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Assessment is an important step and procedure as noted in many successful organizations, and healthcare facilities such as hospitals and clinics are no exception. Many organizations whether involved in the economic, political or social aspects have embraced assessment of various concerns and interests to their organizations to display the true position of events and systems within the organization so that measures can be taken or sustained and conform to the expectations of the organization, its goals, and objectives. Assessment procedure, thus, can be done before, during or after executing varied projects and processes in organizations. Assessments, therefore, are conducted to provide the gaps that exist in an organization, confirm or monitor progress in already established projects, or ascertain if intended goals and objectives of the various process are met or not. Thus, the kind of assessment conducted depends on the type of organization and purpose of the assessment with the aim of helping the organization and concerned parties to realize their objectives effectively. Therefore, this paper presents an assessment of a hospital facility (hospital and community-based clinics) and its system for several applications pertinent to the hospital environment.  

Administrative

Any organization has to formulate the management and leadership styles that would help it realize its objectives with ease. The leadership style chosen is dependent on many aspects such as the goals and objectives of the organization, the number of personnel, the size of the facility, and training and experience among other factors. Therefore, for the noted hospital, with a hospital bed capacity of 1800 and 30 communities-based clinics, it requires a robust administrative team with vast experience and knowledge to provide leadership to the hospital personnel for it to meet its objectives with ease. There are competencies that must be assessed in the administrators or leaders of the hospital such as effective communication skills, management skills and experience, analytical skills and dedication among other skills. The head of the hospital, as well as those leading the varied clinics, must possess the required skills and competencies as described above for the health facility to run effectively. The organizational leadership should be clear that shows the hierarchy of leadership and distinguishes different departments with clear communication channels between the staff and the management. All the mentioned factors have to be assessed and a determination made in the administrative team (Wright & Bykonich, 2005). It helps the organization realize its goals with ease. If not and, thus, there is the need to apply changes in the administration. For effective administrative assessment, the appropriate clinical setting would be both inpatient and outpatient.

Database architect and design would include the position in the administrative structure that shows people from the top value in the hierarchy to the smallest one in decision-making processes. OLTP application that produces transactional and normalization data allows creation, reading, updating and deleting records. It would also link all the 30 clinics, indicating the head in each facility and linking it to the leadership of the main hospital. It would also capture the leadership in various departments connecting them to the chain and structure of the administrative ranks and chain for the hospital.  The database designs would have clear links that note the direction of the leadership and how they are linked.

The components that would be appropriate for an e-health delivery system related to administrative assessment would include the privacy and security component, authorized health users, authorization authentication, as well as disclosure directives and Audit Trail.

Clinical Decision Support Systems

Assessment of the clinical decisions support systems would evaluate the health information systems within the hospitals and clinics designed to provide health professionals that include physicians among other health workers with assistance in decision-making tasks. It provides them a reference point where they link observation and knowledge they have in making the right choices in all that is done at the hospitals and clinics.  The assessment, thus, has to verify if the available support systems for clinicians are relevant according to the latest knowledge and research findings in many subjects of the health care professionals (Greenes, 2007). Both the knowledge and non-knowledge-based clinical support systems have to be assessed and a decision made that would either lead to change or improvement of the current support systems. Assessments have to be done for both the hospital and the clinics. The appropriate clinical setting for conducting an assessment on clinical decisions support systems would both incorporate the inpatient and outpatient facilities.  It is because both settings allow the assessment to be done as the hospital physicians experience similar incidences for both inpatient and outpatient, hence requiring them to reference.

The database architect and design in the clinical decisions support systems would include the categorization of the possible cause of disease and be categorized by symptoms.  The design would have to use a combination of both applications used in designing database architecture of OLTP and OLAP. It is because it uses both knowledge-based and non-knowledge-based clinical decision support systems. The architecture and designs would have two broad categories as indicated above. For systems that result mostly to analytical results and data, as well as forecasting and reporting, it would be considered to be appropriate and workable in design and architecture of the support systems. On the other hand, for analysis that does use non-knowledge-based support systems, such as computers that produce direct results according to their interpretation, the use of the OLTP application would be embraced. It would allow for easier reading, uploading, deleting and creating information. The design would, hence, consider all the support systems and be evaluated to determine their relevance in relation to the expectations of the hospital and clinics.

The components that would be appropriate for e-health delivery systems related to clinical decision support system assessment include lab test results information, drug information, physician information technology office, authorized health users, and diagnostic imaging, as well as Interpretable electronic health record project.

Electronic Health Record and Computer-based Health Record Systems

Assessment of the health record and computer-based health records system is appropriate in saving time and sharing information between different physicians or hospital facilities and clinics. It has made it easier for traveling patients to have an easy time revealing their medical history to physicians and sharing the correct information. The information is also easily shared and, hence, sustains treatment of patients and executing of health services (International Congress in Nursing Informatics, Park, Murray & Delaney, 2006). Assessment of such devices in a health facility is, therefore, relevant to ensure that the systems are working well and can be accessed at any time including emergency situations. It also ensures that the systems are compatible to the relevant authorities and allied health practices; hence assessment becomes an important event for electronic health record and computer-based health record systems. Both the inpatient and outpatient provides a good set up for the assessment of computer and electronic health records because all information from patients is critical and, hence, required and captured.

In designing database architecture for electronic and computer-based health record, OLTP application would be the most appropriate. A normalized table would be designed and created that allows for deleting of information, uploading of new data, reading and deleting records. It would be the best approach as it would allow capturing of more information and records about patients. Since patients’ information is not static but dynamic, health situation changes more often. Thus, the table will allow for frequent updates and correction made in relation to the real health condition of patients. Hence, their health records would be current besides being accessible to many concerned people and institutions.  The data should be broken into logical pieces that would make it simple for users to access information. It would have columns and rows that have relevant information clearly and simply stated. All these factors have to be considered in the assessment process.

The components that would be appropriate for e-health delivery system related to electronic and computer- based health records assessment include patient demographic information, provider information, and Public health information and registries integration project.

Nursing

Assessment of nursing needs entails a more detailed process. Nurses play an important part in healthcare facilities that include hospitals and clinics. Assessment of nurses has to include the training, knowledge and skills appropriate. It also includes evaluating jobs satisfaction and provision of necessary and appropriate work resources that most of the nurses use to execute their duties. Also, the leadership of the nurses department has to undergo assessment and the general welfare of the nurses in the hospitals and clinics. Both inpatient and outpatient clinical setting are appropriate to conduct the nurse assessment. However, it is mostly successful for inpatient clinical set-ups because the functions and roles of nurses relate to taking care of the patients hence better applied in inpatient set ups.

Database architecture and designs for nurses would combine both the OLTP and OLAP applications. It would entail the hierarchy and leadership structure of the nursing department and various sections in the nursing department clearly indicated, linking roles and responsibilities. It would allow for transactional and analytical data that captures the broad knowledge related to nurses in both the hospital and the clinics. It would also note the lead nurses in the varied clinics and establish their hierarchy and leadership positions in the nursing department.

The components that would be appropriate for e-health delivery system related to nurses include physician information technology office, drug information, provider information, diagnostic imaging and public health information.     

Ancillary Service Systems

Assessment of ancillary system that entails health machines and other equipment ensure sufficient and stable supply of electricity to the facility that includes the hospitals and the clinics. Continuous and sustainable power supply for health facilities is a critical aspect to be considered and assessed to mitigate possible shortages and breakdowns that might impact negatively on health services delivery. Assessment of the mentioned equipment and machines ensures they are serviceable and operational. The main hospital should have stronger power backup such as a generator. The clinics should also have power backups that can serve them appropriately. Both inpatient and outpatient clinical settings are appropriate for assessing ancillary service system.

Database architecture and design would apply the OLTP that develops normal table designs with ease of updating, deleting, and creating data. It is relevant as most of the maintenance processes and events are normally noted, indicating time, the dates and general information about services and repairs of such facilities. Data would be broken to logical pieces that clearly provide appropriate information in a simple way, making it easy to understand and follow.

Appropriate components for e-health delivery system related to ancillary services include authorized health users and privacy and security component.

Patient Numbering Systems at Master and Enterprise Levels

Assessing the patient numberings system at master and enterprise levels would present relevant data for statistics and analysis to determine if there are growth and development for the hospital and its facilities. It captures data on demographics and the number of patients seen. It targets to eliminate double entry of data (Braunstein, 2013). For this case, it would be appropriate because the hospital is big and has several clinics; therefore, each patient would be given a unique number that is shared within the systems of the hospitals. It improves services offered to the customer, and sharing of information across the health facilities becomes easier. It is appropriate in the clinical setting of both inpatient and outpatient.

Database architecture and design would use normal tables easily designed to capture and enter data. It would allow for editing by deleting, uploading and creating data about patients. It would capture data from all the 30 clinics and the main hospitals and designed in a manner where an administrator can access the patient record and information by giving them a number.  The links would be clearly stated indicating the last facility visited among other relevant information about patients that enhance comfort and ease of administration.

Components appropriate for e-health delivery system related to patient numbering system at master and enterprise level include patient demographic information and registries integration project.

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