Healthcare Operations Report: ED Challenges and Solutions for TIHC

This report delves into the critical challenges facing emergency departments (EDs) in Australia, particularly within rural healthcare settings, using Tragerfield Integrated Healthcare Centre (TIHC) as a case study. The paper identifies key issues such as access block, workforce shortages, and inadequate...Read More

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HEALTHCARE OPERATIONS
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Healthcare Operations
Executive Summary
In spite of its affluence, Australia is no exemption from shortages of healthcare
professionals, which are experienced globally. The mismatch in Australia between the demand
for healthcare and the supply of healthcare professionals is likely to become worse in the next
one decade. In Australia, the shortages of beds and professionals and its impacts of
misdistribution are worst in rural areas. The current healthcare system faces numerous problems
that include access block, shortage of workface, funding, and inadequate bed capacity. Australia
would not be able to meet the demand of healthcare basically by increasing the supply of health
care personnel and beds, but with creative strategy to demand and supply, it must be possible to
meet the demand for healthcare via different actions. The emergency department (ED) has been
much affected by these challenges and there a need for solutions to address them. The use of
business process reengineering and systems theory, proper selection and recruitment process, and
allocating more resources are potential solutions. The paper will examine key issues affecting
Tragerfield Integrated Healthcare Centre (TIHC) and develop solutions to address the current
problems in ED.

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Table of Contents
Executive Summary.........................................................................................................................2
Introduction......................................................................................................................................4
Findings...........................................................................................................................................4
Issues............................................................................................................................................4
Solutions..........................................................................................................................................7
Business Process Reengineering (BPR) and Change Management................................................7
Systems Theory............................................................................................................................8
Reducing New and Return Appointments...................................................................................8
Resources.....................................................................................................................................9
Provide Care only to Patients with Emergencies.........................................................................9
Recommendations..........................................................................................................................10
Conclusions....................................................................................................................................11
List of References..........................................................................................................................12

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Introduction
In spite of its affluence, Australia is no exemption from shortages of healthcare
professionals, which are experienced globally. The mismatch in Australia between the demand
for healthcare and the supply of healthcare professionals is likely to become worse in the next
one decade. In Australia, the shortages of beds and professionals and its impacts of
misdistribution are worst in rural areas. This worsens the situation where individuals in rural
regions already have worse health than those individuals in urban areas in Australia. Access
block and increasing presentations because of the ageing population has become a major
challenge for public hospitals in Australia. Access block is linked to augmented emergency
department (ED) wait time for health care plus results in ED overcrowding (Arain, Campbell &
Nicholl, 2015, pp. 295). Therefore, solving the undersupply of health professionals and beds and
achieving a better distribution of those in practice are; thus, critical challenges for rural
population in Australia (LaCalle & Rabin, 2010, pp. 43).
Findings
Issues
Access block affecting the emergency department (ED) might be defined as a
phenomenon that comprising nearly all the problems in contemporary emergency departments.
This challenge is more pronounced in most healthcare facilities in rural areas (Hwang et al.,
2011, pp. 529 ). Access block or delay in admission of individuals to hospital inpatient areas
from emergency departments, may be explained as a full system challenge, the equal of “Theory

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of Everything”. Access block is a situation in which patients are incapable of gaining access to
suitable beds in practical quantity of time, no more than eight hours that have become a primary
challenge in rural hospitals in Australia. This is a problem that is evident in the case of
Tragerfield Integrated Healthcare Centre. Access block is connected to increase in wait time for
medical care in emergency departments that result in overcrowding. Overcrowding in emergency
departments in rural public hospitals is the rationale for declined effectiveness plus quality of
care and connected to increased incidence of adverse events (Forero, McCarthy & Hillman,
2011, pp. 217). The accessible has been found to be negative because it is often linked to bed
capacity, as well as there are studies, which show that hospitals wards will not be operated at 100
per cent residence for long devoid of substantial threat to patients due to delayed admission from
emergency department. The majority of the hospitals are operated at filled capacity and the
challenged is worsened by considerable pressures in healthcare, like natural events or long
waiting lists for elective surgery. It has been found that in Australia, the emergency department
rate of admission per 1,000 increased by 35 per cent between 2003 and 2008. Because of the
augmented demand and concurrent bed shortages in many rural healthcare facilities were over 85
per cent that has been taken as the maximum level for efficiency (Forero & Hillman, 2009, pp.
53).
The shortage of workforce in ED has been identified in the case of Tragerfield Integrated
Healthcare Centre affecting the provision of quality and safe care to patients in rural hospitals in
Australia. The latest report from the medical workforce showed that there were 325 doctors per
100,000 population in urban Australia, but only 142 per 100,000 populations in rural Australia.
This shows that there is an acute shortage of healthcare experts, especially doctors in Australia in

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rural healthcare facilities (Sharif, Stanford, Taylor & Ziedins, 2014, pp. 74). The report entitled
“The Specialist Emergency Medicine Workforce in Australia: an update 2002-2012” concluded
that ED personnel was undersupplied, founded on different indicators, comprising numbers of
vacancies, contrast to the then obtainable personnel size with requirements and perceptions on
the adequacy of the workforce. The workforce shortages have some impacts for the labor force,
in which job quality is the primary implications (Richardson & Mountain, 2009, pp 370). The
ED personnel suffering from stress and burnout because of long working hours and nature of
challenges being handled lowers the quality of care for patients (Fatovich, Hughes & McCarthy,
2009, pp. 363).
Public hospitals in Australia do not have adequate beds to accommodate the growing
numbers of admissions in rural areas. Bed shortage has become a persistent problem that need to
be addressed as it has become persistent for many years in public hospitals in rural areas in
Australia. Once bed occupancy rates frequently surpass 90 per cent, lack of spare bed capacity
implies that public hospitals may expect standard bed shortages, as well as overcapacity. Thus,
once occupancy surpasses 95 per cent, EDs will nearly always run in crisis manner. These
hospitals doe not sufficient beds to offer a safe typical care for extremely sick patients that need
unintentional emergency admissions. The hospitals are overfull and cannot admit in addition to
treat patients in a well-timed manner due to total number of sharp hospital beds in Australia has
been slashed by around one-third to a point far under OECD standard. Taking population growth,
the actual decline in bed numbers is even bigger-60 per cent decline from 4.8 public acute beds
per 1,000 populations in 1983 to about 2.5 per 1,000 populations nowadays (Kalisch, Lee &
Rochman, 2010, pp. 938).

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Solutions
Business Process Reengineering (BPR) and Change Management
The BPR is vital tool that that help organization promote change geared towards
efficiency and increased productivity. BPR helps organizations to streamline their processes and
practices to boost efficiency and allow the attainment of the goals set by the organization. This
change management tool addresses the growing spending in the healthcare setting because of the
ineffective business processes that do not guarantee efficiency. The BPR is instrumental in the
healthcare sector in addressing challenges where it promotes changes that will transform the
healthcare practices. BPI will allow the healthcare organization to embrace changes including
information technology (IT) to boost the changes within the organizational to meet the goals of
the organization. Furthermore, BPR is important in permitting the attainment of total efficiency
along with the quality of service through their process. BPR will effectively resolve the current
challenges that Tragerfield Integrated Healthcare Centre experiences by transforming the way
service is delivering through initiating changes to address the access block, shortages of staff,
and bed shortages currently affecting service delivery in the organization. The BPR will
introduce change through embracing IT systems that will transform the way services are
delivered to the patients in the organization, such as adopting EHRs and EMRs that will reduce
burden among the nurses resulting in efficiency. The BPR as a management tool will redesign
the process in the organization that will dramatically improve the provisions of healthcare
services in terms of quality, cost, efficiency and speed. This is an important change management
strategy will solve the current problems that the Tragerfield Integrated Healthcare Centre is
facing (Anand, Chandrashekar & Narayanamurthy, 2014, pp. 123).

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Systems Theory
Systems theory is an important theory that can be used to provide solutions to changes in
the healthcare systems as it emphasis on effective management. The theory allows leaders and
employees to view the organization as it comprises many units that should be studied differently.
The theory requires organization to promote efficiency through looking at the entire organization
as a system. The theory emphasizes the need for healthcare leaders to be in the leading position
in promoting change management process to allow for the development of effective strategies to
meet the growing challenges of the healthcare. Therefore, leaders at Tragerfield Integrated
Healthcare Centre need to embrace systems theory of management to initiate changes to promote
efficiency and effectiveness in the organization. The leaders show view the organization as
system and that the systems have components, which are important in understanding the failures
of the systems and develop the necessary interventions to promote efficiency and performance
(Levitt, 2014, pp. 1051).
Reducing New and Return Appointments
The reduction of new and return appointments will be an important approach in reducing
current problem of bed shortage and access block. Efficiency and productivity would be
improved in ED by utilizing outpatient appointments more appropriately. If reductions would be
made at Tragerfield Integrated Healthcare Centre (TIHC) in inappropriate visits or return
appointment to outpatient clinics will lower the pressure on emergency services and increased
patient satisfaction (Mathews, Ryan & Bulman, 2015, pp. 105). There is a need to utilize the
outpatient clinic more efficiently by exploring unnecessary attendance, as well as improving
effectiveness by enthusiastically pre-evaluating patient charts, as well as pre specifying

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management plans prior to planned outpatient visits. Group appointment will be appropriate for
this case where information will be provided to patients as a group or at an individual level
(Donnellan, Hussain, Aftab, & McGurk, 2010, pp.531 ). This approach of group appointment
will give the patient the chance to talk to individuals with the same illness plus share experiences
and the consultant may spend less time with each patient individually (Kalisch, Lee & Rochman,
2010, pp. 940).
Resources
Tragerfield Integrated Healthcare Centre (TIHC) needs to look for more supplementary
resources would be needed for revamping present processes, boosting access to diagnostic ands
other support services plus developing effectual utilization of infrastructure over extensive hours.
Specifically, suitable, and enhanced, staffing of emergency department is essential to undertake
prompt, timely, as well as safe care for many patients on a daily basis. The resources should
promote the sustained capacity of the emergency department, hospital along with community
providers to accomplish clinical education, training along with supervisory roles in line with
nationwide professional standards and guidelines. The human resources should be rewarded
frequently to boost their morale and ensure that they deliver optimum care to the patients in the
ED. The organization should ensure that the gain the confidence of the staff and use finances to
retain and promote those who deserve (Saghafian, Austin & Traub, 2015, pp. 101).
Provide Care only to Patients with Emergencies
Individuals with emergencies should be only admitted to ED and those that do not
emergency care should be transferred to non-emergency departments. This will help to reduce
overcrowding in the ED and lower the consequences of overcrowding thus benefiting those

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individuals that need emergency care and enhance the quality of care. ED must be only reserved
to individuals with true emergencies. The hospital should have additional primary care clinics in
the community that will attend individuals that do not need emergency care. These clinics should
be in a position to offer services for patients with plus without health insurance to share the
patient load that presently leans on the ED (Scott, Vaughan & Bell, 2009, pp. 398).
Recommendations
Training and education should be at the center stage of ensuring the workforce in ED get
the necessary skills and knowledge to handle the ever-growing number of patients seeking care
in emergency department. There is a need to provide rural specific emergency medicine short
courses and post-graduate courses to the staff. Tragerfield Integrated Healthcare Centre (TIHC)
can implement Rural Generalist Pathway programs to address the staff shortage in ED in rural
areas. This approach will attract more candidates where they will fill the current gap of
workforce in the ED. The training should be organized at regular period to ensure that the
workforce is equipped with the right knowledge and skills to manage the growing numbers of
admissions to ED. This can be organized through seminars, workshops and forums that will
enable the workforce to exchange ideas that will result in knowledge creation that will benefit
the organization (Eley, Eley & Rogers‐Clark, 2010, pp. 8).
Boarding of inpatients in the emerging department is unquestionably the primary cause of
crowding. Tragerfield Integrated Healthcare Centre (TIHC) should start expanding their capacity
to handle the growing presentations and reduce overcrowding experienced in public hospitals.
The bed capacity should be increased to accommodate more patients. The growing the number of
hospital beds will increase the delivery of healthcare services since many patients will be

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accommodated and will reduce crowding in public hospitals in Australia (Lin, Patrick & Labeau,
2014, pp. 88).
Tragerfield Integrated Healthcare Centre (TIHC) should develop effective recruitment
and retention policies that will ensure that the right staff in ED is recruited and that these
employees are retained in the department. This will be crucial in reducing shortages of personnel
in the ED. There is the need to create a recruiting website that will enable many applicants to
express their interest and apply for available positions. The expression will be then matched to
vacancies along with preferences stated. The recruitment practices should meet the national
standards to ensure that the right workforce is in place to reduce the current workforce shortage
that persists in many organizations in public hospitals in Australia (Ho & Maddern, 2011, pp.
258).
Conclusions
The growing number of patients presenting themselves in rural hospitals, shortage of
beds and professionals in rural areas continues to impact the health of the people in rural areas
who cannot access primary care. The ED in public hospitals in Australia has been strained by the
growing number of presentations and there is the need for urgent need to address these issues.
There is a need to allocate more resources to recruit and expand the bed capacity and streamline
the recruitment and selection processes to employ and retain the right workforce. Appointment
modes should be reviewed and staff should be trained and educated on how to best deliver
services in the ED (Pines & Griffey, 2015, pp. 986).

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List of References
Anand, G., Chandrashekar, A., & Narayanamurthy, G. (2014). “Business Process Reengineering
Through Lean Thinking: A Case Study”. Journal of Enterprise Transformation, 4(2),: 123-150.
Arain, M., Campbell, M.J & Nicholl, J.P. (2015). “Impact of a GP-led walk-in centre on NHS
emergency departments”. Emerg Med J. 32(4):295–300.
Dinh, M.M., Bein, K.J., Latt, M., Chalkley, D & Muscatello, D. (2015). Age before acuity: the
drivers of demand for emergency department services in the greater Sydney area. Emerg Med J.
32(9):708–11.
Donnellan, F., Hussain, T., Aftab, A.R & McGurk, C. (2010). “Reducing unnecessary outpatient
attendances”. International Journal of Health Care Quality Assurance. 5(1):527-31.
Eley, D., Eley, R & Rogers‐Clark, C. (2010). “Reasons for entering and leaving nursing: an
Australian regional study”, Australian Journal of Advanced Nursing, 28 (1), 6‐13.
Fatovich, D.M., Hughes, G & McCarthy, S.M. (2009). “Access block: it’s all about available
Beds”. Med J Aust. 190(7):362–363.
Forero, R & Hillman, K. (2009). Access Block and Overcrowding: A Literature Review.
University of New South Wales & Simpson Centre for Health Services Research.
Forero, R., McCarthy, S & Hillman, K. (2011). “Access block and emergency department
Overcrowding”. Critical Care. 15(1):216-221.

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Ho, P. B & Maddern, G. J. (2011). “Physician assistants: employing a new health provider in the
South Australian health system”. Medical Journal of Australia, 194 (5), 256‐58.
Hwang, U., McCarthy, M.L., Aronsky, D., Asplin, B., Crane, P.W & Craven, C.K. (2011).
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Kalisch, B. J., Lee, H & Rochman, M. (2010). “Nursing staff teamwork and job satisfaction”. J
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improving”. BMJ Qual Saf. 23:1051–2
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emergencypatients with downstream blocking. Health care management science, 17(1):88-99.
Lowthian, J.A., Curtis, A.J., Jolley, D.J., Stoelwinder, J.U., McNeil, J.J. & Cameron, P.A.
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J Aust. 196(2):128–32.
Mathews, M., Ryan, D. & Bulman, D., (2015). “Patient-expressed perceptions of wait-time
causes and wait-related satisfaction”. Current Oncology, 22(2):105-129.
Pines, J.M & Griffey, R.T. (2015). “What we have learned from a decade of ED crowding
research?” Acad Emerg Med. 22(8):985–7.

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Richardson, D.B & Mountain, D. (2009). “Myths versus facts in emergency department
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Saghafian, S., Austin, G. & Traub, S.J., (2015). “Operations research/management contributions
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Sharif, A.B., Stanford, D.A., Taylor, P. & Ziedins, I., (2014). “A multi-class multi-
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Health Care, 3(2):73-79.
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systematic review”. Int J Qual Health Care. 21(1):397–407.
Verelst, S., Wouters, P., Gillet, J-B & Van den Berghe, G. (2015). “Emergency department
crowding in relation to in-hospital adverse medical events: a large prospective observational
cohort study”. J Emerg Med. 49(6):949–61.