The goal of this assignment is to analyze applicable HR principles, which incorporate healthcare laws while considering ongoin

Running head: ORGANIZATIONAL NEEDS AND LEGAL CONSIDERATIONS 1

DHA 8004 – Innovative Business Practices in Health Care

Unit 7 Assignment 1

ORGANIZATIONAL NEEDS AND LEGAL CONSIDERATIONS 2

Organizational Needs and Legal Considerations

Laws Important for Effective Health Care Leadership

Healthcare changes daily because the laws, policies and procedures that guide the

healthcare industry change daily. It seems appropriate that in a field like healthcare that rules and

policies need to change to keep current with new technologies, medications and other

innovations. Two of the rules that play a major part in critical access hospitals is a called the 96-

hour rule and the two-midnight rule. First, according to the U.S. Department of Health and

Human Services: Centers for Medicare and Medicaid Services (2019) on average inpatients

should not be admitted to a critical access hospital for longer than 96 hours. Facilities must track

their inpatient days and be sure at the end of the year, the average stay is less than 96 hours per

patient. Some patients may have longer stays, but the average of all patients must be 96-hours or

less. Second, the two-midnight rule requires that a patient must be admitted and stay across two

midnights to have a Medicare qualifying stay. For example, a patient is admitted at 10:00 PM on

Tuesday should stay until past midnight on the following Wednesday. These two rules are set by

Medicare to ensure that the patient is in the correct level of care and that patient’s condition

warrants a hospital admission.

These two rules can cause confusion for the patient, the admitting Provider and the

Facility. In most cases, hospitals will have a department that monitors these rules because if the

facility doesn’t follow these rules, Medicare and take back payments, as well as exclude the

facility from further Medicare payments. The difficult part is trying to get Providers to do their

pre-admission certification that states the Provider is anticipating the patient stay to be less than

96 hours and that the patient will be admitted across two midnights unless the patient’s condition

declines that prompts and interfacility transfer to a higher level of care.

ORGANIZATIONAL NEEDS AND LEGAL CONSIDERATIONS 3

Proposed Monitoring

Data mining within the electronic medical record, as well as staff and patient education

will be needed to ensure that the 96-hour rule and the two-midnight rule are followed. First, the

facility will have to be able to data mine the length of stay data out of their EMR and then have

the expertise to understand the data once it has been extracted. Most EMR systems can break up

length of stay by admission type, admitted Provider and diagnosis. Utilization review staff will

have to monitor the length of stay and provide data to the Chief Nursing Officer so that leader

can work with Provider to adjust future admissions and hold all staff accountable for length of

stay. Second, the facility must provide comprehensive education to the Providers and patients on

what is required during their admission to ensure that all parties have similar information. This

will ensure that Provider provides correct certification of admission and the patient understands

their length of stay. The CNO should provide oversight on the data mining and the education as

part of her leadership and accountability role for the Medical/Surgical floor of the facility.

Balanced Scorecard

The CNO should use a balance scorecard approach to track these two important statistics. In the

balance scorecard, a few important sections need to be identified including the indicator, the time

period that is going to be examined, year-to-date-averages and a relevant benchmark. Then each

time period should be color coded to ensure easy readability. A sample my include:

Indicator Jan-19 Feb-19 Mar-

19 YTD-19

Average

Bench Mark 2019

Volume Indicators

Length of Stay – Average 88 99 91 92.7 < 96

Two-midnight Ruled followed 100 100 96 98.7 100

ORGANIZATIONAL NEEDS AND LEGAL CONSIDERATIONS 4

After collection the information for the balanced scorecard, the CNO should be disseminating the

information to all parties involved including nursing staff, Providers, Utilization Review staff

and the Board of Directors.

Potential Gaps in the Leadership Plan

In the leadership plan, growing the swing bed census and length of stay was addressed.

The 96-hour rule and the two-midnight rule do not apply to a swing bed patient. A swing bed

patient is a patient that needs long term care that will be in the facility longer than 96 hours but

isn’t critical enough to send to a higher level of care or is a patient coming back from a higher

level of care. These patients typically cannot care for themselves on their own, often have

medications and need some sort of therapy services. The issue arises when the Provider doesn’t

know how to properly admit the patient into a swing bed status or doesn’t follow the certification

guidelines to have the admission be considered a qualifying stay. The Utilization Review

department will often find issues associated with a swing bed admission in areas such as poor

documentation, no services ordered that are needed to qualify the patient or lack of meeting

admitting criteria. Also, many times the patient or patient family doesn’t understand the

difference between the admission types, and this could cause trouble with their insurance.

Insurance companies do not handle the different types of admissions the same and their

payments are different leading to different financial obligations by the patient. Many times, the

patient doesn’t know how much they will be spending out of their own pocket until the patient is

discharged from the hospital.

Best Practices and Proposed Intervention

To overcome the gaps, hospitals need to find ways to educate the admitting staff,

educating the patients and providing quality studies on the admitting process. Educating

ORGANIZATIONAL NEEDS AND LEGAL CONSIDERATIONS 5

Providers will help ensure that they follow all the guidelines for different types of admissions.

This will make a more streamline process and ensure that the admission get certified for payment

by the payer. Next, the facility must educate patients on their admission status to ensure that

patient is included in their own care. This would ensure that the patient has a basic

understanding of their health, any financial obligation for their admission and information

needed to properly communicate with their insurance provider. Finally, the hospital needs to

audit their admissions for proper documentation, the admission meets admitting criteria and the

patient bills properly reflect the treatment provided. The audits should be shared with all parties

involved in the admission process, as well as administration.

A well-designed leadership plan should be effectively communicated to all parties that

are involved in the plan. When completing the leadership plan, there should be open and honest

dialogue about the tactics, measurement, benchmarks, frequency and results. If these areas

haven’t been thoughtfully identified and communicated, then it will be just words on paper. In

this case, the leader has to identify the gaps in the overall admission process to ensure that each

patient meets qualifications for admission, the Provider has completed their required work and

the patient is educated on their admission status. If all those items are not completed, then the

leadership plan will not be successful.

Succession Planning and Talent Development

Succession planning is crucial for the success of any organization, but in healthcare

finding talent can be the difference between staying viable and having to close the facility. In

some organizations, succession planning is simply placing an ad in the newspaper or on some

internet hiring site and hoping that a great candidate will see the ad and they will be the right fit

for the job. According to Olivio (2014) there is a need for qualified leaders who can lead a

continually complex healthcare organization. Over the past several years, many experienced

ORGANIZATIONAL NEEDS AND LEGAL CONSIDERATIONS 6

healthcare leaders have been leaving their positions for retirement, academia or consulting.

Many of these leaders have three or even four decades of healthcare experience and they are

being replaced with highly educated but inexperienced leaders. These new leaders have to be

given an opportunity to show they can fill the shoes of their predecessors, but the learning curve

is often sharp and very time bound. This can put stress on the organization, and it doesn’t take

long for the organization to start to show negative repercussions. On the other hand,

organizations that have foresight have prepared for the moment in which their leaders are leaving

the organization and they have detailed strategies to ensure that the organization will continue to

be successful or even stronger. Every organization may approach succession planning

differently, but in the end the organization needs a step by step process for how they are looking

for in a leader, what characteristics and personality do they want the leader to possess, how that

leader will drive the strategic direction of the organization and what they are going to do until

they find that specific person. The strategy must fit the culture of the organizations and the

resources available to find a successful candidate.

Succession planning isn’t always bringing in people from the outside, but also learning

when and who to promote. Well-designed succession plans look for the best candidate and fit

for the organization. At times, the best fit can be a person in the organization that has proven

he/she has the ability, educations, experience and behaviors the organization is search for in their

new leaders. A high functioning talent development process can help current employees

blossom into successful leaders for the organization.

Executive Competency Development

Executive competency development is going to be a crucial element in the evolution of

leaders in an organization. The type of program that each organization will use to develop

ORGANIZATIONAL NEEDS AND LEGAL CONSIDERATIONS 7

executive leaders are going to be much different depending on size of the facility, location,

resources available and culture. According to the American College of Healthcare Executives

(2017) has a leadership certification for healthcare leaders. This program is designed to provide

leaders with a comprehensive education program that will help them develop into a well-rounded

healthcare executive. The certification program is designed to educate and broaden the horizons

of its certified members. This program, as detailed below, not only helps train new leaders, but

requires these leaders to stay current by obtaining annual continuing education credits. Also, the

ACHE offers state, regional and national meetings and educational offerings. Not only do

Members and Fellows get current education, they also have an opportunity to increase their

networking opportunities.

Along with certification, networking is another very important element in executive

competency development. Networking can help a young leader learn from other’s mistakes and

success, as well as provide someone to help reduce the stress associated with being a executive

ORGANIZATIONAL NEEDS AND LEGAL CONSIDERATIONS 8

leader in a complex environment. No matter how much education a new leader has, experience

has value. As an executive leader, learning and growing is a lifetime activity.

ORGANIZATIONAL NEEDS AND LEGAL CONSIDERATIONS 9

References

American College of Healthcare Executives (2017). Board Certification in Healthcare

Management. Retrieved from https://www.ache.org/about-ache/our-story/our-

commitments/policy-statements/board-certification-in-healthcare-management

Fowler, J. (2016). From staff nurse to nurse consultant: Clinical leadership part 9:

Succession planning. British Journal of Nursing, 25(22), 1272-1272.

doi:10.12968/bjon.2016.25.22.1272

Olivio, T. (2014). Is Your Leadership Vulnerable? 5 Trends for Succession Planning.

Becker’s Healthcare. Retrieved from https://www.beckershospitalreview.com/hospital-

management-administration/is-your-leadership-vulnerable-5-trends-for-succession-

planning.html

U.S. Department of Health and Human Services: Centers for Medicare and Medicaid Services.

(2019). State Operations Manual Chapter 2 – The Certification Process. Retrieved from

https://www.cms.gov/Regulations-and-

Guidance/Guidance/Manuals/Downloads/som107c02.pdf

3/4/22, 8:19 PM HR Plan: Organizational Needs and Legal Considerations Scoring Guide

https://courserooma.capella.edu/bbcswebdav/institution/DHA/DHA8004/200701/Scoring_Guides/u07a1_scoring_guide.html 1/1

HR Plan: Organizational Needs and Legal Considerations Scoring Guide

Due Date: End of Unit 7 Percentage of Course Grade: 20%.

CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED

Analyze laws that are important for effective healthcare leadership.

20%

Does not analyze laws that are important for effective healthcare leadership.

Lacks an analysis component concerning laws that are important for effective healthcare leadership.

Analyzes laws that are important for effective healthcare leadership.

Analyzes relevant laws for implementation of an innovative healthcare initiative and identifies how they can strengthen leadership.

Propose how to monitor and assure compliance with the chosen laws that are important for effective leadership.

20%

Does not propose how to monitor and assure compliance with chosen laws important for effective leadership.

Proposes monitoring and compliance leadership interventions that lack cohesion.

Proposes how to monitor and assure compliance with chosen laws important for effective leadership.

Proposes how to monitor and assure compliance with chosen laws important for effective leadership and includes an authoritative reference for monitoring compliance (for example, an assessment tool).

Discuss potential gaps in a leadership plan to implement a new strategy.

20%

Does not discuss potential gaps in a leadership plan to implement a new strategy.

Discusses potential gaps in a leadership plan, but lacks sufficient insight for effective implementation of a new strategy.

Discusses potential gaps in a leadership plan to implement a new strategy.

Discusses potential gaps in a leadership plan to implement a new strategy and proposes best practices solutions.

Propose interventions to address gaps in a leadership plan for implementation of a new initiative.

20%

Does not propose interventions to address gaps in a leadership plan for implementation of a new initiative.

Proposed gap closure interventions lack evidence-based substantiation.

Proposes interventions to address gaps in a leadership plan for implementation of a new initiative.

Proposes interventions with rationale including strengths and weaknesses to address gaps in a leadership plan for implementation of a new initiative.

Explain the relevance of succession planning and talent development, and include resources for ongoing healthcare executive competency development.

20%

Does not explain the relevance of succession planning and talent development and include resources for ongoing healthcare executive competency development.

Either insufficiently explains the relevance of succession planning and talent development and/or does not include resources for ongoing healthcare executive competency development.

Explains the relevance of succession planning and talent development and includes resources for ongoing healthcare executive competency development.

Explains the relevance of succession planning and talent development, and includes resources for ongoing healthcare executive competency development, citing an authoritative source with professionally validated criteria for healthcare executive competency development (Examples could include American College of Healthcare Executives, National Council of Health Leadership).