- Construct organizational training strategies that resolve emerging issues in a healthcare environment.
- Demonstrate college-level communication through the composition of original materials in Standard American English. Unit Outcomes
- Differentiate between the concepts of strategy and strategic management.
- Apply analyses of internal and external environments to strategic planning.
- Describe a business model and its component parts.
- Understand the purposes of strategic alliances.
- Describe the relationships among alliance motivation, structure, and outcomes.
- Please complete all parts in a Microsoft Word® document.
- The body of your document should be at least 1500 words in length. A title page and a reference page should also be included but do not apply to the length requirement.
- Quoting should be less than 10% of the entire paper. Paraphrasing is necessary.
- You must cite and reference at least four credible sources from the university library.
- Formatting should be double-spaced, 12 point, Times New Roman font.
- Be sure to follow the conventions and mechanics of Standard American English (correct grammar, sentence structure, punctuation, etc.).
- The submission should be presented in an organized, logical, and unified manner and consist of superior content that is original and insightful.
- You must meet APA style requirements throughout the submission, including title page, formatting, citations in the body of the text, as well as related references. Please be sure to visit the Writing Center to assist you in conforming to APA style.
Policies and Procedures to Monitor Abuse or Fraudulent Trends in Healthcare
Training workplace healthcare strategies are important for development of hospitals. It describes policies, regulations and procedures needed in the hospital. The report addresses different concepts regarding the training workplace strategies in the hospital. These strategies are categorised on the following formats in the report. The mentioned parts provides a report from the hospital
Policies and procedures to monitor abuse or fraudulent trends in healthcare.
Implementation staff orientation and training programs for healthcare.
Evaluating the initial and ongoing training programs in the healthcare environment.
Enterprise-wide information assets to support organizational strategies and objectives.
- Policies and procedures to monitor abuse or fraudulent trends in healthcare.
The hospital needs to come up with apt procedures that will focus to reduce health fraud or abuses (Srinivasan & Arunasalam, 2013).These strategies should conform to the principles of the code of conduct in medical coding and billing for services in the hospital. These policies include;
Using setting standards in health centres. These standards will decrease these frauds in the hospital and reporting any fraud. Patients are requested to report any fraudulent action experienced in the hospital. Also, coming up with rules and regulations that will focus to restrict medical coding and billings in the hospital (Kongstvedt, 2012).Departments responsible for patients in hospitals should ensure all necessary information and documents relating to patients in the hospital are clearly presented.
Types of abuse identified in medical coding and billing activities
It happens when multiple procedures meant to be billed in packages are billed differently and separately (Srinivasan & Arunasalam, 2013).This creates a higher invoice. For example, physicians fraudulently trying to increase profits by changing the invoice.
(b).Inflated hospital bills in healthcare.
Involves overcharges in hospital bills. For example, when the patient fails to track the bills physicians may opt to increase the bill. Some physicians after adjusting the bills may tend not to correct any mistake incurred in preparing bills. Patients, therefore, should stand up and fight for their rights when it comes to cross-checking bills (Suresh, De, Gollamudi, Pathria, Tyler, 2014).
This is the most billing fraud which includes extra bills not performed.This fraud has affected patients insurance and also it has consumed a lot of dollars from the government. It affects the patient's medical report and it may end up affecting how doctors treat the patient in hospitals (Kongstvedt, 2012).
- Implementation staff orientation and training programs for healthcare.
Generally, staff orientation helps new staff members to meet with the rest of colleagues whereby they later become integrated into the hospital (Khalifa, 2013). The staff orientation program in the hospital will be based on;
- Introducing new medical billing and coding employees to colleagues in hospital.
- Describing rules and regulations expected within the hospital.
- Assigning employees new mentors in the hospital.
- Setting up an evaluation period. This opens room for the new employees to show his /her own capabilities (Slade, Amering, Farkas, Hamilton, O'Hagan, Panther, Whitley, 2014).
Implementation Staff Orientation and Training Programs for Healthcare
Based on training there are different aspects which a leader can use to increase the competency level. Training program for medical billing and filling employees will be based according to different theories. It should be well analysed and developed for future benefits. Therefore, the training program for these employees will consider;
- Need to come up with healthcare objectives. This will help to answer questions like what type of training is needed in the hospital.
- Considering a learning style needed by the new employees. This assists in developments of training programs in the hospital (Slade et al, 2014).
- Incorporating delivery mode. This will be based on designing which training method will be appropriate for the medical billing and filling employees. It shows that most training programs in the hospital will be based on different delivery modes.
- Designing the appropriate budget for the entire training program. The total expenditure to be incurred in the training. How much each employee will spend and what is total expenditure for being materials necessary for training (Thomas & Galla, 2012).
This part will describe the components of successful orientation and training programs in the hospital (Thomas & Galla, 2012). Therefore the following gives a checklist that will aid in implementing training and orientation programs for the medical billing and filling employees;
- Ensuring all goals of employee training and orientation are straight and clear in the healthcare.
- Ensuring all employees in healthcare are participating in learning activities in the hospital.
- Giving employees an opportunity to reinforce what they have learned during the orientation and training time.
- Ensuring the learning environment for the orientation and training is informal, positive and safe for the employees.
- Providing adequate training skills needed by the employees. This incurs explaining to employees the complete development process experienced in orientation and training procedures so as to allow medical billing and filling employees to come up with plans necessary for job development (Thomas & Galla,2012).
- Evaluating the initial and ongoing training programs in the healthcare environment.
Training programs are important in an organization. These types of training programs will be applied to both new medical billing and filling employees and also future development (Donaldson,2012).Therefore the action plan for evaluating training programs for the employees involves;
(a).Orientation evaluation programs.
This program forms an initial training program. It enables new workers to familiarize with the roles of the hospitals and entire departments (Donaldson, 2012).
(b).Developing on-board training evaluation programs.
Involves a series of departmental sessions in the hospital that will take a lot of time. For our case two years. It focuses on ensuring new employees are successful as they familiarize themselves with their roles.
(c).Creating soft skills development evaluation training programs.
Soft skills include employee personal attributes that will enable them to interact harmoniously with other colleagues in the hospital. These training programs are crucial for both new and existing employees in the hospital. It enables to build an efficient and collaborative culture that will ultimately affect the bottom line. It involves evaluation topics such as communication skills, conflict resolution and leadership skills (Brinkerhoff, Brethower, Nowakowski, Hluchyj, 2012).
(d).Designing products and service training programs.
The program is for new employees and existing employees who may want to refreshers on products and services offered in the hospital. The program educates staff on new services and products in the hospital.
Methods used to evaluate the effectiveness of the training program.
These methods include;
(a).Identifying the reaction of employees.
This level measures employee’s response to training program used (Chen, 2014).
(b).Determining the learning results.
It is categorical for on-board training programs since it gives results on what employees have learned from each department in the hospital. It comprises pre-test and post-test questions.
It determines whether training had impacts on attitudes, overall behaviour, and performance of employees in the hospital (Chen, 2014).
Includes methods used to measure performance before and after training in the organization.
- Enterprise-wide information assets to support organizational strategies and objectives.
- Importance of EDW to the healthcare organization.
- EDW provides enhanced organizational intelligence since managers will not be able to use limited data.
- EDW saves time. Data can be easily accessed from a number of resources.
- It enhances data quality and consistency within the organization.
- It provides historical intelligence since it stores a large number of data for future use.
- It generates the return on investment (Mohanty, Jagadeesh, Srivatsa, 2013).
- Strategic objective use of the data warehouse.
Evaluating the Initial and Ongoing Training Programs in the Healthcare Environment
The strategic objective will be reconciling different views of the same data in the organization.
Applies majorly if the organization runs on short-term goals. It includes reducing inconsistent reports and providing reports that enable data sharing. Managers will have to make sub-optimal choices from the organizational point of view so as to complete the project within the time frame and allocated budget (Zikopoulos & Eaton, 2011).
Through data warehouse this objective can be achieved by;
- Managers ensuring different views of the same data are keenly discovered.
- Communicating views being planned so as to reconcile with the goals project.
- Helps in identifying views which were not accounted for in the project.
- Demonstrating how data warehouse can identify strategic objective from two information assets from part (1).
(a).Enhancing data quality and consistency.
This list helps in describing the consolidated picture of the organization data. Warehouse data provides a logical data model which is within the scope of the entire project in the organization. This means that as one adds new data then new requirements for warehouse data are added for future iterations (Zikopoulos & Eaton, 2011).
(b).Providing historical intelligence.
The list will involve giving architecture data thus serves as the key objective. Warehouse data will be in the position to provide two type of architecture data in the organization (Kimball & Ross, 2011). It provides the logical data in architecture whereby logical and Metadata for the organization is easily accessed. Also, EDW will demonstrate the physical data architecture whereby there will be access to performance issues at the physical level by using the apt database information provided.
In conclusion the discussed strategies outlines the entire report for the hospital. Implementation of policies on fraudulent activities describes regulations needed. Training employees helps the hospital to serve large number of patients. EDW provides the organization to utilise various methods of analysing data.
Brinkerhoff, R. O., Brethower, D. M., Nowakowski, J., & Hluchyj, T. (Eds.). (2012). Program evaluation: A practitioner's guide for trainers and educators (Vol. 2). Springer Science & Business Media.
Chen, H. T. (2014). Practical program evaluation. Sage.
Donaldson, S. I. (2012). Program theory-driven evaluation science: Strategies and applications. Routledge.
Khalifa, M. (2013). Barriers to health information systems and electronic medical records implementation. A field study of Saudi Arabian hospitals. Procedia Computer Science, 21, 335-342.
Kimball, R., & Ross, M. (2011). The data warehouse toolkit: the complete guide to dimensional modeling. John Wiley & Sons.
Kongstvedt, P. R. (2012). Essentials of managed health care. Jones & Bartlett Publishers.
Mohanty, S., Jagadeesh, M., & Srivatsa, H. (2013). Big data imperatives: Enterprise ‘Big Data-warehouse,‘BI'implementations and analytics. Apress.
Slade, M., Amering, M., Farkas, M., Hamilton, B., O'Hagan, M., Panther, G., ... & Whitley, R. (2014). Uses and abuses of recovery: implementing recovery?oriented practices in mental health systems. World Psychiatry, 13(1), 12-20.
Srinivasan, U., & Arunasalam, B. (2013). Leveraging big data analytics to reduce healthcare costs. IT professional, 15(6), 21-28.
Suresh, N. C., De Traversay, J., Gollamudi, H., Pathria, A. K., & Tyler, M. K. (2014). U.S. Patent No. 8,666,757. Washington, DC: U.S. Patent and Trademark Office.
Thomas, L., & Galla, C. (2012). Building a culture of safety through team training and engagement. BMJ Qual Saf, BMJ's-2012.
Zikopoulos, P., & Eaton, C. (2011). Understanding big data: Analytics for enterprise-class Hadoop and streaming data. McGraw-Hill Osborne Media.
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