Quality management plan is vital for the effective work and future development of the healthcare organization. Taking a holistic approach in evaluating the hospital’s environment, organizational mission, amenities, environment, and setting, the institution leadership is able to develop a step-by-step rationale, addressing the main issues. Thorough SWOT analysis of the South Florida State Hospital (SFSH) suggests that the key problem lies in understaffing of the personnel, calling for immediate changes in the recruitment and management process.
South Florida State Hospital as an Organization
SFSH is a part of Wellpath Recovery Solutions program which is oriented at providing quality healthcare in prisons and residential treatment facilities. As explained in “South Florida State Hospital” (2020), this medical institution has been the first private hospital to join the association. Since December 2000, SFSH operates as one of the few civil psychiatric hospitals in the region with a capacity of admitting approximately 350 patients at the same time.
Most of the patients admitted to the institution are adults who are severely or persistently mentally impaired. The mission of the organization is to assist individuals with mental illnesses, helping them to achieve maximum level of autonomy and happiness within a less restrictive environment (“SFSH,” 2020). By maintaining a safe healthcare setting under a close supervision of an experienced team of clinicians, SFSH thrives to accommodate the needs of the patients who no longer respond positively to community treatments.
For the limited scope of this quality management plan, the focus of the discussion will be put on OneCare, an innovative healthcare program successfully delivered in SFSH. According to “OneCare” (2020), OneCare is a collaborative correctional care which categorically differs from the typical correctional healthcare, delivered via block communication in silos. Instead of inhibiting coordinated care between different departments in the hospital, OneCare integrates medical and therapeutic perspectives on treating mentally impaired patients in one solution with a team of clinicians and psychologists working together.
This program promotes mental health and substance abuse training among all staff, ranging from nurses to psychiatrists, so that they are capable to apply a shared care plan to treat individuals. OneCare is specifically effective for curing patients with situational depression, anxiety, substance addictions, as well as serious and persistent mental illnesses (SPMI), such as schizophrenia, major depression, bipolar disorder, and others (“OneCare,” 2020). As an evidence-based care, the program uses general clinician guidelines and focuses on early identification and team engagement which increases the success rate of the treatments delivered.
SFSH complex consists of seven residential areas, designed in Mediterranean style with tile floors, pale colors, barrel tile roofs, and rich landscape. Exposure to nature is an integral part of the institutional philosophy, focused on reducing fatigue and stress of mentally ill patients (“SFSH,” 2020). The hospital accommodates the needs of the elderly and those with special medical needs in two separate departments. Seeking to establish the non-institutional atmosphere inside the wards as a part of their illness management and recovery philosophy, SFSH provides two-bedroom patient rooms with multiple windows to engage individual participation in treatment activities (“SFSH,” 2020).
Large, low windows are used to prevent paranoia among people with SPMI (Seppänen, Törmänen, Shaw, & Kennedy, 2018). The institution also utilizes soft, indirect, ample natural daylight to promote recovery of patients with severe depression. Neutral odors and good ventilation are consistently maintained inside the facilities.
The Town Center, located in the center of the campus, serves simultaneously as a congregate space to encourage socialization and group therapy. This way individuals may attend education classes, eat in the common dining areas, visit a beauty salon, library, or a chapel all in one place (“SFSH,” 2020). The reason behind such architectural planning is put on the community reintegration of the patients with readmission and incident rates remaining as low as one case per month (“SFSH,” 2020). Despite the overall welcoming environment of the hospital, SFSH is not able to fully respond to the needs of all the patients, leaving substantial gaps in safety and care regime addressed later in the paper.
SFSH offers a wide array of healthcare and ancillary services, combining conservative and innovative treatments for a better result. As mentioned in “Services” (2020), the hospital primarily focuses on behavioral and mental healthcare, on-site care, and substance abuse programs. SFSH also takes advantage of more innovative services such as Electronic Record Management Application (ERMA), Patient Activity Monitoring Management (PAMM), Medication-Assisted Treatment (MAT), and OneCare.
A part of the institution’s services is dedicated to patient health education and awareness programs. With the response to community integration, SFSH collaborates with community services agencies and provides comprehensive health appraisals as a primary component of their medical care (“Services,” 2020). The hospital specializes in chronic, continuous care within the context of emergency and hospitalization arrangements
Currently, SFSH experiences substantial understaffing of nurses and mental health professionals, primarily explained with the inadequate working conditions, required overtime hours, and night shifts. The facility functions with the total staff number of 450 employees (“SFSH,” 2020). As shown in “Careers” (2020), the institution operates with the help of licensed practical, registered, vocational nurses, psychiatrists, and recovery specialists.
Other professionals contributing to the cause of the organization include but are not limited to mental health technicians, security officers, nutritionists. SFSH also provides residential training and internships for medical students who oftentimes decide to continue their career in the institution. According to “Careers” (2020), the staff of the hospital is united with the 5-H culture: humility, honesty, hard work, hunger for knowledge, and humor. Despite the promised comprehensive rewards such as paid time off or flexible spending account, some employees remain dissatisfied with the working conditions.
Apart from regular furnishing provided in the residential areas, SFSH has a well-equipped medical base. As listed in “Services” (2020), the hospital frequently uses brain polarizer to treat mild and acute depression in combination with medical substances. The device sends low intensity current for brain polarization with the treatment continuing from two to four weeks. Another useful tool utilized in the institution is aversion therapy equipment, aimed at treating substance addictions. In addition, the hospital possesses a binocular microscope, fully automatic auto analyzer, centrifuge machine, X-ray unit, and a bio-chemical laboratory (“Services,” 2020).
Overall, the basic assessment of the equipment provided in SFSH shows that the hospital uses a satisfactory number of modern equipment to minimize or eliminate the symptoms of the patients and pain associated with them.
The primary goal of SFSH is to provide long-term supportive care for adult patients with SPMI. Around 40% of the patients in the institution are geriatric females (65+ years old) who permanently live in the residential areas (“SFSH,” 2020). Some of the individuals admitted to the institution are diagnosed with less severe mental health conditions, such as depression, anxiety, substance abuse, or post-traumatic stress disorder (PTSD). However, the vast majority of people hospitalized suffer from personality, psychotic, and mood disorders in acute stages, posing a threat to the people in a local community (“SFSH,” 2020). The department focused on accommodating special medical needs takes into account the degree of patient’s aggression and tendency to hurt himself or others, temporarily putting restrictions on one’s social interaction.
Statement of the Problem
On the basis of the thorough analysis of the hospital environment, its amenities, and staff, the problem investigated later in the project will be the shortage of nurses. Currently, SFSH struggles to maintain a full staff capacity which leads to lower healthcare quality and potentially higher readmission rates. The nature of the issue arises from the number of concomitant factors:
- work environment;
- work conditions;
- specialty of the job.
First, the work environment of the psychiatric hospital is specifically dangerous for mental healthcare practitioners and nurses, dealing with aggressive patients. Threatened by a possible physical harm and disturbed emotional wellness, professionals choose alternative places of work with lower risk aversion rate. Second, the work conditions offered in SFSH require much patience, dedication, and self-sacrifice. Long overtime hours, little flexibility, night shifts, and pressure from the micromanagement – all together contribute to the shortage of healthcare providers. Third, the healthcare setting and specialties associated with the work in a psychiatric hospital limit the number of eligible employees, emphasizing the need for emotional stability, empathy, and support balanced with strictness, accuracy, and decisiveness.
With relatively the same monetary compensation available for their services, many healthcare practitioners prefer working in a private sector on less physically and psychologically demanding positions, prioritizing their own health. The scope of this problem extends far beyond understaffing in one specific unit of SFSH, suggesting that the shortage of personnel is a general trend in the industry. A higher number of nurses, psychiatrists, rehabilitation specialists contributing to the cause of the organization together would sufficiently improve the quality of services offered while reducing the pressure put on the hospital staff.
Opinions regarding the strengths of the SFSH environment differ among the three main groups of stakeholders. As reported by the customers, the main advantages include easy access of the family to hospitalized individuals and integration of patients into the community life with the help of the Town Center. In return, the staff stressed the supportive nature of the working environment and step-by-step instructions of the managers in task-oriented situations. Managers mentioned the architectural features and effective organization of the residential life which contributes to the improved level of healthcare among mentally impaired patients.
Unlike strengths, weaknesses remained consistent within all of the interviewed groups of stakeholders. As summarized from the customers, staff, and managers’ testimonials, SFSH lacks adequate safety measures. The aforementioned disadvantage is especially relevant in the department of the special medical needs which hospitalizes patients with psychotic disorders. The nursing stationery there does not have a glass wall which increases the threat of patient’s aggression and puts the staff on duty at risk. Similar precautions apply to the windows and doors of the mental health hospital, as family members reported seeing individuals wandering the institution’s corridors without staff assistance. Struggling to maintain satisfactory safety standards, SFSH experiences acute shortage of personnel.
Some of the opportunities for growth of the organization include the expansion of the residential areas. Both customers and staff highlighted a perspective of building one more building for the elderly patients as primary population in the institution. Managers also proposed enforcing a new reward-based payment system for overtime work and night shifts as a possibility to attract more staff. In addition, SFSH has a potential for developing the array of its services, providing help to teenagers and young adolescents. The primary area of growth identified in the context of teen psychiatry was eating disorders, anorexia and bulimia, in particular.
Customers of SFSH suggest that one of the future threats for the institution would be decrease in the number of patients requesting all-year chronic care. Disturbed by the lack of personnel and inadequate safety conditions, families would choose other mental health hospitals for their relatives. Another threat relates to the increased readmission rate due to the lower quality of healthcare provided. Staff of the hospital outlines the possibility of some of the patients escaping the facilities as the key threat to the safety of the local community, as some of the individuals hospitalized are potentially dangerous without medical assistance.
Plan for Improvement
This quality management plan will focus on the issue of nursing shortage, providing several steps to improve the current state in SFSH. As suggested by Van den Oetelaar, Van Stel, Van Rhenen, Stellato, and Grolman (2016), there are two ways to cope with understaffing: through attracting additional talent or through changing the dynamics within the existing personnel. Both perspectives will be applied in the improvement plan with the sheer opportunity of balancing the workload.
Attracting Additional Talent
First, the hospital should address the existing safety issues in the wards and nursery stations by increasing precautions and putting more restrictions on the freedom of movement for highly dangerous patients. Second, managers should allow scheduling flexibility to reduce stress levels and increase the level of satisfaction in the nursing personnel. Third, the organization should also promote career development and engage more actively in the recruitment process of the local medical schools. Finally, staff should be given time and place to communicate their ideas freely with the supervisors to develop an updated bonus system, encouraging more productivity and efficiency.
Changing the Dynamics Within the Existing Personnel
With the nursing shortage as a global trend in the US healthcare industry, more attention should be given to the reorganization of the dynamics within the existing personnel. First, managers should prioritize the assignments between the subordinates in response to their workload. Second, SFSH should continue developing the OneCare program, integrating the significance of teamwork and effective communication. Third, in times of stress, healthcare practitioners should be provided with free counseling sessions to increase staff retention rate and promote better working atmosphere.
Comprehensive quality assessment is one of the essential components of the healthcare organization’s growth. In the context of SFSH, this plan carefully evaluates the institution’s background, services, environment, and setting, taking into account voices of customers, healthcare providers, and managers. With the staff shortage as a central problem, the plan for improvement suggests two ways of overcoming the understaffing issue: attracting additional talent and changing the dynamics within the existing personnel.
Careers. (2020). Web.
OneCare. (2020). Web.
Seppänen, A., Törmänen, I., Shaw, C., & Kennedy, H. G. (2018). Modern forensic psychiatric hospital design: Clinical, legal and structural aspects. International Journal of Mental Health Systems, 12(1), 1-12. Web.
Services. (2020). Web.
South Florida State Hospital. (2020). Web.
Van den Oetelaar, W. F., Van Stel, H. F., Van Rhenen, W., Stellato, R. K., & Grolman, W. (2016). Balancing nurses’ workload in hospital wards: Study protocol of developing a method to manage workload. BMJ Open, 6(11), 1-22. Web.