NHS FPX 6004 Assessment 2 Policy Proposal
Student name
Capella University
MHA-6004
Professor Name
Submission Date
Policy Proposal
Healthcare organizations must develop successful policies to address the performance deficiencies and deliver compliance with regulatory standards in all clinical services. The policy develops protocols of evidence-based heart failure discharge planning designed to decrease Southeast Health Medical Center’s discharge readmission rate of 21.56% to 19.7 or less during the following twelve months (Centers for Medicare & Medicaid Services, 2023). The suggested interventions will include the use of structured discharge checklists, pharmacist-led medication reconciliation, educating patients using teach-back, following up with patients after discharge through telephone follow-ups, and educating patients about regulatory adherence after the intervention. Evidence-based protocols with implementation allow healthcare facilities to enable benchmark compliance as well as improve patient safety and organizational performance outcomes.
Need for Policy and Practice Guidelines
To enhance the success of a good patient outcome in clinical operations, the concerned healthcare organizations need to have good policy frameworks to avoid performance gaps, which risk regulatory compliance in clinical operations. The current heart failure 30-day readmission rate of Southeast Health Medical Center is 21.56, which is higher than the national readmission rate of 19.7 per cent and the expected readmission rate of 20.35 per cent that should be anticipated in the facility (Centers for Medicare & Medicaid Services, 2023). The readmission rate in the hospital is 1.0597, which is an inappropriately high rate, i.e., the performance result of the hospital is lower than the performance result of a well-operating hospital would be expected to be. This poor performance is a direct violation of the requirements of the Hospital Readmissions Reduction Program in pursuance of Section 1886(q) of the Social Security Act, which says that immediate corrective action must be taken. The policy development (based on the evidence) will provide an organizational structure, which will be a necessity to transform underperformance into long-term clinical excellence and compliance with regulations.
The implications of low performance at the current benchmark have far-reaching implications on many aspects that form concurrent benchmarks of patient care and efficiency of operations within an organization. Any preventable cases of readmission subject the patient to the increased possibility of acquiring hospital-acquired infection, medication errors, failing functioning, and mental distress the patient experiences due to readmission (Bichescu and Hilafu, 2023). This extraneous 11-13 excess readmission per year wastes resources of the organization that are primarily in nature, such as beds in inpatient facilities, capacity of the emergency department, hours of the nursing staff, as well as clinical support services. Additionally, the rate of readmission is suggestive of the system-wide inefficiency of the discharge planning, coordination of the care process, patient education, and transitional care processes that should be performed by 42 CFR 482.43 (Centers for Medicare & Medicaid Services, 2020). Due to the poorly working discharge procedure, the following inefficiencies in the operations of the discussed organization appeared: the working process was not organized properly, the staff were irritated, and the organization was negatively influenced in terms of providing high-quality care.
Failure to have proper corrective policies will be translated into high financial punishment, reputation, and any other harming the patient, which will jeopardize the sustainability of the organizations. The possible fines of the hospital readmissions reduction program (HRRP) that could be applied to the Southeast Health Medical Center are up to 3 percent of all Medicare reimbursement to the facility, of which, in turn, is estimated to compose an annual loss of revenue of 103,000 dollars (Kaiser Family Foundation, 2022). As long as the non-examined systematic deficiencies in the discharge planning are not mitigated through systematic documented efforts, there is a risk of the organization being sentenced to regulatory fines, including the possible loss of Medicare certification (Centers for Medicare & Medicaid Services, 2020). The stakeholders need to understand that implementation of the policy does not just bring about a compliance agenda, but is actually a strategic imperative to survive as an organization and work towards its mission.
Proposed Organizational Policy and Practice Guidelines
Empowerment of evidence-based interventions and the regulatory requirements should be combined in practical healthcare policies to achieve quantifiable changes in clinical outcomes and organizational performance. The policy requires full protocols of heart failure discharge planning, which should include standardized discharge checklists that the patients have been signed off on by the pharmacists, follow-ups with the patient within seven days of discharge, patient education by the nurse through the teach-back methodology, and follow-ups with the patient within seven days of discharge. It is an implementation in line with requirements of the HRRP (Section 1886(q) of the Social Security Act) and CMS discharge planning regulations (42 CFR §482.43) that have patient-centered care transition requirements (Shenoy et al., 2022). Implementation of policies can be carried out in a strategic manner to ensure compliance with regulations and also ensure that it promotes the organizational mission, which is to provide safe, high-quality, patient-centered care in any clinical setting.
Environmental Factors: Regulatory Considerations
The success of the policy implementation is considerably affected by the environmental conditions, imposing restrictions and demands that determine the feasibility of the proposed practice recommendations. They need to have secure systems of communication about post-discharge telephone calls and electronic health information exchange (Wei et al., 2022). In order to preserve the accreditation, the Joint Commission standards provide that documentation of the patient education, medication reconciliation, and discharge directions should be documented in the medical record (The Joint Commission, 2023). The scope of practice of the registered nurses provided in state nursing practice acts enables the registered nurses to provide the teach-back education and telephone follow-up assessment that needs protocol development within the legal limits. When building a relationship of referral with a post-acute care provider and making follow-up appointments, the United States anti-kickback laws and the provisions related to the relationship of referral in the Stark Law should also be considered.
Accessibility of resources in respect of staffing, financial muscle, and logistical infrastructure is the key to the extent and sustainability of the proposed practice guidelines implementation. To effectively implement it, it will require specific roles of heart failure nurse navigator (1.0 FTE), additional hours of a pharmacist in the case of medication reconciliation (0.5 FTE), and added staffing to the care management department, namely when it comes to having a phone follow-up (0.5 FTE), which will cost the hospital around 180,000 a year in human resources (Mack, 2024). Initial capital expenditures of around 75000-100,000 are needed to finance financial investments in remote patient monitoring equipment, changes to the electronic health record system, and patient education materials (Calduch et al., 2021). Logistics will be involved in establishing schedules to ensure that there is some availability of appointments in a span of seven days, transportation of patients with physical limitations to appointments, and provision of multilingual education resources to different groups of patients.
Cause-and-Effect Relationships of Environmental Factors
The environmental factors give a direct cause-and-effect relationship, which can either result in the successful realization of evidence-based practice guidelines in healthcare settings. It will lead to the lack of the proper staffing ratios, hence, the lack of the relevant discharge education and medication reconciliation, which in turn, will result in the patient’s bafflement, as well as in non-regulation of medicine and patient readmissions (Moges et al., 2022). Unless enabled to use electronic health record functionality, inconsistent protocol utilization and lack of coordination in care will occur, due to failure to provide automated notification on high-risk patients and provide standardized documentation templates. The seven-day gap in the outpatient cardiology follow-up in this case necessitates scheduling delays to exceed evidence-based time intervals, and it is impossible to keep the protective effect of an early follow-up (Bilicki and Reeves, 2024). The detection of these causal pathways will enable the resources in a strategic way, minimize the barriers to the maximum effectiveness of the policy, and offer a fair implementation process.
Ethical, Evidence-Based Practice Guidelines and Stakeholder Impact
In the intervention, evidence-based interventions should be justified using ethical considerations in order to minimise the reported gaps in performances in order to make the implementation of such interventions fair and effective across different populations. The systematic reviews indicate that structured discharge planning that integrates drug reconciliation, patient education, and early follow-up can reduce heart failure readmission by 16.6 to 50%, respectively, depending on the intensity of the interventions (Tran et al., 2025). A set of culturally modified instructional materials in different languages, consideration of the level of health literacy, assessment of social determinants of health, such as transportation and housing stability, and attention to patient autonomy are all that is needed to make an ethical decision considering the discharge planning decision-making (Browder et al., 2023). The proposed guidelines directly impact the nursing staff, with an increase in the patient education roles, pharmacists, as they are obliged to balance more of the medication reconciliation roles, physicians, as they are obliged to increase the discharge documentation requirements, and the case managers, as they are obliged to increase the follow-up coordination efforts.
Stakeholder Engagement in Policy Development and Implementation
Effective policy implementation involves the effective engagement of different stakeholders whose experience, opinion, and firsthand knowledge are what support the development of guidelines and ensure that sustainable change is realized in the organization. Critical information on the problems of workflow integration and patient education barriers on the basis of direct care delivery experience that would keep protocols clinically viable could be provided by nurses. Pharmacists identify readmission risks associated with medications and come up with effective reconciliation systems that will maximize patient safety and minimize the duplication of documentation (Tran et al., 2025). Expert information on the community resources, insurance approvals, and social determinants of successful transitions to outpatient care can be provided by the case managers and social workers (Browder et al., 2023). The data analytics skills needed to define meaningful metrics and monitor improvement, and find barriers to implementation that ought to be addressed using adaptive solutions are provided by the personnel of the quality department.
Conclusion
Among the strategic needs that the Southeast Health Medical Center will be forced to adapt to in order to reduce underperformance in terms of heart failure readmission, and ensure compliance with the regulations. The suggested evidence-based practice guidelines that include the use of structured discharge planning, medication reconciliation, patient education, and early follow-up provide evidence-based measures of the reduction of readmissions that account 21.56% to the national average of 19.7. Meaningful stakeholder engagement, proper allocation of resources, consideration of regulatory challenges, and ethical and culturally sensitive care delivery should also be coupled with any successful implementation. These evidence-based practices are likely to enable the organization to not only evade the HRRP penalties but also to achieve better patient outcomes, a better quality of care, and a stronger competitive position in the value-based markets of healthcare.
References
Bichescu, B. C., & Hilafu, H. (2023). Effects of hospital-acquired conditions on readmission risk: The mediating role of length of stay. Manufacturing & Service Operations Management, 25(4), 1603–1621. https://doi.org/10.1287/msom.2022.0088
Bilicki, D. J., & Reeves, M. J. (2024). Outpatient follow-up visits to reduce 30-day all-cause readmissions for heart failure, COPD, myocardial infarction, and stroke: A systematic review and meta-analysis. Preventing Chronic Disease, 21, e240138. https://doi.org/10.5888/pcd21.240138
Browder, S. E., Kontos, M. C., & Cené, C. W. (2023). Preventing heart failure readmission in patients with low socioeconomic position. Current Cardiology Reports, 25(11), 1535-1542. https://doi.org/10.1007/s11886-023-01960-0
Calduch, E., Muscat, N., Krishnamurthy, R. S., & Ortiz, D. (2021). Technological progress in electronic health record system optimization: Systematic review of systematic literature reviews. International Journal of Medical Informatics, 152(1), e104507. https://doi.org/10.1016/j.ijmedinf.2021.104507
Centers for Medicare & Medicaid Services. (2020). Medicare and Medicaid programs; Revisions to requirements for discharge planning for hospitals, critical access hospitals, and home health agencies. Federal Register, 84(189), 51836-51884. https://www.federalregister.gov/documents/2019/09/30/2019-20732/medicare-and-medicaid-programs-revisions-to-requirements-for-discharge-planning-for-hospitals
Centers for Medicare & Medicaid Services. (2023). Hospital readmissions reduction program data (July 2020–June 2023). https://data.cms.gov/provider-data/dataset/9n3s-kdb3
Kaiser Family Foundation. (2022). Hospital readmissions reduction program (HRRP). https://www.kff.org/medicare/issue-brief/hospital-readmissions-reduction-program-hrrp/
Mack, K. (2024). Financial reimbursement of a pharmacist-led chronic care management program utilizing pharmacist extenders within a privately owned family medicine clinic. American Journal of Health-System Pharmacy. https://doi.org/10.1093/ajhp/zxae383
Moges, T. A., Akalu, T. Y., & Sema, F. D. (2022). Unintended medication discrepancies and associated factors upon patient admission to the internal medicine wards: Identified through medication reconciliation. BioMed Central Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08628-5
Shenoy, A., Shenoy, G. N., & Shenoy, G. G. (2022). The US hospital-acquired condition reduction program: A linear and logistic regression analysis of domains and penalty status. International Journal of Healthcare Management, 1–9. https://doi.org/10.1080/20479700.2022.2065619
The Joint Commission. (2023). Hospital: 2023 national patient safety goals. https://www.jointcommission.org/standards/national-patient-safety-goals/hospital-national-patient-safety-goals/
Tran, L., Rahme, C., Linnertz, S., & McCall, K. (2025). Impact of implementing a pharmacy-driven intervention bundle on hospital readmission rates for patients with heart failure. Journal of Pharmacy Practice, 38(1), 103-110. https://doi.org/10.1177/10600280251363594
Wei, W., Felippi, R., Abbasi, G., Pinn, T., Rose, K. St., & Rana, I. (2022). The impact of electronic health record interventions on patient access to post-hospital discharge prescriptions. Hospital Pharmacy, e211306. https://doi.org/10.1177/00185787221130689
FAQs
What is the purpose of a policy proposal in healthcare?
A policy proposal is designed to solve a problem in the health care industry by utilizing research methods to solve that particular problem. The policy proposals focus on better health outcomes, efficiency, and making decisions.
Q2: What key components should be included in a policy proposal?
The fundamental components of a policy proposal include problem description, background information, problem solution, evidence, strategy for implementation, and results. These factors ensure that the proposal is concise and efficient.
Q3: Why is evidence-based research important in a policy proposal?
Evidence-based research is necessary for a policy proposal since it adds credibility to the recommendation made due to the presence of valid evidence.
Q4: How does a policy proposal impact healthcare practice?
In many ways, a policy proposal affects health care practice in areas like formulating new health care policies, refining current processes, and solving problems within health care delivery.