’s assessment (Frederick, 2016).
For most healthcare firms they have deployed nurses to offer services that require their skills and knowledge, therefore this reduces the cost of personnel in terms of performing other services (Smith, 2008). Hence, having different caregivers coming at different intervals for patient evaluation tended to jeopardize the continuity of care. According to (Pierce, 2010), most patients and nurses were dissatisfied with the existing traditional home care model.
Buurtzorg health care delivery system has created a unique radical approach to this issue of home care. Jos de Block goal when coming up with this model was to bring a holistic, neighborhood approach that provides services that satisfies patient’s independence (Buurtzorg Inc, 2015). This is made possible through training in self-care and the creation of networks that use neighborhood resources, and completely rely on the provisions of professionalism by the nurses.
· Maintenance of patients independence
· Ensure that there is proper training of patients and families in self-care.
· Rely on nurse’s professionalism.
· Create self governance teams of nurses so that they can offer medical and supportive care services.
· Independent teams with a maximum of 12 nurses taking care of 50-60 patients.
· There is a small back office that handles the administrative acts.
· Coaches must be available so that they can solve problems that may arise.
· Always relies on IT systems so that they can monitor any online schedule, document nurse’s assessments, and ensure there is effective billing.
Hence, Buurtzorg nurses in this model are responsible in conducting a wide range of services including: assessing of patients needs, developing and implementing their care plans, providing services as needed and generating documents as required for ease facilitation of care and billing (Buurtzorg Inc, 2015). Buurtzorg model also collects data of their patients, satisfaction after patient’s completion of the course of care. There is also the model information technology that enables easy scheduling, documentation and billing. Based on this model, nurses don’t need to report to their managers because their working hours are being tracked (Gladon et al, 2014). Nurses are also paid accordingly in terms of their education levels, there is also standard annual increment and bonuses are also paid based on how long one has been working with Buurtzorg. The surplus revenues that the firm creates from the model is used for nurses education and team projects so that there can be improvement of community health and advancements in organizational innovations (Buurtzorg Inc, 2015).
Therefore, the application of this model to Buurtzorg health centre offers them the ability to regulate themselves, maintains a flexible work arrangements so as to meet the patients and nurses needs (Shirley, 2011). According to the model, there is the need of nurses coming up together so that they can review patients cases and discuss their problems, therefore, this provides them with adequate knowledge of their patients and meet the satisfactory needs of their patients.
1.1 Company Overview
Maxim Healthcare Services is a healthcare firm that provides healthy home, medical staffing and wellness initiatives to the community of US (Maxim Health Inc, 2011). The health firm tends to offer home personal care through the management and treatment of conditions through skilled nurses, medical social workers, therapists and some home health aides. They also offer non medical care services to the old, new and expectant couples and other individuals suffering from other conditions (Maxim Health Inc, 2011). The medical team also has facility service such as allied health staffing, governments staffing, executive placement, administrative staffing and clinical research consulting and staffing.
Founded in 1988, Maxim healthcare is roughly made up of 20 different brands and an approximate of 360 offices nationwide. In the year 2009 the company made a significant restructuring where there was the appointment of a new CEO, and also several senior leadership positions such as CIO, CFO, CCO, CMO AND COO (Maxim Health Inc, 2011). Hence, the expansion of the leadership structure has made the company focus on some additional compliance and ethics (Martinson et al, 2012).
The support of the compliance focus has also to them structuring new software’s that play a significant role in the monitoring and billing, so as to enhance quality patient care. The restructuring of the company’s compensation program has also made employees be recognized in a number of excellence areas (Martinson et al, 2012).
The significance of the company’s structure has led to them expanding and realigning their resources. Hence, they have been able to effectively manage and achieve the health compliance standards of delivering quality health care. Thus the success of their structure mainly comes as a result of the division the teams into two the clinical team and the management team (Maxim Health Inc, 2011). The combination of these two teams results to delivery of high quality health care for their patients.
SWOT tends to be a strategic tool in the analysis of any company or business. In this case, SWOT analysis will show the strength, weakness, opportunities and threats that the firm might face. SWOT analysis for our firm may offer them with unique abilities of competitive advantage.
- There tends to exist a strong distribution and sales channel.
- There is the viability of high growth rate for the company.
- The application of their strategy also reduces the labor cost.
- The cost structure tends to be expensive for the firm.
- The tax structure is also not appropriate for the firm.
- The existence of a competitive market tends to affect them.
- High loan rates may also be possible thus affecting the firm.
- It is also hard to maintain their brand portfolio.
- The growing economy may positively influence their activities.
- The growing of the global market may be a new opportunity for them expanding their activities.
- Their ability to offer new products and services is also an opportunity of them growing.
- The rising cost of raw materials tends to be a challenge for the company.
- Fluctuation of prices is also a threat to their operations.
- They may also face the issue of less financial capacity.
- The increasing costs of medical services may tend to discourage people to go to hospital, thus firms will experience low patients numbers accessing their facilities.
Undertaking a situational analysis of the health centre tends to describe and analyze the situation in regards to the health services being offered. Therefore, there is collection of different aspects of information so that there can be the provision of the overall picture of the organizational goals. Therefore, situational analysis is a primary assessment of health services that need to be addressed. Hence, it tends to explain the happenings and factors that facilitate or prevent progress into the company (Maxim Health Inc, 2011). Thus it tends to highlight the problems and needs of the health centre so that the decisions made can be effective.
Therefore, the existence of an information service department in this hospital made up of 104 employees meant that it was hard to maintain consistency application of the best health practices (Maxim Health Inc, 2011). Therefore, with the legacy of project management system it was hard to determine whether goals and deliverables of the company were in line with the health business. The executive team was also unable to determine the visibility of the work done by the nurses and physicians.
My observation in such a case is that not only does the organization face visibility problem, but there are other challenges such as:
- Poor time tracking- where there is no consistency and no method is available for tracking the employees work or the application of firm’s base work.
- There is no request management- this means that they lack a comprehensive system that can track the patient’s request, making it hard for them to rank and prioritize their patients.
- Inefficient resource management comes as a challenge because there exist little transparency into the company’s capacity, resource allocation leading to poor visibility in the future demand plans.
It is essential for the Maxim team to identify the best support tool for its projects and resource management so as to establish a perfect solution. Therefore, the best solution after carrying out critical analysis that can help the company is through application of a cloud based solution, ultimately known as Innotas. This model is quite vase for its strong market recognition, ability to fast time their value and proper matching functionality that meets some of the organizational needs such as:
- Development of a sophisticated request management which has the ability to score and prioritize patients and projects, so as to ensure that resources are working on the right projects and at the correct time.
- The implementation of the model means there will be strong time tracking that enables the tracking aspect of each activity the company conducts. Hence, there will be more accountability, increased productivity and reduced operation cost.
- There will also be robust management of resources where there will be the existence of planning scenario of demand and capacity for patient’s services.
The implementation of this model needs us to consider five steps for the implementation process. They include: analysis of the situation, setting up the objectives, appraisal options, setting the tasks and monitoring an evaluation of the model.
- Situational analysis in our case shows that Maxim healthcare centre is suffering from the challenge of maintaining consistency of the correct application of health standards. Therefore, it becomes a challenge for them to set out a clear objective in terms of the health business standards. This issue also leads to the rise of poor visibility of the work the employees undertake. Therefore, in this stage of implementation cycle one evaluates all factors that impact the organizations catchment in regards to healthcare delivery (Lustig, 2015).
- After critical evaluation of the situational arising, before implementing the Innotas system it is vital for one to perhaps consider looking at the organizations priority and objectives settings, so that he or she can determine whether the set out system to be implemented is in line with where the company wants to be in future. Therefore, in this stage we look at the pros and cons of the model and try to evaluate whether the model can be effective in the eradication of the challenging situation (Fleming, 2014).
- After setting out a clear priority and objective setting as to whether the strategy fits in eradicating the challenge. It is also necessary to look at other means that could be applied so as to establish the standing point we are in and try to evaluate the best ways that our model could yield greater results (Ironside, 2015). Hence, in this case we could perhaps consider advancing the Innotas strategy through innovative methods so as to gain more results beyond our recognition.
- Setting of tasks is also a vital step in the implementation of our program. Here, we tend to clearly allocate each employee a duty. By allocation of duties it means there will be ease supervision of how the model is being channeled through the organization so as to reduce the levels of challenges the firm is facing (Hickey, 2009). This step also tends to show the time a particular task is to be done and by whom. Hence, there will be ease tracking of the person who committed a default in regards to a particular task.
- Monitoring and evaluation of the results pertained from the model. In this step considering the Innotas strategy, monitoring and evaluating of how its conduct also tends to be a critical factor (Martinson et al, 2012). Therefore, in this stage one will be able to determine whether the model is directing us to the correct directions and if there is achievements of the desired results from the model.
Therefore, implementing the Innotas model using the above strategy will enable Maxim Healthcare to achieve their desired aim of having a standardized and centralized tracking system, they will also be able to effectively measure and manage their patient’s request, and there will also be ease allocation of resource time and overall management of the projects. Hence, they will be able to keep track of their time spent and be able to gauge the investments that are available.
- The implementation of this model means there will be great transparency in the company. Robust reporting is also evident meaning that it allows productivity and meeting of the budget requirements so as to achieve significant cost savings.
- There is visibility after the implementation of this strategy in the company.
- Working on the highest priority projects is also evident thus allowing staff to work in more strategic projects freely.
The challenging issue in this case is that the adaptation of this strategy by other firm’s means they will be on the same level of being competitive advantaged (Shirley, 2011). Hence, they may need to develop more systems to keep them competitive.
The analysis carried out across these two health firms is based on a spatial modeling where there were some gaps that existed (Navarra & Ferrer, 2015). Therefore, through solid understanding the planning teams of the two firms were able to come up with where the current needs are across their firms. Therefore, the planning teams set out some tangible proposals that were later implemented in these organizations, thus leading to the yield of positive results. Analyzing is also another vital step that has enabled us to understand the guidelines and planning conjunction initiatives across these two cases.
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