Reducing Hospital Readmissions

Ethical Case Studies

Consider the ethical dilemma the health care professional faces in the selected case study. Pay particular attention to details that will help you analyze the situation using the three components of the Ethical Decision Making Model (moral awareness, moral judgment, and ethical behavior).

Note: The case study may not supply all of the information you may need for the assignment. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any speculations that you make.

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Open and Close Icon Reducing Hospital Readmissions

Caleb Powell was preparing the agenda for the upcoming executive leadership meeting and he shook his head ruefully. As chief executive officer for Virginia County Regional Hospital (VCRH), Caleb believes that a key piece of VCRH’s future success lies in reducing readmission rates, not only in the areas identified by federal guidelines, but across the board. A few weeks ago, he read a piece from the National Institutes of Health discussing strategies associated with reduction in readmission rates. He decided that he wanted to discuss the issue in detail with his leadership team.

Caleb’s goal is to align the hospital’s strategic planning with the goal of reducing readmissions. The stakes are high; under provisions of the Affordable Care Act, hospitals with higher than expected 30 day readmission rates for heart failure, heart attack and pneumonia are penalized with reduced payments. Historically, hospitals (including VCRH) have struggled to avoid the penalties, but Caleb believes that believes that a focused approach will allow them to be successful. He also believes that reducing readmission rates will improve patient satisfaction, which has become a key metric in measuring hospital quality.

Caleb’s initial research into this issue revealed that while many facilities were incurring the Centers for Medicare and Medicaid Services (CMS) penalties, there was still significant variability in terms of hospitals implementing successful strategies for reducing their readmission rates. However, several themes have emerged. Hospitals that established partnerships with physicians, physician groups and other local hospitals have had greater success. In addition, a clear discharge planning process and nurse driven medication reconciliation have also been associated with reducing the risk of readmissions.

At the same time, Caleb is concerned that an aggressive policy to avoid readmissions could be construed as too focused on the hospital’s bottom line and indifferent to patient needs. The last thing he wants is to create a policy that prevents patients from seeking or receiving care. Caleb hopes that this meeting will begin a productive discussion around developing strategies to improve VCRH’s performance in this area.

Caleb’s email to the executive leadership team with the agenda for the meeting included the following note:

“As we research the readmission rate issue for improvement, we need to be aware that we cannot add additional days to the patient’s initial stay. It’s a balancing act. We also cannot hinder a patient from coming back into the hospital for a readmission. I’ll be asking for your input about whether we should create a system to profile health care providers whose patients have high readmission rates.”

 

Develop a solution to a specific ethical dilemma faced by a health care professional by applying ethical principles. Describe the issues and a possible solution in a 3-5 page paper.

For this assessment, you will develop a solution to a specific ethical dilemma faced by a health care professional. Read each portion of the assessment carefully and use the suggested resources to help you complete the assessment. This assessment provides an opportunity to consider ethical principles and how they can be applied in health care situations.

 

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance level descriptions for each criterion to see how your work will be assessed.

For this assessment, you will develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:

1. Access the Ethical Case Studies media piece linked in the Resources to review the case studies you may use for this assessment and select the case most closely related to your area of interest and use that case study to complete the assessment.
   • Note: The case study may not supply all of the information you may need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.
2. Identify which case study you selected, briefly summarize the facts surrounding the case study, and identify the problem or issue in the case study that presents an ethical dilemma or challenge and describe that dilemma or challenge.
   • Use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) found in the Ethical Decision-Making Model media piece in the Resources to analyze the ethical issues.
3. Analyze the factors that contributed to the problem or issue.
   • Identify who is involved or affected by the problem or issue.
   • Describe the factors that contributed to the problem or issue and explain how they contributed.
   • In addition to the readings provided, use the Capella library to locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation.
     • Cite and apply the journal article as evidence to support your critical thinking and analysis of the case.
     • Assess the credibility of the information source.
     • Assess the relevance of the information source.
4. Discuss the effectiveness of the communication approaches present in the case study.
   • Describe how the health care professional communicated with others.
   • Describe the communication and communication strategies that were applied, both in creating and in resolving the problems or issues presented.
   • Assess instances where the professional communicated effectively or ineffectively.
5. Discuss the effectiveness of the approach used by the professional related to any problems or issues involving ethical practice in the case.
   • Describe the actions taken in response to the ethical dilemma or challenge presented in the case study.
   • Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.
   • Discuss the key lessons this case provides for health care professionals.
6. Apply ethical principles to a possible solution to the proposed problem or issue from the case study.
   • Describe the proposed solution.
   • Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.
   • Discuss how likely it is the proposed solution will foster professional collaboration.
7. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
   • Determine the proper application of the rules of grammar and mechanics.
8. Write using APA style for in-text citations, quotes, and references.
   • Determine the proper application of APA formatting requirements and scholarly writing standards.
   • Apply the principles of effective composition.
   • Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.

Example Assessment: You may use the assessment example, linked in the Assessment Example section of the Resources, to give you an idea of what a Proficient or higher rating on the scoring guide would look like.

Additional Requirements

1. Length: At least 3–5 typed, double-spaced pages, not including the title page and reference page.
2. Font and font size: Times New Roman, 12 point.
3. APA Template: Use the APA Style Paper Template as the paper format and the APA Style Paper Tutorial for guidance. See the Resources for these documents.
4. Written communication: Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
5. References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.
6. APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page.
7. Turnitin: Submit your assessment to Turnitin prior to grading. Then, only submit your final assessment to faculty for grading.

Note: Read the Applying Ethical Principles Scoring Guide to fully understand how your paper will be graded.

Submit your paper for evaluation by clicking on the assessment title and uploading the paper as a Word document.

If you would like assistance in organizing your assessment, or if you simply have a question about your assessment, please do not hesitate to ask your courseroom instructor or the teaching assistants in the NHS Learner Success Lab for guidance and suggestions.

 

Ethics for Health Care

• American College of Healthcare Executives. (2016). ACHE code of ethics. Retrieved from https://www.ache.org/abt_ache/code.cfm
• American Nurses Association. (n.d.). Ethics topics and articles. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources
• Centers for Disease Control and Prevention. (2017). Public health ethics resources. Retrieved from https://www.cdc.gov/od/science/integrity/phethics/resources.htm
• Levitt, D. (2014). Ethical decision-making in a caring environment: The four principles and LEADS. Healthcare Management Forum, 27(2), 105–107.
• Levitt-Rosenthal, N. (2013). Ethics, values, and decision making. Frontiers of Health Services Management, 30(1), 27–32.
• Mahoney, J. S., Mulder, C., Hardesty, S., & Madan, A. (2017). Integrating caring into patient-centered care through interprofessional education and ethics: The Caring Project. Bulletin of the Menninger Clinic, 81(3), 233–246.
• Maintaining Academic Honesty.