I need help rewriting the following to make it more succinct, precise and streamlined for

I need help rewriting the following to make it more succinct, precise and streamlined for better readability and flow. Sandra Bates HCM 415 Healthcare Strategic Management and Policy Final Project Dr. Donald Nowill February 22, 2025 The case focuses on Kaiser Permanente’s South Sacramento Medical Center, where Dr. Karen Murrell sought to redesign an emergency department ED (Souza et al., 2021). The ED had several substantial problems, such as a long patient length of stay, high patient bottlenecks, long patient waiting times and leaving without being seen (LWBS). The consequences of Long waiting times concerned Dr. Murrell. The average door-to-doctor time was 55 minutes, and the average LOS was 4.5 hours. At its worst, the LWBS rate was 12 %, which was way above the national goal of 1%. The issues arising from the department’s process included poor process flow and the incorporation of irrelevant activities in the workflow. For example, a medical screening exam requires 8 minutes per patient, which causes much delay if patient turnout exceeds the department’s capacity. Physicians were on long shifts, but they could not work to fill patients’ demands, which frustrated and dissatisfied the patients. The stress was compounded by the higher number of patients with no or inadequate insurance and the higher number of psychiatric patients who take longer to recover. The Department of Public Service 2016 saw significant improvements through the implementation of lean management principles (Souza et al., 2021). While challenges persisted, particularly in terms of capacity and maintaining high performance across the Kaiser Permanente system, the department was operating close to its optimum, attending to 2,500 – 2,600 patients per bed per year, exceeding the national ratio of 1,800. This success with lean management principles offers a promising solution for the healthcare industry, demonstrating that innovation can increase capacity without the need for additional physical infrastructure. Kaiser Permanente’s strategic aims, objectives, and core competencies reflect the mission, vision, and value statement of providing quality and affordable health care and enhancing the health of its members and society. These principles include innovation and integration in care delivery and focus on preventative care. The mission is to provide equal health care services and make them available in the appropriate period. It also propounds a vision aligned with the idea of changing the face of healthcare delivery through innovation and efficiency of processes where the organizational structures supporting the systems serve the current patient and stakeholder needs. Kaiser Permanente’s values of excellence, accountability, and patient-centered care are deeply ingrained in the organization’s operations. These principles guide the healthcare delivery system, providing a platform for continuous improvement, teamwork, safety, and efficiency. For instance, the application of lean management principles aligns with the organization’s value of minimizing waste and enhancing resource use (Souza et al., 2021). Similarly, the emphasis on disease prevention reflects the organization’s commitment to addressing health disparities and controlling rising health costs, reassuring stakeholders of the integrity of Kaiser Permanente’s operations. Keywords identified from Kaiser Permanente’s mission and vision statement are affordable, quality, and community health. Accessibility is made possible through pre-paid health plans that share risk and cost among their members, quality through integrated care delivery systems, and a focus on results-based outcomes. Kaiser Permanente’s mission, vision, and values were the driving force behind addressing the challenges in the South Sacramento ED. The no-wait ED initiative is a prime example of putting the mission into practice and providing timely and efficient care. Dr. Murrell and her team’s focus on patient satisfaction, facilitated by lean management, led to changes in the organization of work, process integration, and improved patient flow throughout the organization. This patient-centered approach underscores Kaiser Permanente’s commitment to meeting patient needs and enhancing their healthcare experience (Souza et al., 2021). Similarly, affordability and quality formed the basis of the mission to include an observation unit as a process in the ED. The unit enabled early intervention and admission of patients who could be discharged within 24 hours, thereby decreasing the number of beds occupied while others are admitted. Besides, patient satisfaction was enhanced through this approach, which translated to the organization’s commitment to efficiency and cost orientation. Restructuring the ED into low-intermediate, high-acuity zones helped to achieve the mission in that it ensured that all resources were utilized correctly. All patients’ needs were met as early as possible. The vision of innovation and integration of health care was well seen in the lean tools used in the department, including the value stream map and the team system (Souza et al., 2021). These approaches, which enhanced accountability and integration as embraced by the organization’s culture of teamwork and learning, are in line with the organization’s open-data philosophy applied to health care. This philosophy promotes transparency, performance measurement, and evaluation, allowing physicians to recognize other colleagues’ experiences and discover areas for upgrading. It brought improvement in efficiency and helped the organizational objective of reimagining healthcare. The values of excellence and patient-centered care were vital in responding to the capacity challenge. The focus signaled the ED’s modern approach to growth, avoiding unnecessary infrastructure development and emphasizing the efficiency of service delivery instead. Measures like the color-coded team assignment system and visual workplace enhanced flow and reduced errors, delivering quality patient care despite operating under capacity. These endeavors laid the foundation of the organization’s commitment to proper, fair healthcare delivery. Kaiser Permanente’s organizational mission is to offer affordable services and serve its members with high-quality health care. The vision is to advance the community’s health by integrating care and innovation (Souza et al., 2021). The foundation gives insight into a proactive, patient-centered planning technique that supports continuous improvement. Pricing and sustainability are at the heart of the organization’s drive to provide appropriate solutions to enhance health in ethnically diverse populations. For example, Kaiser Permanente’s implementation of lean management in the South Sacramento emergency department follows the organization’s strategic approach to enhancing the availability and quality of healthcare services (Souza et al., 2021). The organization sketched out the theme of operational excellence by promoting efficient processes with no slips. The development of value-stream maps, the redesign of patient circulation, and the use of team care are monuments of an integrated approach. Kaiser Permanente’s strategic vision also creates socially healthy communities, and its priorities are driven by caring for people at an early stage of disease development and vulnerable communities. Unlike other EDs that may turn away patients who do not have insurance or use Medicaid, the South Sacramento ED’s willingness shows pledges toward improving health disparities. The leading case concerns South Sacramento ED, which experiences growth in demand, increased demand, and decreased effectiveness without declining quality of care. After implementing lean practice in 2007, the ED’s capacity problem is still being struggled with (Souza et al., 2021). The hospital treats 2,500-2,600 patients per bed annually, which is way above the national industry average of 1,800. Many psychiatric patients are admitted often for longer times and need more intensive and lengthy treatment. Unlike alternative psychiatric facilities that were to contemplate state and federal funding reductions, hospitals such as South Sacramento started admitting long-term care for mentally ill patients. As such, it generates concurrency in the flow of the patients, leading to congestion, which is resource-intensive. Strategic planning is essential in identifying appropriate solutions for these increasing concerns. Conventional models cannot satisfy a business organization’s requirements for successful implementation in a dynamic business environment. Meeting the competing factors of capacity, patient satisfaction, and quality of care will be essential to maintaining the ED’s performance and achieving Kaiser Permanente’s strategic objectives. Strategic management and strategic planning issues include finding innovative ways to deal with flow without the benefit of extra space. Possible approaches include enriching observation unit capacities, telemedicine, or redesigning the flow, which should be considered to enhance capacity. Large patient volumes and extended stays in psychiatric facilities affect staff turnover. Workforce development, recruitment, and training should be part of strategic planning since they enhance workforce morale. Some of these pressures can be relieved by offering lean-focused training and adopting care models based on the teams (Souza et al., 2021). Concepts such as demand forecasting, performance measurements, and care delivery improvement must be supported by technology. The open-data systems applied in the ED that help visualize increased transparency and constant improvement can also be used in other fields. Strategic management is a central activity for healthcare managers, especially when managing issues concerning the South Sacramento ED. They are accountable for raising awareness of problems, developing action plans, and guaranteeing those solutions are conducive to the organization’s mission and vision. Dr. Karen Murrell’s leadership defines the healthcare manager’s role in the change process. She adopted lean principles and managed to spearhead the change in the department, showing she fully comprehends flow defects and patients’ requirements (Souza et al., 2021). By forming a multidisciplinary flow group and using value-stream mapping, she showed how outcome-focused and creative ideas must become the focus of strategic planning. Other roles of healthcare managers are to direct people, encourage them to share their ideas and opinions and promote a culture of change. Multiple stakeholders are involved in the strategic planning process at Kaiser Permanente. They include patients, physicians, and nurses. Patients are the healthcare system’s leading drivers, shaping providers’ strategies by their demands and experiences. Patient satisfaction ratings and wait time data inform decisions about providing and delivering high-quality care. Physicians, nurses, and support teams are crucial when it comes to the adoption process of strategic initiatives (Souza et al., 2021). They include engineers who, when designing, develop practical solutions to problems likely to be experienced during operation. It also makes the staff feel owned and responsible for the project’s success or failure. Key characteristics of the case study are based on Kaiser Permanente’s South Sacramento Medical Center, particularly the emergency department headed by Dr. Karen Murrell. The issues experienced in the ED in 2007 included long patient waiting times, long liaison waiting lists, high leaving without being seen percentage rate, work-inefficient processes, and increasing patient volume. The lean management concept changed the ED and improved the process to boost patient outcomes (Ziaei et al., 2023). Major patient flow restructuring measures included various activities such as redesigning patient traffic patterns, establishing an observation area, launching integrated care delivery models, and promoting an organizational customer service culture. These changes proved to improve important aspects of performance. However, the ED continues to struggle with capacity, and increasing pressures in terms of demand require a fresh look at strategic planning to maintain the new performance goals. Policies implemented at Kaiser Permanente directly respond to many of the issues experienced by the South Sacramento ED but may need further modification. The lean approach would focus more on process improvement and efficiency, and the organization’s approach would address issues such as long waiting times and patient flow (Ziaei et al., 2023). Measures that include the implementation of team-based care assignments and open-data systems could impact tangible ways and means specific to the organization’s mission, aims, and objectives centered on delivering quality healthcare solutions at an affordable rate. The goals guiding Kaiser Permanente South Sacramento ED relate to Kaiser Permanente’s mission of delivering quality care at a low cost. The lean management initiatives implemented by the ED address the improved management of the organization, particularly in terms of efficiency and patient satisfaction, which is the undertaking of Johns Hopkins Health Care (Ziaei et al., 2023). For instance, a 6.6 to 0.4 percent reduction in LWBS rates highlights time-sensitive and fair patient treatment. SWOT Analysis Strengths Lean has reduced patient waiting time and patient flow compared to the past. For instance, the median door-to-doctor time was cut from 55 minutes to 19 minutes, while the LOS for the low-acuity patients went down to 41-49 minutes (Ziaei et al., 2023). The organization’s dedication to enhanced performance creates conditions that make staff look for and correct problems. Weaknesses The occupancy at ED is close to optimum. 2,500 – 2,600 patients annually per bed against a national rate of 1,800. It confines its challenges to meet the increasing demands. Larger patient populations and extended configurations of psychiatric hospitalizations cause stress on staff and can lead to staff burnout and staff turnover. By identifying psychiatric cases, the ED admissions end up experiencing delays in the flow of patients. The lack of a better place to admit the less stable psychiatric patients complicates the overall flow of patients into the facility, creating bottlenecks. Opportunities The broader scope of data analysis and telemedicine may improve organizational processes and elevate the standard of required treatment. It means that engaging with other organizations and policymakers can help with the overall problems, such as the lack of available psychiatric care and the social determinants of the population. Virtual consultations or the functioning of decentralized care units are also standard, which established solutions to address capacity issues and expand outreach. Threats Sometimes, agency, state, or local reviews of new facilities or service expansions take a long time to complete, slowing the delivery of practical solutions. Lack of funds at the state and federal levels for healthcare services may compel the organization to reduce the amount of money that can be used in strategies. Organizational and process improvements will be crucial to guarantee patient safety, especially as other providers adopt strategies to lower care costs. Several factors affect care delivery in the South Sacramento ED and must be addressed. The regulatory environment impacts care delivery both as an opportunity and a challenge. For example, diminished state and federal funding has capped the number of specialized psychiatric facilities available, which puts the load on EDs. Solving this problem may require lobbying to obtain more funds or to simplify procedures for constructing other facilities. Virtual consultations for low-acuity patients decrease ED overcrowding, and analyzing large amounts of data may help anticipate demand and better resource distribution. Kaiser Permanente’s current policies regarding problems in South Sacramento ED include increasing efficiency and quality of care. The strategy for these policies is implementing lean management strategies that minimize and eradicate waste to improve the efficiency of the processes (Ziaei et al., 2023). These involve regrouping patients into low, medium, and high acuity areas and creating an observation unit for short stays. Also, the open-data philosophy supports staff transparency because the staff utilizes it to analyze performance and look for improvement spots. The above policies have enhanced leading performance indicators, like the median door-to-doctor time of 19 minutes and the LWBS rate of 0.4%. However, an increased admission of psychiatric patients and the department’s reach capacity raise questions about policies that address system factors such as mental health care and facilities. As much as Kaiser Permanente policies address many internal factors, the organization lacks the appropriate strategies to deal with external environmental factors. For instance, the policies have enhanced the ED’s processes and throughput but do not effectively address the more profound problem of limited beds in psychiatric units. The external factor raises the load on the ED because patients with psychiatric disorders need more time in the hospital, especially in a bed, and the care is complicated, which does not allow for bed turnover and is stressful for resources. Kaiser Permanente must institute new internal policies and develop new ones to address the challenges. Telemedicine should be used for the least severe patients, which means that after the initial consultation in case of COVID-19, a person can receive further consultation online, freeing up the ED space. The policy would increase capacity and make way for more complex cases. Some benefits include having a specialized South Sacramento facility unit dedicated to psychiatric care, which will ease the burden placed on the ED, thus offering more focused care to these patients. It aligns with the organization’s mission to provide equal and quality healthcare services. Strategies that help promote staff resourcing and avoid staff burnout are essential. These could be drafting lean training programs, providing wellness, and hiring more staff to handle many patients (Ziaei et al., 2023). Internally, the organization should employ policies that enhance working relationships with policymakers and the community. For example, establishing a specific advocacy group that will address issues of insufficient funding and regulatory requirements will improve the management of outside risks in a better way. Healthcare managers are key strategic planning actors. In the case of Kaiser Permanente, managers like Dr. Murrell note the challenges, come up with solutions and are on the frontline encouraging change management initiatives. Managers are the change champions and must disseminate information to help change policies and relate all the processes to organizational goals. For instance, the shift in healthcare services management spearheaded by Dr Murrell, which aligns with the lean concerns, underlines the significance of managerial direction in service operational changes (Ziaei et al., 2023). Policymakers and other related stakeholders are central to the strategic planning process for organizational changes. Within Kaiser Permanente, these stakeholders include patients, healthcare workers, leaders and managers, policymakers, the community, and healthcare organizations. Patients’ views help define the main development directions, especially regarding quality and care availability. These include quality-weighted prompt and timely completed surveys and average LWBS, which point to areas that need policy changes. Physicians, nurses, and other hospital employees can initiate and modify the policies. They offer first-hand information on operation realities and possible solutions that make policies work well. Managers and directors oversee the more detailed tactical implementation of the strategic plan to ensure that adopted policies are consistent with the organization’s mission and vision statements. Some of their responsibilities include resource management, performance standard definition, and organizational commitment. Most outside players apply their funding power in policy formulation, using legislation to express their opinions and advocacy to bring about change. Kaiser Permanente South Sacramento ED’s challenges include increased patient volume, limited bed space, and increasing demand for psychiatric services. Nonetheless, experiences in operation efficiency using lean management principles showed that the ED is still under pressure by capacity limitations and systemic weaknesses in psychiatric assets (Ziaei et al., 2023). Prior studies have also brought out theoretical and practical implications of these challenges on performance, strategic outcomes, strategic stakeholders, and the fit between strategic planning and established organizational mission and vision. Key implications arising from this study include the need for the healthcare manager to look for versatile and innovative interventions to enhance the capacity to meet challenges related to psychiatric patients. Some of these involve expanding telehealth to decrease ED traffic of minor patients who do not need to be there. It will also solve the congestion problem in the ED while enhancing the quality of psychiatric patients’ care. Collaborating with governmental and non-governmental bodies to raise funds for mental health services could expand the facilities. The inclusion of leadership, healthcare staff, and community partners increases diversity. Stakeholders should be encouraged to participate effectively through daily or weekly meetings. In the case of stakeholders, one should ensure that most of them are held accountable for the success of the chosen strategies or plans. Kaiser Permanente must incorporate innovations and community health aspects into all policy frameworks to accomplish proactive strategic planning. For instance, scaling up preventative care initiatives and data management can lower ED pressure while enhancing patient care. Also, a written guarantee of health equity partnerships and advocacy can strengthen the organization’s mission of addressing the needs of different populations. References Souza, D. L., Korzenowski, A. L., Alvarado, M. M., Sperafico, J. H., Ackermann, A. E. F., Mareth, T., & Scavarda, A. J. (2021). A systematic review on lean applications in emergency departments. Healthcare (Switzerland). MDPI AG. https://doi.org/10.3390/healthcare9060763 Ziaei, P. E., Salhab, D., Ahuja, R., & Hamzeh, F. (2023). Lean Health Check Framework. In Proceedings of the 31st Annual Conference of the International Group for Lean Construction (IGLC31) (pp. 1498-1509). International Group for Lean Construction. https://doi.org/10.24928/2023/0163

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