Overview Brent Zeller, Chief Administrated Officer and Rudyard

Overview             Hampton Community Hospital, centrally located in the Village of Southampton New York, is a 130-bed hospital accredited bythe Joint Commission. A location of Stony Brook General Medicine, HamptonCommunity Hospital is a New York State-designated Stroke Center and the home ofthe first Level III Trauma Center on the East End of Long Island. The hospitaladmits more than 7,000 patients annually and has about 30,000 emergency room visitseach year and about 50% during the summer season. The Hospital’smultidisciplinary approach to healthcare provides access to a wide variety ofmedical specialties for a full range of clinical services. The Hospitalofficially became part of the Stony Brook General Medicine healthcare system onJuly 12, 2017. Mr.

Brent Zeller, Chief Administrated Officer and Rudyard So, Chair,Board of Directors are proposing to build Emergency Care Center to be locatedat East Hampton for the reason in improving efficiency and preserving accessfor emergency care. Hampton Community Hospital is 24 miles from East Hamptontown and 37 miles from Montauk town, opening a freestanding emergency caredepartment will provide emergency service in these areas. This will be a conveniencefor the residences and visitors to get emergency care service, may serve as theclosest point of health care contact for many.

This freestanding emergency caredepartment will serve as the most immediately accessible source of primary carefor the east end of long island and will staffed by a mix of well providerstrained in both emergency medicine and primary care from both Hampton CommunityHospital and Stony Brook General Medicine Healthcare System. This freestanding emergencycare will provide 24/7 access to an emergency physician, emergency nurse,laboratory and radiology technicians, moderate-complexity blood testing andadvanced imaging and can provides care for most emergent illness, includingheart attack, stroke, and minor trauma.Identification ofIssues / Analysis / Evaluation             Choosing aright location for a freestanding emergency department requires a very thoroughanalysis from day one. The factor that need take into consideration based onthe T-System Inc. are the following: (a) the area population, that’s includesthe forecasted growth projection, residential density, demographics, locallabor market, and payer mix (b) competitor locations (c) industry dynamics that’sincludes physician network and alignment (d) ease of access and visibility fromthe road (e) safety in the surrounding area (f) drive times for patients andthe proximity to suppliers and local hospitals (g) zoning regulations (h) taxesboth income and sales taxes (i) traffic condition (j) cost of the location (k)regulation for the state. The most important element of the overall businessplan is having a solid financial plan. A smart plan must take intoconsideration all costs related to the building of freestanding emergency carecenter, how the revenue will be generated and used and also includes thecontingency for unplanned or unexpected expenses.             Freestandingemergency departments is the solution to gain new market share, will increaseand enhance brand awareness and will provide a quality care to the communitiesin the East Hampton and the surrounding communities.

According to the AmericanHospital Association, there were 241 freestanding emergency care department in2009, a 65 increase since 2004. Building the freestanding emergency caredepartment can be the bridge the gap between an acute-care hospital and a traditionaloutpatient clinic, if it is planned and operated properly, this can be afinancially attractive stand-alone business entity.             A freestandingemergency care department is unattached to a hospital, open 24/7, equipped withall advance medical scanner such as CT scan, x-ray, ultrasound, and a standinglaboratory. This will be staffed at all times with certified emergency physician,nurses, and technicians. The reason in building a freestanding emergency care departmentis to improve the practice environment, physician autonomy and control,decrease in the overcrowding, improved the quality of care and improved patientexperience, allowing a better access to care, satisfaction both patients andstaff (Higgins, 2016). It becomes more challenging for all hospital to survivein the current healthcare environment, particularly regarding financialmatters. It is tough to find the money to fund care quality initiatives andother improvements while staying afloat (White, 2016).

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One of the challenges isfinding the alternative sources of funding for capital. Adapting to marketforces, the merging of the Hampton Community Hospital with Stony Brook GeneralMedicine Healthcare System is significant part of the healthcare landscape. Joiningforces will help two institutions in building the freestanding emergency caredepartment under the same corporate umbrella. A freestanding emergency caredepartment is more than just a healthcare delivery setting, it is a business.According to T-system Inc.

freestanding emergency care department are owned andoperated by hospital affiliates accustomed to navigating this complex businessenvironment, some are developed by independent business owners. From the businessperspective, building freestanding emergency care department poses many challengesthat someone with a healthcare background may not be equipped to solve alone,including site selection, construction project management, resource management,vendor contracting, and financial planning. This is the reason that you need a qualifiedand knowledgeable people to help you in building this project.Recommendation and Action Plan             Financialfeasibility study is very important in building the proposed freestandingemergency care department, this is to determine if the project will be viablefor the Hampton Community Hospital and the Stony Brook General MedicineHealthcare System. Finding the best answer will depend on commissioning the appropriateproject.

Financial feasibility study should play as a business plan and providea clarity and purpose. Institution need to assess their market opportunities, developprudent business plans and monitor execution. Financial feasibility study inthe building block for the entire process. You need a financial advisor to beinvolved in the early stages of planning. According to article posted atLancaster Pollard (De Jong & Wilson, 2014) the following five bestpractices for the institution business to pursue with regards to financialfeasibility study: (a) Conduct a debt capacity study, this analysis willpinpoint financial benchmarks necessary for the institutional success. (b)Identify key service lines, service line goals are critical because adding or subtracting,the result will be organizational change.

Recognizing this in early stage infinancial feasibility process and make necessary accommodation in the change ofmanagement process. (c) Establish a coordinated time line, the institutionshould have its financial feasibility advisors, project manager and lender tohelp outline the time frame and deadline dates for the different stages in theproject. Set a realistic expectation for the for the construction timeline too,and adjust the timeline according as the need arise. (d) Build realisticrevenue projection, the success of this project depends with the carefulexamination of the demographics and the utilization of the information thatwill support the financial feasibility study’s revenue projection. (e)Recognizing staff as a key expense, successful institution understands staffingbenchmarks and have adjusted them appropriately for project and operationalimpact.             A suggestionmade by Henry Higgins, MD on his article published in Emergency PhysicianMonthly, a step by step guide in setting up freestanding emergency caredepartment: (a) you have to choose the site and the development team and methodcarefully.

Either use the investor/lease approach, in which you can solicitinvestors with existing capital and you can also raise money through fundraisingand donation, look for additional financial support like grants. (b) Develop abusiness plan by underestimate the income and overestimate the cost, meaningyou have to prepare for the worst and hope for the best. You have to do researchand develop a comprehensive business plan that outlines how your freestandingemergency care department will market the availability of new services in thecommunity. (c) You have to create your marketing strategies. (d) As yourproject develops, you need help and assistance, hiring a professional team isone of the first thing you have to considered such as project manager andconsultant. (e) Make your plans known to officials in the community, you haveto put your face on your project. (f) Set up your legal entities, obtainlicensures, and get insurance. This guideline will be able to ensure a highquality of care and a good environment to your freestanding emergency caredepartment, not to mention the financial reward that you can get in running asuccessful business.

            The mostsignificant element of the overall business plan is a solid financial plan. Obtainingmultiple bids for all work orders to ensure competitive pricing. You need toinvestigate each reviews and request on the process of planning, investigate industrystandards to forecast revenue with such accuracy as possible.

You have tosecure all funding needed for your project and re-evaluate the budget to ensurethere is no changes. It is very important to evaluate your financial viabilityand one of the key to setting up a successful freestanding emergency caredepartment is designing its service to match with the patient needs andnumbers. Financial planning and creating budget are developed within theframework of the institutional strategic plan and this is very important andnecessary to the organizational goal that the management need to attain inbuilding the best freestanding emergency care department that will help the eastend of long island communities which is the main institutional objective of theHampton Community Hospital. Overall Documentation and Effectiveness                                      There is noimprovement program can be succeeded without a good leadership. One must play anactive leadership role in the program throughout its project duration ofbuilding the freestanding emergency care department.

Furthermore, every leadershould include an analysis and review of the progress against the program’s objective(Carrus, et al., 2010). Planning and budgeting are the most important part inthis project, this will allow the institution to plan for and set expectationfor the future, asses current and future financial performance, and ensure thatthe operations are carried out in a manner that is consistent with institutionalexpectations. To have a solid financial plan is the most valuable element tothe overall planning in building the freestanding emergency care department. Asmart plan also takes into the consideration of all the cost related to thebusiness, and how this revenue will have generated and used, that’s includes acontingency for unexpected expenses in the project.

Hampton Community Hospitaland its affiliate will achieve a great remarkable success by creating andactively managing detailed plans for site selection, building and construction,resource management, vendor contracting and finances.             Freestandingemergency care department is a good investment in healthcare system and a guaranteedfuture return of investment. This is a viable and growing business in the wholecountry that will provide emergent and urgent service that are distant from thehospital based emergency department. This will address both issues of accessand social determinants of health to improve the community population health. Buildingon expanded role of emergency department in health care delivery, and emergencymedicine movement towards embracing population health based on the partnershipof emergency medicine and primary care according to Greenwood-Ericksen, et al.,2017 a journal article published in American College of Emergency Medicine.