Effects of absence of a Cancer Care Coordinator in an Oncology Hospital and Remedial Framework

This report focuses on the challenges that are associated with the absence of a joint Cancer Care Coordinator (CCC) between an outpatient facility and an adjoining private hospital. Specifically, the outpatient setting specializes in oncology, hematology and auto-immune disorder treatments for ambulatory patients. It is one of the largest facilities of its kind in Queensland, seeing approximately 18,500 separations annually. The day hospital is attached to a leading private hospital, although the two are owned and operated as separate entities. The absence of a CCC has many consequences that are detrimental for the patients at both facilities as well as the nursing staff.

Running Head: Healthcare Management 1
Effects of absence of a Cancer Care Coordinator in an Oncology Hospital and Remedial
Framework
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Healthcare Management 2
PART 1
Assessing the Effects of absence of a Cancer Care Coordinator in an Oncology Hospital
1.0 Introduction
The provision of coordinated care for patients through their cancer diagnosis, treatment
and survivorship is recognized best practice. The involvement of a multidisciplinary team as well
as community support services has the potential to drastically influence a patient’s treatment
experience as well as their health outcomes. This report focuses on the challenges that are
associated with the absence of a joint Cancer Care Coordinator (CCC) between an outpatient
facility and an adjoining private hospital. Specifically, the outpatient setting specializes in
oncology, hematology and auto-immune disorder treatments for ambulatory patients. It is one of
the largest facilities of its kind in Queensland, seeing approximately 18,500 separations annually.
The day hospital is attached to a leading private hospital, although the two are owned and
operated as separate entities. The absence of a CCC has many consequences that are detrimental
for the patients at both facilities as well as the nursing staff.
Historically, it has been common practice for patients to be hospitalized for the duration
of their cancer treatment. There has recently been a shift towards outpatient facilities as it has
been recognized that patients who can receive treatment while remaining with their support
network in their own homes will have better health outcomes. Due to the aging population in
Australia, the rate of patients requiring cancer treatments is increasing annually; straining public
and private hospitals. Put simply, hospitals cannot accommodate or afford to treat everyone
requiring treatment. This has led to the strategic implementation of many outpatient facilities.
However, these facilities do not provide all the services and resources that a patient can access

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while an inpatient such as counselling, physiotherapy and dietetics; consequently, patients are
suffering. When comparing what the inpatient setting has to offer that the outpatient setting
doesn’t, one thing stands out – access to a CCC.
Analysis of the Strategic Issue and its Significance
The absence of a CCC at the facility is the sole cause of non-acute admissions, delay in
admissions, low staff morale and cost implications on the neighboring facility. Based on the
highlight of the emergent challenges above, three points of discussion can be established to
emphasize on the significance of a CCC.
To begin with, the absence of a CCC is causing negative impacts on staff morale
especially due to lack of adequate resources to respond to complex issues. According to
Hildegard Peplau’s theory of Interpersonal relations, effective provision of healthcare services
calls for the establishment of healthy relationships between the nurses and the patients. Such
relationships are hard to attain when the nurses are unable to provide the best care to patients.
(Ashmos & Huber, 2014). A CCC would be essential in this case by not only ensuring the right
resources are available but also overseeing their utilization to ensure accountability and proper
maintenance.
Secondly, the absence of a CC at the center is affecting patient experiences. Leininger’s
Culture care theory lays much emphasis on the crucial link that exists between an organizational
culture and provision of healthcare services (Behan, 2014). The current situation at the facility is
an indication of the absence of a clear care culture which in most cases is established and
facilitated by a CCC. The delays in admission and non-acute admissions have led to
inconveniences which eventually cultivate negative experiences among the patients. It can

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therefore be deduced that there is a direct correlation between the presence of a CCC and
improved experiences among the cancer patients.
Lastly, the absence of a Cancer Care Coordinator at the facility has been accompanied by
cost implications on the neighboring facility. This happens specifically due to non-acute hospital
admissions. Consequently, the hospital offers comprehensive care to patients who not only do
not deserve such services but also fail to pay for them.
Analysis of causes and consequences
An oncology center just like any other healthcare organization is characterized by a
myriad activities and processes which run on a daily basis. Each of these procedures has an end
based on the objectives at the facility. The processes ought to be carefully coordinated due to
their overly complex nature. This therefore implies that lack of coordination within the
healthcare facility may come with a number of consequences especially if the problem remains
unsolved for a long period of time.
Before delving into the consequences that would come if the issue is unresolved, it would
be important identify the possible causes of the current scenario. The low level of staff morale
can be attached to the poor relationship between the workers and the management. There is no
effective partnership between the staff and the management. This gap has led to diminishing
cooperation between the staff and the hospital management. Consequently, the latter have not
remained keen on providing the staff with the necessary resources for nursing assessments and
quality services in other forms of care. Lack of appropriate facilities and the much needed
support from the management can therefore be outlined as the possible cause of staff morale.

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The aspect of non-acute admissions as well as delays in admission could also be
attributed to the widening gap between the staff and management. The challenge has hindered
the efficient transmission of patient information to the staff resulting not only in wrong
admission but delays in accomplishing the process. Finally, admission of non-acute cases at the
neighboring hospital is the major cause of cost related implications. This is because the patients
are registered into complex care for which they do not pay adequately.
Health related consequences
First of all, the absence of a CCC may come with drastic implications on patient health
and experiences in case no effective mitigation strategies are put in place. The cancer patients
deserve the best experience and treatment services. Failure to get the quality assessment from the
staff members leads to negative impacts on patient experiences (Becker, Huselid & Ulrich,
2013). Low morale among the workers has in one way or the other impacted their overall output
in terms of services delivery. The unavailability of adequate resources is another aspect which
has hampered the delivery of quality services at the hospital. The gap between the staff and
management has only served to aggravate the situation. Each of these challenges lead to
provision of services which are way below the required standards leading to slowed recovery
processes and an overall decline in good patient experience.
Social consequences
The second notable impact of the absence of a CCC within the hospital is the associated
effect on the social environment of the hospital. It is a fact worth noting that the services offered
at the care facility do not meet the comprehensive care standards. The nature of services offered
especially by the nurses has contributed to delays in admission processes, admission of non-acute

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cases and consequently, a general negative impact on patient outcomes. The cancer care
experience of a patient goes a long way in influencing not only the patient’s opinion of the
healthcare organization but the general perspective of the society towards it. It can then be
deduced that negative patient experience has negative social effects. As a result of negative client
feedbacks and poor patient outcomes, the society is less likely to embrace the services offered at
the hospital (Britnell, 2015).
Economic Consequences
Unwanted patient outcomes in addition to negative attitude towards organization by the
society may end up reducing the facility’s annual patient separations. A reduction in the number
of clients visiting the hospital for services has negative economic impacts on the organization as
a whole. At the same time, delays in admission also lead to high operation costs incurred by the
private hospital to which the facility is linked. This therefore implies that the challenges arising
from the absence of a CCC at the hospital has a number of economic impacts as well.
Ecological argument
Provision of adequate healthcare services is majorly aimed at enhancing a perfect
ecological balance. For instance, through proper care and provision of care services to cancer
patients, the mortality rates associated with this sickness are hugely lowered. Provision of care
services to patients based on the comprehensive care standards has a special influence on patient
outcomes (Broscio & Scherer, 2013). In case the patients receive the needed care, their recovery
speeds up. On the other hand, the continued absence of a CCC sustains the provision of
substandard services which in turn deteriorates the health conditions of the patients instead of

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enhancing their recovery. In drastic cases, the patient may end up losing the battle. High death
rates as a result of cancer related complications effectively distort the ecological balance.
The aspect of low motivation which is cited as one of the challenges within the
organization may also lead to worker exit which eventually distorts the organizational ecological
balance. Based on the projection that the absence of a CCC is a challenge in most of the cancer
care facilities, the consequences may overflow from the organizational levels to state and at
times national levels especially if the mitigation strategies established to counter the challenges
are not effective enough (Burt, 2015). Due to the adverse effects associated with the strategic
issue, the resolutions ought to be effective in doing away with the associated consequences.

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PART 2
Strategic Remedial Framework
Abstract
The need for comprehensive care especially for cancer patients continues to increase at an
alarming level. This phenomenon could be attached to the increasing number of cancer cases as a
result of the changing lifestyles especially in the developed countries. In order to attain the
comprehensive care and quality health standards, there is the essential need to implement the
right strategies in the management of healthcare organizations. Proper management implies the
presence of adequate coordination approaches which equally need skilled personnel with the
right attributes. The absence of a Cancer Care Coordinator at the hospital is symbolically a
cancer on its own. The consequences are drastic and when the necessary mitigation factors are
not put in place, the effects may end up failing the organization in a number of fonts. After
highlighting the health, social and economic consequences of the absence of a Cancer Care
Coordinator, this report details the remedial strategies which can be implemented in order
achieve long lasting solutions. The work is based on review of necessary literature in addition to
the analysis of both present and past data trends on cancer care services. The report is therefore a
summary of planning, implementation and evaluation strategies. From the critical review of the
elements above, a tacit list of recommendations shall be listed at the tail end of the report.

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1.0 Introduction
According to the need theory of nursing, the main objective in any organization dealing
with nursing and other health care services is to consistently ensure that patients get the very best
in terms of medical services and attention. There is the inevitable need for safe record keeping to
enhance continuity of information in addition to the efficient transfer of details which increases
the effectiveness of health care services (Cox & Blake, 2012). In a nut shell, a healthcare
organization ought to remain keen on achieving maximum client satisfaction through the
organized use of resources and facilities available within the organization. A state of disarray
usually comes with a number of challenges. For instance, when there is lack of coordination in
the process of record keeping, crucial historical information about the details of patients’
sicknesses may be lost. This in turn hampers the appropriate provision of healthcare services to
such individuals. Poor quality services lead to negative patient outcomes and satisfaction which
eventually costs an organization. In order to enhance organizational best practices, there is need
for an appropriate leadership set up (Grant & Marshak, 2012). These leaders have the managerial
mandate to ensure that activities and programs within the healthcare organization are not only
well coordinated but also executed effectively. Consequently, this report focuses on the
challenges that are associated with lack of a Cancer Care Coordinator in a healthcare
organization and the extensive need for possible mitigation strategies.
The healthcare organization in this context is an Oncology Day Hospital which
specializes in the treatment of cancer patients in addition to other cancerous tumors. The
organization offers outpatient services and has an annual patient separation of 18,500. The
facility is attached to a leading private hospital in the country. The current issue inhibiting
effective operations at the hospital is the absence of a Cancer Care Coordinator. This has led to

Healthcare Management 10
situations in which patients with non-acute cases are admitted into the hospital for complex care.
At the same time, the admission period for the patients is relatively lengthy which leads to a high
level of dissatisfactions on the side of the clients. Delayed admissions come with losses to the
organization as the time lost during such delays affects a number of processes. Additionally, the
nurses are lowly motivated and constantly experience frustrations in their bid to effectively
perform their duties. The challenges faced by the nurses can be attributed to lack of adequate
resources at the facility which largely hampers their bid to offer quality assessment and treatment
services to the clients. Each of the aspects mentioned above can be traced back to lack of proper
leadership at the organization (Haddock & McLean, 2012). This has led to the provision of
services at the facility which do not meet the comprehensive care and quality health standards.
Good leadership attributes give room for proper coordination of activities, balance distribution
and use of available resources, coordinated admission processes and most importantly, the
motivation of the human resource which make a crucial organ within the facility. Based on the
background above, the consequences associated with the strategic issue are sensitive which
needs an immediate response. This reveals the inevitable need for a remedial framework. The
framework shall comprise a detailed evaluation of the strategies which can be easily
implemented in order to resolve the issue at hand.

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2.0 Remedial Framework
2.1 Planning
Classical theory of management
The planning phase of this framework shall be pegged on the classical theory of
management. In line with the arguments of this theory, the plan shall seek to produce what is
good and right for the cancer care organization. The first stage in coming up with a remedial
strategy involves putting in place a tacit plan comprising the various elements. This proposal
goes hand in hand with the proposals of classical theory which emphasize on structure as a vital
management tool. These elements are then to be carried forward into the next stage of the
remedial framework. The planning phase shall involve the consideration of a number of factors
which may include the financial implications of the venture, ethical considerations, duration of
events as well as a definite trend of deadlines to enhance time management (Ka¨rreman &
Alvesson, 2012). In a bid to deduce the best mitigation strategies, the planning session shall
involve a critical analysis of the possible causes of the situation at hand. Reviewing the current
state of affairs at the cancer care facility, a number of challenges can be established.
The first notable issue is the aspect of delayed admission processes. This challenge can
be traced to the lack of appropriate recording strategies at the hospital. The incompetency of the
staff could also be a possible cause of this problem. Secondly, there is the issue of non-acute
hospital admissions done which are accompanied by negative financial implications especially
on the private hospital to which the Oncology Day hospital is attached. This could be as a result
of inadequate procedures laid down to regulate the nature and speed of admissions. These
admissions cause the outpatient facility to lose revenue since the patients are treated under

Healthcare Management 12
inpatient services which is already covered by the insurer. The third problem is the issue of low
staff motivation which is confirmed by the high level of frustration among the nurses hindering
their ability to effectively perform their duties. The theory of human relations highlights the
central place of motivation in enhancing the quality of services. Lack of self drive and proper
output among the nurses can be attached to the nature of leadership at the facility (Knippenberg,
2014). It is therefore a clear indication that the current strategies at the hospital have not been
effective enough in ensuring a healthy work environment. This affects both the nurses and the
patients. Lastly, the facility does not have enough resources which actually explain why the
nurses are unable to perform their nursing assessments within the stated standards.
The overview above highlights the specific problems ailing the facility. The remedial
framework shall therefore be guided by the strict objectives to note that each of these problems
are resolved in good time using efficient strategies. From a general point of view, each of the
issues stated above require the attention of a Cancer Care Coordinator. It is however a fact worth
noting that each of these issues are related to organizational strategic management. As such, the
coordinator will need to possess adequate skills both in line with management and their area of
specialization. As part of the strategic plan, the CCC shall be charged with the following
responsibilities:
 Ensuring a coordinated flow in the admission processes to minimize both delay in
admission as well as non-acute admissions
 Ensuring an appropriate work environment conducive for both the patients and the
hospital worker
 Enhancing the level of motivation among the nurses through adequate training, staff
appraisal, reward systems and knowledge management.

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 Maintaining an efficient financial management system to encourage accountability and
correct use of resources within the facility.
 Minimizing cost implications on both the hospital and the private facility to which it is
linked through the implementation of organizational best practices.
Due to the fact that most of these processes shall be implemented under the supervision
of the new coordinator, the recruitment process of the CCC ought to come first in the
implementation phase of the remedial framework. The coordinator shall be required to posses the
necessary work experience, academic qualifications and appropriate managerial skills as this
would increase the effectiveness of the mitigation process. With the functions stated above, the
remedial framework plan shall run along the following guidelines:
 Recruitment of a Cancer Care Coordinator
 Training of the CCC to enhance their skills and improve quality of services
 Overhaul of the hospital’s record system and replacing the old procedures with new
and more effective ones
 Training and motivation of nurses and other support staff
 Provision of lacking facilities and resources to enhance the quality of nursing
assessment and other services at the hospital.

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The current patient separation at the facility is 18,500. From this data, the annual budget of the
hospital can be estimated at $1000000. Based on the projected financial ability of the
organization, the plan budget has been summarized thus:
2.1.1 Budget Summary
ITEM AMOUNT
Recruitment and Training of Coordinator $ 50,000
Review of Hospital Records $20,000
Staff Training and Motivation $100,000
Provision of lacking resources $100,000
Total $270,000
The pie chart below can be used to determine priorities within the budget
Amount
Recruitment
Record review
Staff training
Resources

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Using a span of 6 month, the plan activities and schedule shall be as follows
Activity Start Date End Date Duration
Recruitment and Training of Coordinator 1st January 1st February 1 Month
Review of Hospital Records 1st February 1st March 1 Month
Staff Training and Motivation 1st March 1st May 2 Months
Provision of lacking resources 1st May 30th June 2 Months
Graphical Presentation of Project Schedule
Recruitment of
Coordinator Record Review Staff Training Provision of resources
0
0.5
1
1.5
2
2.5
1 1
2 2
Duration

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3.0 Implementation
The implementation stage shall be solely guided by the elements of the plan above. It is
also important to point out that the schedule for activities as well as the stated deadlines is meant
to ensure the remedial framework starts and ends within a stipulated period of time. In the
implementation stage, the fist procedure shall involve the formulation of a recruitment and
selection criteria (Patrick, 2013). The selection criteria needs to be effectively established to
ensure that the Coordinator who finally lands the job has what it takes to resolve the current
problems at the organization and lift it to new level in terms of development. The selection
criteria shall incorporate a detail of academic requirements, personality, experience as well as
skills of the intended employee. Based on the objectives of the remedial framework, the
coordinator shall be required to posses the necessary experience in line with the field of cancer
care and treatment. The Coordinator must possess the right academic qualifications in the related
fields as these skills will be helpful in execution of duty. In addition, the coordinator shall be
required to posses the right managerial skills which include effective communication, decision
making and conflict resolution abilities. The leader also needs to be flexible to change and
effective in team management which shall be vital when it comes to the coordinator of cancer
care services at the facility.
Once the selection criteria have been established, the job opportunity is announced and
applications welcomed both through physical channels and via online platforms. A selection
panel comprising the hospital stakeholders, patient representatives and board of directors shall
oversee this process. At the end of the application period, the details of the applicants shall be
reviewed in order to come up with a finer list of successful individuals who shall then be
welcomed for an interview. The selection of the applicants for the interview process shall be

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strictly based on the stated selection criteria and only those who meet these requirements shall be
invited for an interview. To ensure a free and fair process, the various legal considerations for
instance employment regulation laws shall be factored in. As an ethical consideration, the
selection procedure shall be done on merit and not necessarily with the aim of favoring certain
individuals based on age, gender, religious and sexual orientation.
Once the selection process is complete, the successful applicants shall be contacted for
the interview process. This activity shall be done with reference to the stated criteria. The
process is meant to deduce more information about the applicants especially on their personal
attributes and communication skills (Reagans & Zuckerman, 2011). The panel shall then select
the best interviewee who to be incorporated into the next phase of the remedial framework. The
selected individual is to be taken through a period of training and induction before being
accorded the mandate to be part of the other ingredients of the remedial framework. Once the
CCC has been trained, he shall in turn coordinate the other stages of the plan which include
review of the hospital records to enhance efficiency as well as staff training and motivation. The
Coordinator shall also work with other members within the management team to identify the
crucial but missing facilities and resources. A budget for the same is then implemented and the
resources obtained to allow easier nursing assessments and quality cancer care services. It would
also be important to note that the implementation phase ought to take place within the projected
period of 6 months. The periods for each activity for the implementation process has been
carefully stated in the plan schedule hence ought to be adhered to ensure the efficiency of the
remedial framework.

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4.0 Evaluation
Experimental and quasi-experimental models of evaluation
The evaluation process shall be based on experimental and quasi-experimental models of
evaluation. These models deduce conclusions on the progress of a strategy based on the
outcomes registered in line with specific targets. In a bid to ascertain the effectiveness of the
remedial framework, there is an inevitable need to evaluate the progress of the project. The
evaluation process shall mainly be anchored on the core objectives of the remedial framework.
The issues in review include delayed admissions, non-acute admission, cost implications on the
organization as well as low motivation and commitment of nurses. The cancer care coordinator
who is charged with coordinating and implementing these mitigation strategies shall be valuable
in the process of evaluation (Sturdy & Grey, 2013). The coordinator himself shall be assessed
and evaluated by external auditors to establish his impact on the whole mitigation process.
Effective evaluation processes come with deadlines, targets, goals and rewards. As such, the
coordinator shall be given specific targets to be achieved within a given period of time. Adequate
accountability would be required in case these targets are not met within the stated period of
time. For instance, the number of non-acute admissions at the hospital is expected to reduce by
40% after a period of 5 months. Similarly, after 2 months, there ought to be reduction in cases
involving delays in admission. The resources that are missing but remain necessary ought to be
availed to the workers within a period of 2 months. Finally, the level of motivation of nurses and
quality of their services to the patients is expected to improve drastically during the mitigation
period.

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Michael Scriven's Consumer-Oriented model of evaluation
This model reveals the correlation between evaluation and the extent to which consumers
are satisfied based on the implementation of mitigation strategies. The evaluation rates
consumers, who in this case are the cancer care patients, among the key stakeholders in an
organization. The evaluation process shall therefore be based on the above benchmarks. This
therefore implies that the remedial framework shall be deemed effective if after a given period of
time, non-acute admissions shall either be low or extinct, the nurses shall be highly motivated
and able to perform their duties effectively and there shall be a notable reduction in time taken to
complete admissions (Sturdy & Grey, 2013). Consequently, the implementation of the remedial
framework should be accompanied by a positive deviation on the return on investment
experienced by the organization. This aspect shall also be a crucial element in the evaluation
process. The process is essential as it helps the key stakeholders to identify the areas that need to
be adjusted in a bid to ensure a holistic remedial action against the challenges at the cancer care
facility.

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5.0 Conclusion
Provision of essential care remains one of the core objectives in healthcare facilities. In
the case of cancer patients, these individuals deserve the right attention due to the various
challenges that come with such forms of sicknesses. A part from the huge expenses involved,
cancer patients go through a lot of traumatic and mostly psychological problems. This therefore
implies that the most effective strategies ought to be put in place with the main aim of according
the patients the best experience. The remedial framework above would be a step in the right
direction towards achieving the objective above (Rollins, 2013). The organizational case study
indicated the absence of a Cancer Care Coordinator as the main challenge at the health facility.
The associated impacts included delays in admission and non-acute admissions which also have
cost implications on the private hospitals. Low worker motivation laced with inadequate
resources was also noted as some of the emerging strategic issues. The remedial framework
above has adequately addressed each of these challenges by coming up with mitigation strategies
specifically aimed at dealing with each of the problems. The planning phase involved identifying
the root cause of the problems hence the implementation stage was distinctly targeted at dealing
with these causes while offering long lasting solutions. Employing a coordinator through an
efficient selection criterion was identified as a key mitigation strategy. This phase was essential
since finding a qualified and competent coordinator would enable an easier execution of the
remaining phases of the remedial framework. To enhance the progress of the process,
appropriate evaluation strategies were also established.

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6.0 Recommendations
The remedial framework above details a number of strategies which would be implemented in
order to obtain a long lasting resolution to the strategic issue. In line with the framework, the
following recommendations have been listed for consideration.
 In line with Leininger’s culture care theory, the hospital management ought to ensure a
non discriminatory and result oriented selection procedure. This would imply the
employment of the most qualified coordinator capable of accomplishing the tasks
especially those related to resolving the strategic issues at hand.
 Based on the proposals of the theory of interpersonal relationships, the hospital should
invest on staff empowerment through training, motivation and increase in the level of
awareness. This increases their competency and willingness to offer the best services to
the patients.
 There is need to note the missing resources and provide them. This would allow the
nurses to effectively perform their nursing assessments which in turn lead to positive
impacts on patient outcomes.
 The hospital management also needs to create a good work environment by factoring in
the health and sanitation needs in addition to the establishment of a proper reward scheme
to increase the motivational levels.
 There should be constant evaluation of the mitigation processes to ascertain their
effectiveness and hence make necessary adjustment to improve service quality.

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