Case: Disparities in care AT Southern Regional Health System

Instruction: answer Case Study Questions. Answer should be between 75 to 100 words.

Case study question # 1

1. Decisions, Decisions case: advise Mr. Martin on how to create the subcommittee. How many people and which people and positions would you appoint? What should the purpose and goal of the subcommittee be? What would you do to ensure the subcommittee fulfills its purpose?

Case: Decisions, Decisions background AND case overview

University Memorial Hospitals (UMH) is located in a small, Midwestern college town, which is home to a large state university and teaching hospital. UMH is a 571-bed, state- owned, teaching medical center that employs over 4,000 people. As the primary public hospital in its state, UMH provides tertiary care and specialty services to patients from numerous urban and rural communities. The mission of UMH is to provide high-quality patient care, to educate healthcare professionals, to advance health research, and to provide community service. The Planning department’s multiple responsibilities include strategic planning, facility planning, and program development.

Organizational Problem

“Where am I supposed to leave my kids while I’m helping Dr. Smith with patients?” Mary Rogers, a recently hired nursing assistant, asked Tom Martin, manager of the Planning department at UMH. “Here in University Town,” she continued, “the daycare facilities are too expensive and inconvenient. Sometimes I have to take time off from work to care for my children. Can’t you in Planning do something to remedy that?”

About a year ago, an employee mentioned the idea of a daycare center for hospital employees. Since then, Mr. Martin had been approached repeatedly by aggravated employees, such as Mrs. Rogers, who were dissatisfied with the inadequate supply and high cost of daycare facilities in University Town. As the number of families with two fully employed parents increased, UMH employees faced greater difficulty in finding suitable care for their children during work hours. Mr. Martin realized that UMH must respond to the changing environment and act as a leader in meeting the needs of its employees. UMH, however, needed to consider a variety of issues before committing to the massive project of building a daycare center.

The CEO of UMH assigned Mr. Martin and Planning the task of determining the advantages and disadvantages of creating a daycare center. Given the large number of UMH employees, the daycare center would have to be able to accommodate a large number of children. If the project seemed feasible, Mr. Martin would also be responsible for developing an acceptable business plan to be presented to UMH’s board of directors. He contemplated various ways of approaching this project and decided to create a subcommittee to discuss the pertinent issues and formulate a report for the board. Both UMH and University employees would be invited to participate on the subcommittee to account for the various employee perspectives.

Mr. Martin and his subcommittee considered the possibility of a joint venture between the hospital and the University to build a daycare center in a mutually convenient location. If this option were pursued, UMH and the University would need to collaborate and discuss numerous issues including who would manage the facility, where it would be located, how many slots would be allocated to University versus UMH employees, and what criteria would be used to grant participation to employees.

Mr. Martin wanted to make the best proposal possible for the board, and he was not sure whether he should even recommend building the center. He wondered if UMH overlooked any options that could more effectively meet the daycare needs of employ- ees. He knew the organization needed to respond to the changing environment. In recent months, UMH had consistently experienced increased absenteeism and decreased employee morale. Mr. Martin wondered if the appropriate action was to build a daycare center or if a different approach held the solution.

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Case study question # 2

2. Disparities in Care at Southern Regional Health System case: Suppose Tim Hank wants to appoint a Healthcare Disparities Council to advise him on how to reduce healthcare disparities. Use this chapter to help Mr. Hank create the council. How many people and which stakeholders would you appoint? What would the purpose and goal of the council be? What would you do to ensure the council fulfills its purpose?

Case: Disparities in care AT Southern Regional Health System

Tim Hank leaned back in his chair and closed his eyes. While he had been afraid the reports might have bad news, he now had to figure out what to do with this new information. Flipping through the first binder on his desk, reporting results of the recent Robert Wood Johnson Foundation–sponsored assessment of the cardiovascular care provided by his organization, he was increasingly concerned. Southern Regional Health System was based in Jackson, Mississippi, an area known for a highly diverse population and high poverty rates. Black and Hispanic residents in the area were about three times more likely to live in poverty than were whites. Unemployment was also a big problem that affected whites and nonwhites differently—in the Jackson area, black residents were two and a half times more likely to be unemployed and Hispanics over twice as likely to be unemployed as white residents. Beyond poverty and employment differences, though, was the issue of different care given to different patients. This issue of disparities in care was receiving increasing national attention, but Hank had thought the care they provided at Southern Regional was “color blind.” Given the health system’s mission of providing “excellent quality of care for all,” he assumed that the care was equitably delivered across patients and patient populations.

Apparently, this was not the case. This first report showed that there were indeed disparities in the care provided by Southern Regional. Data on heart care had been collected by race and ethnicity for the past year, and these baseline data showed differences. For instance, using the four core measures for heart failure that the Centers for Medicare & Medicaid Services currently collects and reports, only 41 percent of patients were receiving all recommended heart failure care, and the numbers were worse based on race and ethnicity. The analysis showed that while 68 percent of whites received all recommended care, the comparable number among nonwhites was 27 percent. For one measure—the percentage of heart failure patients receiving discharge instructions—only 65 percent of Hispanic patients received the information, compared to 85 percent of non-Hispanic patients. Also troubling Hank was the fact that none of these measures was close to 100 percent—this certainly wasn’t the type of care he’d want offered to his own family. Yet he truly didn’t understand how his hospital could be providing such disparate care.

The second binder on his desk offered little information to ease his concern. This report, the “Assessment of Organizational Readiness to Change” for Southern Regional Health System, showed that few individuals in his hospital were aware of the nationwide problem of disparities in care, and even fewer were aware that such an issue might be problematic within their own hospital. Now he had the data for Southern Regional that showed significant gaps in care provided to African American and Hispanic patients relative to white patients, but the accompanying readiness-to-change evaluation showed a strong tendency among hospital employees and physicians to resist any proposed changes and instead “go with the flow.” Hank knew that his ability to bring the issue of disparate care to the forefront of hospital concerns and successfully make strides to reduce these disparities would be a legacy he would love to leave. Yet he didn’t know how he could possibly begin to address this issue at Southern Regional Health System.