Making decisions to cut clinical services to the underprivileged is a very stressful position. Having the right information, determining the validity of the information, and knowing how to access accurate information will help make necessary decisions more attainable. Making well thought, well informed decisions will maximize the benefits to provide healthcare while optimizing best possible outcomes with the available resources.
The decision made to eliminate which area to cut needs to be thoroughly analyzed.There are tools available to help strategize the best outcome. Using the Informed decision toolbox, (IDT), there are multiple steps in the decision making process. The processes involved are available to help make the decisions while continuing to provide as best quality care on a reduced budget.
The IDT has a set of tools to help managers find the best solution to making difficult decisions to apply to healthcare.County clinics providing medical care through Medicaid typically provide services. Some of these services include immunizations, flu shots, breast and cancer screening, family planning, HIV screening, STD testing, behavioral services for kids ages 6 and up, Alzheimer’s support group, and more. The IDT approach is a decision making tool and is used to assist management in a more systematic method, analyzing information to make the best possible decision in order to provide the desired outcomes. In order to make the necessary 15% necessary budget cut for the county clinic scenario, the IDT will be utilized. Included in the process is a description of the stages, which step appears to be the best step to move forward with the budget cut.
According to Rundall, (2007) the six steps include:1. Framing the Question. Composing the right question, understanding the right questions, and understanding the true intent of change will help with the desired outcome. The best possible outcome needs to benefit the patients as much as possible with the restraints of the budget cuts. Evaluating the question, describing the intervention, describing the desired outcome, explain the type of setting and population is a part of this step.
In this example, the fact is cutting the budget while eliminating services.The end result is offer services within a more restricted budget. There are five issues to consider when framing a question. The first, clearly states the desired outcome, setting, time, and population. The second, asks each question as a single directive, to keep the focus clear.
The third question, evaluates the need to be driven by objective criteria, not vague direction. For example, asking “which seems best?” isn’t sufficient. A more clear objective criteria would ask “which is most likely to produce more profit in one year?” is more specific and will produce an exact answer. The fourth issue is keeping in mind regulations and reimbursement influences.
The last issue is a reminder of the external factors involving the economic and political environment, as it may reflect the desired outcome.2. Finding the Sources of Information. Talking to peers, colleagues, customers, and exploring the internet is a beginning of expanding on knowledge on various topics. Necessary research, including internet websites, professional foundations, societies provide a great source of evidence based research which involves time is critical to a well thought and planned decision.
3. Assessing the Accuracy of Information. Using resources that are peer reviewed, reputable sources such as governmental and state sources from the internet can ensure your research is accurate. The research used to help make decisions needs to be current and relevant.4. Assessing the applicability of the evidence.
Researching the population that will be most affected by a fiscal change will help reveal how it will apply to certain them.5. Assessing the actionability of evidence. Making difficult decisions needs to be based on current and reliable data. Careful analyzation of evidence leads to good decisions. The information represented is based on the entire state of Florida as a whole.
At the county level, it is unclear how directly the modifications to the programs will impact its stakeholders.6. Determining if information is adequate given the organization’s needs, values, and context. The needs and values of the stakeholders can help shape the strategy that is called upon. Decisions need to have thorough research but time isn’t always available.
In these circumstances, strategizing based on evidence, for the best possible outcome can be the best decision at the time. Step 3, assessing the Accuracy of the evidence, I believe, is the most pivotal step. Being that the statement is clear, cutting the budget by 15%, there is clarity in the desired outcome. With that, decision makers use useful evidence to the organization’s accuracy.With budgetary goals, accuracy is not negotiable.
Thorough research is necessary to narrow down budget constraints and how it will impact the local population. The toolbox addresses other issues regarding accountability, knowledge transfer, and a questioning organization. Management decisions are more visible and the need to be apparent is even greater. This need results in accountability by the organization.
Leaders make the decisions on well researched evidence, attempting to foresee unexpected circumstance, utilizing resources well, while performing optimally to reach organization goals. Knowledge transfer refers to the distributing of knowledge to be used by others in an effort increase awareness, improve performance, provide an edge over competition, or enhance innovation.The utilization of evidence in informed decision involves encouraging managers to question the evidence for important decisions, ask managers to be active in journal clubs, and encourage internal seminars within the organization, ask managers to review research on past strategic organization decisions, offer educational programs on evidence informed decision making, establish formal relationships with organizations, provide a portion of the manager’s compensation for using evidence in decision making and sharing with shareholders, review evidence supplied by consultants and important decisions and activities.Evidence must be applicable, accurate, actionable, and accessible.
Inaccurate evidence leads to bad decisions. Evidence that isn’t actionable isn’t easy to work implement. Evidence that easily accessible can cost increase time, money, and be ineffective. Thorough research of evidence is a critical step in decision making. The Duval and surrounding Medicaid clinics provide insurance to over 1600 patients who don’t have health insurance.
Cutting the budget 15% is better than closing the clinics altogether. An alternative to closing the clinic is limiting dental services, with the choice to have available with copay or fee per service.