Indiana University (IU) Health Paoli Hospital is a Critical Access Hospital in southern Indiana. IU Health Paoli serves a rural population and offers obstetrical (OB) services. The OB department offers an individualized family centered birthing setting. The hospital delivers around 130 babies annually. The mission of the OB department is to offer a personalized compassionate delivery of care and provide a quality outcome for mother and newborn. The staff on OB is all registered nurses (RN), certified in in-patient obstetrics and electronic fetal monitoring.
All 14 staff members are neonatal resuscitation and advanced cardiac life support providers. 2 of the 14 RN’s are internationally board certified lactation consultants and have an 83% breastfeeding rate at discharge. Labor support offered is hydrotherapy, birthing ball, epidural and they also offer vaginal birth after cesarean. Six family practice physicians offer obstetrical services at the hospital and three of the physicians offer cesarean section services. The 2012 Annual statistics for the OB department reflected a primary cesarean rate of only 13% and no early elective deliveries prior to 39 weeks gestation.
All RN’s and physicians are focused on quality, compassionate care and outcomes. All standards of care and core measures for OB care of followed and implemented to the fullest degree. The OB Nurse Director is very passionate about quality outcomes and staying patient centered with the delivery of care, decisions and policies. A special quality that all nurse’s and physicians possess on this unit is each patient, birth is a miracle. The opportunity to be present at this memorable time in each patient’s life is an honor not a job.
The Term Paper on Improving Patient Care
There is growing enthusiasm in the United States about the use of electronic medical records (EMRs) in outpatient settings. More than $20 billion of the federal economic stimulus (the American Recovery and Reinvestment Act of 2009) is slated to assist physicians, hospitals, and other health care settings in adopting health information technology (Gill, 2009). The government wants to shift into the ...
The patient satisfaction scores and comments from NRCPicker® reflect this passion and commitment. In the analysis of the OB department, a focus on strengths, weaknesses, opportunities and threats were utilized (SWOT).
The SWOT analysis reflects opinions from staff and physicians not official data (Hillestad & Berkowitz, 2013).
Methods to collect this data involved self-observation, in person interviews with some staff and physicians, email surveys and Indiana Hospital and Health Association (IHHA) market share data and NRCPicker® patient satisfaction scores.
Overall participation from staff and physicians for this SWOT analysis was 97%. From email surveys, findings revealed; the average length of employment for nursing was 10 years and nursing staff and physicians all felt that the core values of the hospital were hard wired and displayed professionally and personally. The core values are TEAM: trust, excellence, accountability and mutual respect. Nursing staff completes annual competencies and evaluations to measure their skills clinically and customer service focused.
Patient or customer service evaluations are based on the Quint Studor principals of AIDET (acknowledged, introduce, duration, explanation and thank you), purposeful hourly rounding, bedside shift reporting and patient room white board use. These principals help along with patient satisfaction scores and are reflected by scenario competencies and shadowing plus the results of the NRCPicker® scores. IHHA quarterly releases market share data to hospitals. This data runs somewhat behind rather than current but is helpful in trending, looking at growth areas or potentials for growth or where lost to.
The two main competing hospitals offering OB services are St. Vincent Dunn Hospital in Bedford, IN approximately 25 miles away and Jasper Memorial Hospital in Jasper, IN approximately 50 miles away. St. Vincent Dunn deliveries approximately 300 babies annually and Jasper Memorial does about 1000 birth per year. The two main differences that both competitors have over IU Health Paoli is they have OB/GYN board certified physicians and pediatricians where Paoli only offer family practice physicians to cover both OB and pediatric care.
The Term Paper on Shouldice Hospital Patients Process Service
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An advantage that IU Health Paoli has is that it offers contraceptive measures such as tubal ligations that neither Jasper nor Bedford offer due to religious affiliations. In 2008, IHHA showed that IU Health Paoli held only 35% of the market share in Orange County, Indiana. This is a 2% decline from the past two years of 37%. Jasper Memorial has shown an increase of market share in 2008 to 18% of orange county from 12% and 9% the prior two years. St. Vincent Dunn has reflected a steady decline to only 6% 2008 Orange County market share from 11% in 2006.
Overall Jasper Memorial appears to be the main competitor for IU Health Paoli. Strategies to pull that 18% back to Paoli could focus around what staff stated in personal interviews. Two staff nurse’s felt that Jasper Memorial advertises a lot in the Orange County newspapers where Paoli lacks in advertising. Another nurse felt that the specialty of physicians also pulled Orange County residents to Jasper; she stated “Most patients now prefer a pediatrician to assess and examine their newborn for a piece of mind.
” A plus that came across from staff in surveys and interviews was that the compassionate care and the breastfeeding support offered at Paoli blows Jasper out of contention. Staff expressed they would advertise the 1:1 personalized care and quality outcomes such as breastfeeding success. An opportunity for growth was expressed in two avenues but from advanced nursing practice roles, midwifery and clinical nurse specialist (CNS).
Nursing staff felt that the population of orange county would welcome the practice of a midwife at the hospital.
The Center for Disease Control released in 2009 that 1 in 8 American women with vaginal births were attended by a midwife (Garvey, 2012).
The Term Paper on Community Health Practice
Community Description and Data Interpretation Pueblo, Colorado, also known as “The Home of the Heroes”, was given this proclamation in 1993 by the United States Congress, due to Pueblo having as many as four recipients of the “Medal of Honor” living here in the community. Pueblo dates back as far as 1842, and was known as “Fort Pueblo” (History of Pueblo). Over the years, Pueblo became the “ ...
Staff also felt that adding in the specialty of a CNS would help improve care, evidence based practice and quality outcomes. New technology that is available to OB is the Labor curve interpretation of fetal monitor strips. This technology interprets the strip to help detect abnormalities in fetal heart tones and in uterine contractions. This tool is only to assist; it does not impose a liability risk due to not a permanent part of chart.
It only works during labor and alarms with interpretation for nurse and physicians. As a novice labor nurse, I would find value in this product. The SWOT analysis concludes that self-perception is that IU Health Paoli OB department offers excellent outcomes and compassionate care to laboring mothers and their newborns. Staff and physicians care about the patients, are skilled and certified to provide preeminent outcomes. Some data from NRCPicker helps support this perception but keep in mind that a SWOT is a guide not a prescription (Pearce, 2007).
The size of the hospital and its lack of advertising seem to factor into the stagnant state it is in. As healthcare reform moves forward, and reimbursement becomes more of a challenge, the survivability of a small OB unit dims. The good news is going into this uncertain time; the cash on hand at IU Health Paoli is 368 days. This is the best in the whole IU Health system of 18 hospitals. Hopefully they can withstand the odds and remain strong and deliver miracles every day in Orange county, Indiana.
