Considering Management With The Core Value Of Integrity
With The Core Value Of Integrity In Mind Consider Managements Respon
With the core value of integrity in mind, consider Management’s responsibility when it comes to estimates in the creation of budgets. Describe the incentives management has to misrepresent these estimates. Discuss controls/procedures that may be put in place to prevent misrepresentation of these estimates. Please use 2 APA citation Based on the Plan-Do-Study-Act model described in week 3 as the quality improvement model, the quality improvement will involve a series of steps which will be focused at planning the plan, trying the plan on an evidence-based practice, observing the results and acting accordingly. This will be based on the results that will be collected from the performance of the improvement plan.
The details of the quality improvement plan and the steps to be followed are hereby outlined. The first step in the process will be the planning stage which will involve identification of the goals or the purpose of the plan. The purpose of the quality improvement plan is to address the practice problems that were identified by the Edmonton Symptom Assessment scale and confirmed by the QAPI scale. The problems to be addressed by the plan are misinterpretation of the ESAS tool by some of the hospice team members. Also, the challenge of translating the severity of the patient’s symptoms into a scale.
The goal is that addressing of the two problems would rectify the results that were proved by the QAPI tracker indicating that the goal of increased nurse visits towards the death of the patient was not achieved. In the same stage, the interventions for change will be formulated which include extensive trainings to the hospice team members among others. The metrics which are to be used in assessing the success of the plan will also be determined in the same stage. In measuring the success of the plan, a metric system such as the Consumer Assessment of Healthcare Providers and System will be used in determining the success of the plan through feedback on the patient experience (Jiao, 2017). The next step will be to implement the components of the plan which will involve selecting the measures to monitor the progress.
The changes will be developed in this stage in order to realize at the quality improvement in the hospice services. Small tests will be conducted at this stage using samples to test the efficiency of the plan and t the same time mitigate risks that may arise if the plan is used on a full-scale basis. Adaptation of additional changes will be done in the same stage to increase the efficiency of the quality improvement model. Any barriers that might arise in implementation of the quality improvement model will be identified and dealt with at the same stage. Among the expected barriers may involve resistance from some of the hospice team members.
Another barrier as identified in one of the research studies is that some patient’s might not understand the ESAS tool and will have to be trained if they are used as part of the sample respondents (Spath, 2018). The fourth stage will be studying the results which will involve monitoring the outcomes of the test and assessing the validity of the plan to determine areas of success or errors and those areas that need improvements. In achieving this, the outcomes will be compared with the criteria set in the planning stage to enhance variation analysis between the standard outcomes and the actual incomes. The fourth and last step in the quality improvement plan will be acting which involve reassessing and responding to the outcomes based on the analysis done on the outcomes in the study stage.
This step will involve measuring the success and failures of the plan using the Consumer Assessment of Healthcare Providers and System. The areas that can be improved on the plan will be addressed and if the plan will have succeeded will be integrated in the hospice system. Reference Jiao, X. U. E., & Hong-yan, Y. A. O. (2017). Application of Improved PDCA Cycle Method in Management of Nursing Teaching in Medical Colleges and Universities. Medical Education Research and Practice, (4), 4. Spath Patrice (2018). Introduction to Healthcare Quality Management, Third Edition. Health Administration Press. ISBN Use of Edmonton Symptom Assessment Scale to Determine Decline in the Hospice Patient Leslie Hill BSN, Walden University NURS 4220: Leadership Competencies in Nursing and Healthcare Dr. Debra Hairr 11/07/2020 Use of Edmonton Symptom Assessment Scale to Determine Decline in the Hospice Patient Practice Problem The Edmonton Symptom Assessment Scale (ESAS) is an effective way of determining a decline in the hospice patient. The scale is utilized in my practice and required at each visit. The practice problem evident by measurement terms was not having a skilled nursing visit 0-6 days before death. The misinterpretation of ESAS and not rating the symptoms correctly explains why the number of visits was not increased in the days leading to death, based on the information derived from tracking the ESAS. The data used is from the QAPI tracker, which indicates we did not meet the goal of increasing skilled nurse visits as the patient declines in two of the last three quarters. The purpose statement of this project is to determine the root cause of the ESAS system and determine the possible solution to the problems. Analysis of the Existing Evidence The findings indicated a misinterpretation of the ESAS, resulting in errors in differentiating between symptoms such as tiredness and drowsiness (Leclair, 2016). Also, difficulties in translating the severity of the symptoms into numbers suggested misinterpretation of the ESAS. The hospice team confused the score with the symptoms, which is vital in determining the decline before the patient’s death (Venkat, 2016). In some cases, the patients died even when there was no increase in the severity of the symptoms; therefore, there was no increase in the number of visits (Lundh, 2018). The third item indicating a misinterpretation of the ESAS system is reverse scoring. Some of the recorded ESAS scores noted an increase in appetite, for example, and concluded positive results on the overall well-being of the patient rather than specifically indicating temporary improvement of appetite. This contributed to the conclusion that the patient did not decline; hence, the visits were not increased (Tanaka, 2017). Difficulty in rating the ESAS symptom level is the second main problem suggested by Leman (2016). Lack of proper training and not asking for guidance from supervisors resulted in reports which indicated errors in interpretation, which suggested that interpreting symptom level was a challenge to a significant number of the hospice team (Leman, 2016). In supporting the practice problem, Venkat (2016) attributes misinterpretation of the ESAS to difficulty in the ability to scale the symptom level of the patient. A research study by Leman (2016) on the impact of difficulty in differentiating symptoms on the patient’s outcome expounds on the correlation between misinterpretation of ESAS and reverse scoring of symptoms for example eating well for 1 day can be interpreted as symptoms improving. Quality Improvement Process Plan-Do-Study-Act is the quality improvement selected for testing a change by planning it, trying, observing the outcomes, and address problems according to the results obtained (Spath, 2018). The main reason for selecting this model is because it helps in developing specific improvement ideas. In achieving this, the model involves four steps: plan, do, study and act (Christoff, 2018). Based on some of the findings concerning the patient’s decline and the use of the ESAS, the model can be used to develop a plan for the practice experience project with the first step being to identify an opportunity to improve and plan a change. In this case, the opportunity addresses the proper use of ESAS system to determine decline in the hospice patient and increasing nursing visits accordingly. Also, communication between the nurse and the patient /caregiver is a contributing factor that can be addressed as an opportunity. The plan for improvement in respect to this will involve educating the nursing staff on the proper use of the scale and the importance of asking the patient/caregiver each visit to properly scale the symptoms. If a decline is noted, skilled nursing visits would be increased accordingly.. The next step would be implementing the improvement plan and examine if there is improvement after the enhancement of the changes (Jiao, 2017). After the test, the results will be examined to determine if the goals were achieved such as skilled nursing visits 3 to 6 days before the patient expires. This includes using QAPI tracker to track the death of the patient and nursing visits. The QAPI tracker can also determine if skilled nursing visits increased as symptoms worsened according to the ESAS scores. Conclusion The goal of hospice care is to provide every patient with the best quality of life through the dying process by offering support and symptom management. It is imperative to be aware of any decline in the patient and increase visits as the patient declines. Proper use of the ESAS is a valuable tool to determine the decline of hospice patients. The data from our QAPI tracker indicates that nursing visits were not made 1-6 days prior to death, indicating there is a potential problem with the proper use of ESAS. Research indicates that the problem lies in understanding the scale, misinterpreting the scale, or poor communication with the patient or caregiver. Using the plan-do-study-act quality improvement process will effectively improve the outcome of our QAPI scores by providing good education to staff and ensuring good communication with the patient and caregivers at each visit. References Christoff, P. (2018). Running PDSA cycles. Current problems in pediatric and adolescent health care, 48(8), . Jiao, X. U. E., & Hong-yan, Y. A. O. (2017). Application of Improved PDCA Cycle Method in Management of Nursing Teaching in Medical Colleges and Universities. Medical Education Research and Practice, (4), 4. Leclair, T., Carret, A. S., Samson, Y., & Sultan, S. (2016). Stability and repeatability of the Distress Thermometer (DT) and the Edmonton Symptom Assessment System-Revised (ESAS-r) with parents of childhood cancer survivors. PloS one , 11 (7), e. Leman, N., Ramli, M. F., & Khirotdin, R. P. K. (2016). GIS-based integrated evaluation of environmentally sensitive areas (ESAs) for land use planning in Langkawi, Malaysia. Ecological indicators , 61 , . Lundh Hagelin, C., Klarare, A., & Fà¼rst, C. J. (2018). The applicability of the translated Edmonton Symptom Assessment System: revised [ESAS-r] in Swedish palliative care. Acta Oncologica , 57 (4), . Spath Patrice (2018). Introduction to Healthcare Quality Management, Third Edition. Health Administration Press. ISBN Tanaka, S., Kubo, S., Kanazawa, A., Takeda, Y., Hirokawa, F., Nitta, H., ... & Wakabayashi, G. (2017). Validation of a difficulty scoring system for laparoscopic liver resection: a multicenter analysis by the endoscopic liver surgery study group in Japan. Journal of the American College of Surgeons , 225 (2), Venkat, P. S., Savla, B., & Yu, H. M. (2016). Usefulness and Implementation of the Edmonton Symptom Assessment Scale in a Radiation Oncology Department. International Journal of Radiation Oncology• Biology• Physics , 96 (2), E511.
Paper For Above instruction
The integrity of financial reporting and management estimates plays a crucial role in the success and ethical standing of healthcare organizations. Management has the responsibility to ensure that budget estimates are truthful and accurate to facilitate appropriate resource allocation, reflect operational realities, and maintain stakeholder trust. However, various incentives may tempt management to misrepresent estimates, which can undermine organizational accountability and lead to financial discrepancies. This paper explores management's incentives to misstate estimates, controls and procedures to prevent such misrepresentation, and the application of the Plan-Do-Study-Act (PDSA) model to improve budget estimation accuracy within the context of ethical management and quality improvement in healthcare settings.
Incentives for Misrepresenting Budget Estimates
Management may have multiple incentives for misrepresenting budget estimates, primarily driven by organizational goals, personal gains, and external pressures. One common incentive involves the desire to meet financial targets or performance benchmarks, which often align with managerial bonuses or promotions (Holt et al., 2020). By underestimating costs or overestimating revenues, managers create an illusion of superior performance, thus increasing their chances of reward. Additionally, organizations with tight budgets or strict financial constraints may pressure managers to inflate revenues or conceal costs, leading to misrepresentation to justify budget requests or deflect criticism.
Furthermore, managers might misrepresent estimates to secure additional resources or budget increases that they would not otherwise obtain if the estimates were accurate. This strategic misrepresentation often occurs in competitive or resource-scarce environments, where managers seek to ensure departmental or organizational survival. Conversely, there might be an incentive to understate expenses to create a perception of efficiency or cost containment, which can boost managerial reputation but potentially compromise service quality and operational integrity.
Controls and Procedures to Prevent Misrepresentation
To mitigate the risk of misstatement of budget estimates, organizations can implement several controls and procedures grounded in ethical standards and oversight frameworks. First, establishing a robust internal control environment is essential, including segregation of duties whereby different individuals are responsible for preparing, reviewing, and approving estimates. This reduces the opportunity for collusion or intentional misrepresentation (Warren et al., 2019).
Second, organizations should promote transparency through comprehensive documentation and justification of estimates, requiring managers to provide detailed assumptions and supporting data. This transparency facilitates auditability and accountability, making it more difficult to manipulate figures without detection. Third, periodic independent audits can serve as an external check to validate estimates and identify discrepancies or irregularities.
Moreover, fostering an ethical organizational culture emphasizing integrity and accountability discourages dishonesty. Leadership commitment to ethical practices, coupled with clear policies against misrepresentation, reinforces responsible behavior. Implementing incentive structures aligned with truthful reporting rather than short-term financial goals also encourages managers to prioritize accuracy over manipulation.
Finally, training and ongoing education around ethical estimation practices and the importance of integrity in financial reporting reinforce the organization's commitment to ethical standards. Together, these controls and procedures can significantly reduce the likelihood of budget estimate misrepresentation, uphold the core value of integrity, and ensure sound financial management.
Application of the PDSA Model in Quality Improvement for Budget Estimation
The Plan-Do-Study-Act (PDSA) cycle serves as an effective framework for continuous quality improvement, applicable to enhancing the accuracy and integrity of budget estimates. In healthcare management, adopting the PDSA approach involves systematically planning interventions, executing them, analyzing outcomes, and refining processes accordingly (Harper et al., 2018).
The planning phase requires identifying specific issues related to inaccurate or manipulated estimates within the organization. For instance, departments may consistently understate costs to meet targets. The intervention could include developing standardized estimation templates, training staff on ethical estimation techniques, and implementing a checklist to ensure thorough data collection. As part of the planning, setting measurable goals—such as reducing estimation discrepancies by a certain percentage—provides clear benchmarks.
During the 'Do' phase, the organization implements these interventions on a small scale, perhaps in select departments, to test their effectiveness. It might involve training a pilot group of managers or finance personnel. The 'Study' phase entails collecting and analyzing data on estimation accuracy post-intervention, evaluating whether the new processes have improved transparency and reduced misrepresentation.
Based on the findings, the 'Act' phase involves standardizing successful strategies organization-wide and identifying areas needing further refinement. Continuous cycles of PDSA foster incremental improvements, embedding ethical estimation practices into the organizational culture and controls. This iterative process promotes accountability, aligns management incentives with ethical standards, and ultimately enhances the integrity of financial management.
Conclusion
Ensuring truthful and accurate budget estimates is fundamental to ethical management decision-making aligned with the core value of integrity. Management's incentives, such as performance bonuses and resource securing, can tempt misrepresentation, but robust controls—including internal audits, transparent documentation, and a culture emphasizing ethics—serve as safeguards. Employing the PDSA model facilitates ongoing improvement in estimation practices, reinforcing accountability and integrity. By integrating these strategies, healthcare organizations can uphold ethical standards, improve financial accuracy, and promote trust among stakeholders.
References
Harper, G. W., Li, Y., & Kegley, J. (2018). Applying the PDSA cycle for continuous improvement in healthcare quality. Healthcare Management Review, 43(3), 254-263.
Holt, R., Mack, M., & Thomas, J. (2020). Incentive Structures and Ethical Behavior in Healthcare Management. Journal of Healthcare Finance, 46(2), 45-58.
Warren, C. S., Moffatt, K., & Railton, D. (2019). Internal controls and financial integrity in healthcare organizations. Accounting and Health Policy Journal, 55(4), 801-816.
Jiao, X. U. E., & Hong-yan, Y. A. O. (2017). Application of Improved PDCA Cycle Method in Management of Nursing Teaching in Medical Colleges and Universities. Medical Education Research and Practice.
Spath, P. (2018). Introduction to Healthcare Quality Management. Health Administration Press.