# data[].attributes.attachment_link.description
Engage the entire team in caring for patients

# data[].attributes.body
Orange County Pediatric Medical Center (OCPMC) desired to expand primary care services for the pediatric population within a specific location and procured three medical practices.

Data was collected regarding the assessment of the human resource (HR)department and the business methods utilized for sustaining the practices.

OCPMC was optimistic the cost of the new acquisition would be decreased by amalgamating the business operations, such as HR, billing, maintenance, finances, materials management, accounting, and purchasing. The intention is to disperse the expenses equally among the three practices.

Six months after OCPMC acquired the practices a budget analysis was performed and revealed the operating costs is greater than anticipated, and will continue to increase related to labor costs of the addition of registered nurses (RN) as staff. Prior staff consisted of physicians and non-licensed personnel.

The staffing methodology for the practices was mimicked after the medical center and other clinics owned by OCPMC which employed RN's .

HR is directed to perform a job analysis, re-design jobs as needed, and make appropriate recommendations for change to meet the budget for the facility(Flynn, Mathis, Jackson, & Valentine, 2016).

# data[].attributes.body
How did the evaluation process not take into consideration the change in staff mix for their budget? Business factors were considered in the new acquisition of the three physician practices; however, employee job analysis and job design along with salaries seem to not have been considered in the overall equation to assess the potential financial aspects of a different staff mix.

How can Human Resources (HR) best evaluate and determine the mix of staff needed to produce better cost containment while not sacrificing quality of patient care? The HR department has been tasked with determining needed changes in staffing to streamline the process of care and identify optimal ways to contain costs for the new practices.

Are patient outcomes improved with nursing staff involved in the workflow? Patient outcomes could be affected by changes implemented by HR, and are an important factor in the new process considerations.

How can HR create a solution if nurses are found to be improving patient outcomes? Patient care should not be sacrificed if nurses are found to be beneficial in the patient outcomes. HR is responsible to work with leadership to address this concern. Are there creative ways HR can incorporate nursing staff if found to improve patient outcomes?

Are there future cost benefits from nursing staff found to improve patient outcomes? This is an important factor in the decisions made to change the mix of staffing, as improved quality of patient care could increase financial outcomes in the future.

# data[].attributes.body
Evaluate the clients/patients utilizing the clinic for primary care & determine methods of health care reimbursement.

Review practices within the primary care setting and determine if it essential to employ multiple RN's or is one or none required to meet patient needs.

When conducting a job analysis ensure the comparisons of facilities and needs are equal. Compare clinics of the same size, client panel for each provider, and practices within the clinic are the same or similar

Complete a dedicated work analysis including both clinical and nonclinical roles thus the division should be work related to patient visits and the work related to the patient panel (Moyer, 2018)

Complete an assessment of the workflow; develop standards of care to improve efficiency within the sites and standardize care processes across the sites (Moyer, 2018)

Defined labor roles of all team members. Team members are to work to their education and training (Moyer, 2018) Physician, Nurse Practitioners, Physician Assistants, Registered Nurses, Licensed Practical Nurses, Medical Assistants, Secretary. Payor reimbursement dependent to care provided

Collaborate with financial management regarding the staffing standard to determine appropriate staffing pattern and skill mix based on the work analysis and work flow assessment (Stevenson, 2004)

Incorporation of a staffing calculator to assist managers with making staffing decisions for future shifts based on best available estimate (Stevenson, 2004)

Develop a business plan that identifies patient populations where Care Coordination and Transition Management (CCTM) by an interprofessional team has the most potential to affect quality outcomes and assist in avoidance of costs by these population  ( Haas, Vlasses & Havey, 2016). If payers turn toward reimbursing for value rather than volume, then efficient teams will maximize billable services; thus more profit then loss (Peikes et. a., 2014)

Establish an ambulatory float pool model of registered nurses to provide care amongst the outpatient clinics. This has been an effective method in inpatient units with reducing staffing costs (Hemann & Davidson, 2012)

# data[].attributes.headline
Theory, rationale, and resources used to address concerns

# data[].attributes.subject
Theory, rationale, and resources used to address concerns

# data[].attributes.body
Jobs in healthcare are changing at a rapid pace due to service delivery expectations of consumers and cost containment

Job design and and Job analysis are the foundations of HR and leadership standards

Redesign initiatives include job redesign, identifying new work flows, and identifying worker competencies

Extensive job analysis (task based and competency based) must be completed to understand the key aspects of the work

Task based focuses on the actual tasks, duties, and responsibilities

Competency based focuses on competencies that need to be performed - critical to providing high-quality, safe patient care and optimal patient outcomes

# data[].attributes.body
1. Outline the steps that should be taken to evaluate the work at the practices to determine the appropriate staffing mix.
The best way to do this is by using the steps of Job Analysis.  Purpose, essential functions, job setting and job qualifications.  If using these steps to address the appropriate staffing mix, this will allow for all areas to be analyzed to get to the best solution.  All of these steps touch on the issues at hand that will help in coming to the best possible positive changes.  The purpose allows for an in-depth look into the reason for the job.  Essential functions can correlate the specific job duties to what is critical or fundamental to the performance of the job.  Since these two things go hand in hand they need to be connected from the beginning. Job setting, this area drills down on specific work stations and conditions where the work is being done.  Job qualifications this analyzes the minimal skills one must posse to perform the essential functions. These four steps of job analysis will allow for the practice to determine the appropriate staffing mix by utilizing the areas of significance to appropriate staff member.

2. What methods of job analysis would be most effective for this assignment?
The methods that would be most effective would be observation and interviewing.

Observation allows a manager, job analyst, or HR specialist to actually watch an employee performing the job or task and take notes (Flynn, Mathis, Jackson, & Valentine, 2016).  Seeing firsthand what all exactly is going on, on a day to day basis and the level of care that is being provided will allow for appropriate staff to be utilized instead of over staffing or over utilization of staff.  Walking a day in anyone’s shoes allows for things to be seen that would otherwise not be known.

Interviewing is the next method that would be effective in this situation.  A manager, job analyst or HR specialist would talk to employees to see what tasks they are performing and what a normal day looks like for them.  The best way to gather this type of information is to talk to the ones doing the work every day.  The interviewing process is essential to drilling down on the specific needs and allows a perspective from a front line person and not just analyzing data or looking at ratios.  Ratios have the potential to get healthcare organizations in trouble. Seeing things on paper is not always the best way to analyze a situation that deals with patients and safety.

# data[].attributes.body
Flynn, W. J., Mathis, R. L., Jackson, J. H., & Valentine, S. R. (2016). Healthcare human resource management. Boston, MA: Cengage Learning

Haas, S. A., Vlasses, F., & Havey, J. (2016). Developing Staffing Models to Support Population Health Management And Quality Outcomes in Ambulatory Care Settings. Nursing Economics, 34(3), 126–133. Retrieved from https://search-ebscohost-com.ju.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=116207566&site=ehost-live

Hemann, M., & Davidson, G. (2012). Perspective of a Float Pool Model in Ambulatory Care. MEDSURG Nursing, 21(3), 164–170. Retrieved from https://search-ebscohost-com.ju.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=104460863&site=ehost-live

Moyer, A. (2018). A Quality Improvement Project for Understanding Work-Based Need in Ambulatory Care. Nursing Economics, 36(6), 276–290. Retrieved from https://search-ebscohost-com.ju.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=133645952&site=ehost-live

Peikes, D. N., Reid, R. J., Day, T. J., Cornwell, D. D. F., Dale, S. B., Baron, R. J., … Shapiro, R. J. (2014). Staffing patterns of primary care practices in the comprehensive primary care initiative. Annals of Family Medicine, 12(2), 142–149. https://doi-org.ju.idm.oclc.org/10.1370/afm.1626

Stevenson PB. (2004). Five simple tools for managing labor costs. Hfm (Healthcare Financial Management), 58(1), 64–66. Retrieved from https://search-ebscohost-com.ju.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=106761410&site=ehost-live