The Transitional Care Model (TCM) is an intervention aimed at the reduction of risk for negative health outcomes among older adults that move between and across health care settings (Hirshman, Shaid, McCauley, Pauly, & Naylor, 2015). Evidence-based health care management approach, which lies at the core of the model, allows nurses to focus on “identification of patients’ health goals, design and implementation of a streamlined plan of care, and continuity of care across settings and between providers throughout episodes of acute illness” (Hirshman et al., 2015, p. 3). Moreover, the TCM helps to promote patients’ satisfaction by maintaining a high level of communication and transmission of health care information among different units and clinicians participating in the transferring process.
The aim of this paper is to outline the key components of the implementation phase of the project. It will present a detailed description of the implementation process and provide a time frame of the project. Moreover, the paper will address the issue of evaluation of the implementation of the TCM with the help of transitional care components. The paper will also discuss statistical tools required.
In order to successfully implement the TCM, it is necessary to continuously measure how its core components are applied. Patient outcomes and resource use are other essential elements of the implementation process that have to be measured in order to ensure full operational potential and sustainability of the TCM (Toles et al., 2012). For measuring success of the implementation of the TCM, the following core components will be used: screening and staffing, relationships maintenance, engagement of patients and their family members; assessment and management of risks, education and promoting of self-management, collaboration, promotion of continuity, and coordination (Hirshman et al., 2015). Even though these elements of the transition process are defined separately, it is important to remember that in aggregate, they create a holistic care process. Rigorous evaluation of the implementation process with the help of the nine core components will help to substantially reduce rehospitalisation rates of older patients. Moreover, it is expected that assessment of the implementation of the TCM will reduce health care costs by eliminating costs of extra intervention (Hirshman et al., 2015).
In order to assess the adherence to the nine core components, standard tools for evaluation of cross-cutting metrics will be used. They will help to benchmark the adoption of core components of the model in a situation when not all elements can be applied due to a limited nature of resources such as EHRs. Moreover, benchmarking will help to ensure that adaptation of the core components does not reduce benefits of the TCM model. In order to evaluate cross-cutting metrics, it is necessary to conduct a set of analytical procedures such as ANOVAs, variance analyses, and regressions among others (Faltin, Kenett, & Ruggeri, 2012). To this end, Statistical Package for the Social Sciences (SPSS) will be used as a statistical software solution. It will help to efficiently manage and organize cross-cutting metrics as well as produce well-structured reports containing selected datasets and parameters. Graphical user interphase of the package will make it easier to navigate the process of analysis (Faltin et al., 2012).
In order to measure the success of the implementation of the TCM model “a stepped-wedge cluster randomized clinical trial design” (Muntinga et al., 2012, p. 8) will be used. The design is “a type of cluster randomized trial design involving sequential roll-out of an intervention to primary care practices (clusters) over a number of time periods” (Muntinga et al., 2012, p. 8). The intervention in the design is the TCM model practices will be compared with usual care practices in a control group. It will help to ensure full operational potential and sustainability of the model, thereby substantially improving the quality of life of older adults.
The implementation of the TCM model is dependent on the notion of self-regulation among nursing and clinician teams. Therefore, a research team will be responsible for the creation of theoretical and practical material for interventions. After the key routines and protocols predicated upon sound knowledge and professional experience have been developed, nursing and clinician teams will start implementing them without interventions from the research team. The key step in the implementation of the TCM is the education of health care professionals (Burke, Kripalani, Vasilevskis, & Schnipper, 2012). Therefore, members of nursing teams will participate in a customized training program. The program will include 2-day motivational interviewing courses and the Resident Assessment Instrument (RAI) workshop (Muntinga et al., 2012). Almost all budget needs associated with the implementation of the program stem from the necessity to cover education expenses. Patient visits will require additional costs.
Prior to the start of the implementation of the TCM, nurses will receive “a training on the job motivational interviewing session as well clinical education on geriatric topics provide by the expert team staff” (Muntinga et al., 2012, p. 7), which will help them to better understand complex care needs of older patients. It is an essential component of the model because the training program covers all challenges in elderly care, thereby allowing health care professionals to ensure patient safety and satisfaction. The topics of the training program will be tailored according to the information obtained from RAI reviews. Four months into the implementation of the TCM, all involved health care team members will participate in a refresher RAI workshop.
The success of the implementation process is predicated on the performance of three TCM elements: quality management, transfer of knowledge, the creation of care networks. Quality care management will be based on the following components: regular team meetings, education sessions and workshops, and multidisciplinary reviews of patients (Muntinga et al., 2012). It is essential that training and education sessions and workshops are held on a regular basis; therefore, they will be conducted every four months. This approach to education will help to create “a platform for peer supervision and encourage knowledge exchange between nurses” (Muntinga et al., 2012, p. 7). If the need arises, additional nurses’ educational needs will be met with the help individual coaching and support sessions. In the case of transferring a complex patient, a team of health care professionals will organize a multidisciplinary consultation during which an interdisciplinary review of a situation will be conducted. The team will consist of a practice nurse, a primary care physician, a pharmacist and members of a geriatric team (Burke et al., 2012). Other health care professionals will be invited to join the consultation team in extremely complex cases.
In order to effectively conduct transfer management, geriatric teams will “set up and maintain regional networks of local organizations” (Muntinga et al., 2012, p. 7). It will help to promote the coordination between different health care organizations in the region, health care providers, and community-based establishments. Members of these organizations will regularly meet and discuss the coordination of care of older adults during transfers.
Regular geriatric assessments conducted by practice nurses will help to establish health care needs of older patients and create tailored care plans. The assessments will be conducted with the help of two home visits. The first visit will involve the identification of care needs through the multidimensional assessment with RAI instruments (Burke et al., 2012). The information obtained via RAI assessment will allow nurses to standardize their care routines and will function as a basis for a reminder arrangement for follow-ups. The results of each assessment will be reviewed by primary care physicians for the creation of a customized care plan. During the second visit which will occur in two weeks after the first one, patients will be offered necessary information on treatment options and will be invited to participate in the decision-making process. It will help to place patients’ wishes at the center of a care plan in order to ensure a high level of their satisfaction. Table 1 presents the time frame of the project.
Time Frame of the Project
|Motivational interviewing courses
|The creation of local and regional networks
|A refresher RAI workshop
The development of the third phase of the project helped me to better understand steps that have to be taken in order to ensure that the TCM is installed properly. Moreover, the process expanded my knowledge of statistical tools.
Burke, R., Kripalani, S., Vasilevskis, E., & Schnipper, J. (2012). Moving beyond readmission penalties: Creating an ideal process to improve transitional care. Journal of Hospital Medicine, 8(2), 102-109.
Faltin, F., Kenett, R., & Ruggeri, F. (2012). Statistical methods in healthcare (1st ed.). Chichester, England: Wiley.
Hirshman, K., Shaid, E., McCauley, K., Pauly, M., & Naylor, M. (2015). Continuity of care: The Transitional Care Model. Online Journal of Issues in Nursing, 20(3), 1-12.
Muntinga, M., Hoogendijk, E., van Leeuwen, K., van Hout, H., Twisk, J., Horst, H.,…Jansen, A. (2012). Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition). BMC Geriatrics, 12(1), 2-10.
Toles, M., Barroso, J., Colón-Emeric, C., Corazzini, K., McConnell, E., & Anderson, R. (2012). Staff interaction strategies that optimize delivery of transitional care in a skilled nursing facility. Family & Community Health, 35(4), 334-344.
Elasticity, Own Price And Demand In Hotel Industry
This paper is based on the topic of elasticity. It explores the topic by looking at the concepts of own price and income elasticity of demand. The paper also evaluates how the understanding of these concepts may help me as the manager of a luxurious family owned hotel in Edinburgh. In addition, the paper uses the concept of elasticity to explain other related concepts such as market power, arbitrage, demand curve, and price discrimination.
The concept of elasticity measures how different economic variables relate to each other (Emmanuel, Slemrod & Giertz 2012). Examples of economic variables include price, supply, demand, quantity, and quality. For example, if the price of a certain commodity is lowered, elasticity looks at how many people would purchase that commodity. In an ideal situation, the lowering of the price would attract many people and as a result, the demand of that commodity would go up (Mulhearn & Vane 2012).
Own Price (Price Elasticity in Demand)
The concept of own price, also known as price elasticity in demand, is used to explain the relationship between the price of goods and services with their demand. In an ideal situation, when the price of goods and services goes down, the demand goes up (Fortlewis.edu: ECON 262: Demand elasticity n.d). The price of goods and services therefore determines their demand. Specifically, the concept of own price means the percentage change in the quantity demanded in response to a 1% change in the price (Griffiths & Wall 2011).
The calculation of own price is therefore done by dividing the percentage change in demand by the percentage change in price, while holding other factors constant. For example, if the price of a certain good or service increases by 30% and the demand decreases by 30%, then the own price of that good or service based on its initial price would be negative three (-3) (Griffiths & Wall 2011).
The reason for the negative is that there is an inverse relationship between demand and price (Griffiths & Wall 2011). The strength of own price is that it is capable of giving accurate measurements when the changes in price and quantity are below 20%. Its limitation is that when the changes in price and quantity are above 20%, the accuracy of own price decreases because the own price of goods is not always constant (Griffiths & Wall 2011).
Income Elasticity of Demand
Income elasticity of demand is a measure which explains the relationship between demand of goods and services with income (Griffiths & Wall 2011). In an ideal situation, the demand of goods and services goes up when income increases. Income elasticity of demand is calculated by dividing the percentage change in income by the percentage change in demand. For example, if the income in a certain community increases by 10% and the demand of a certain good or service increases by 10%, then the income elasticity of demand of that good or service would be one (10/10=1) (McAleese 2004).
In most cases, the relationship between income and demand of goods and services does not result to positive values. The reason is that goods and services are of different categories. The first category is known as inferior goods and services. This category comprises goods and services which are of low value and are mostly purchased when people have low income. However, when income goes up, the demand of such goods and services goes down because people opt for luxurious substitutes. Such goods and services therefore have a negative income of elasticity of demand as shown in the graph below
As shown in the graph above, when the income is high; the demand of inferior goods and services is low. The strength of income elasticity of demand is that it is capable of predicting the future demand of specific goods and services, which enables firms to invest wisely. Its limitation is that it does not give suggestions for stabilising the income of people in various income brackets (McAleese 2004).
The second category is known as normal goods and services. This category comprises goods and services which have a positive income elasticity of demand. It means that an increase in income is accompanied by an increase in demand of normal goods and services (McAleese 2004). This category also has necessity and superior goods. Necessity goods are those whose income of elasticity of demand is less than one, while superior goods are those whose income of elasticity of demand is greater than one (Emmanuel, Slemrod & Giertz 2012).The graph for normal goods and services is as shown below
The third category is that of sticky goods or services. These are goods and services whose demand is not affected by the changes in income and as a result, their income elasticity of demand is usually zero (Armstrong & Kotler 2009).
The concepts of own price and income elasticity of demand may be useful to me as the manager of a family owned hotel in Edinburgh. The reason is that it would enable me to set fixed prices for the services of the hotel. If as the manager I would vary the prices of the services due to changes in the business environment, that variation would scare away customers (Ferrell & Hartline 2010).
The understanding of the concept of income elasticity of demand would compel me as the manager to conduct a research and establish the income bracket of the regular customers. As a result, I would be in a position to come up with marketing strategies which appeal to customers of that specific income bracket.
Market power, also known as monopoly, refers to a situation in which a particular market is dominated by a single firm. The firm with monopoly usually dictates the price of goods and services by manipulating their supply. In many cases, monopolies are associated with exploitation of consumers due to lack of alternatives for the consumers. However, monopolies may not always exploit the consumers because governments may intervene and compel them to reduce the prices of goods and services (McEachern 2011).
The pricing strategy in a monopoly is not depended on business rivals. The firm which dominates the market sets the price indiscriminately, and is usually at liberty to charge different prices for the same good or service to different customers, depending on their ability and willingness to pay (McEachern 2011).
In an industry with a monopolistic structure, other small businesses are referred to as price takers. The reason is that they are not able to influence the price of goods and services because of the dominant player. As a result, they set their prices depending on the price set by the dominant player in the market. Those who deviate from the price set by the dominant player are forced to quit their businesses (Charyulu 2011).
Many monopolies are characterised by barriers to entry (Blythe 2006). Such barriers include things like pricing, marketing, and branding. It therefore means for new entrants to enter a monopolistic industry, they must have huge capital. They also need to invest immensely in marketing their businesses so as to gain a portion of the customers. The reason is that the firms which enjoy monopoly usually invest immensely in branding, which makes it difficult for new entrants to get customers for their goods and services (McEachern 2011).
This term is used to refer to a type of trade which thrives on price differences in two markets. It is also a type of trade which is not prone to the usual business risks, meaning that the traders only incur the transaction costs. The trade depends on market research on the fluctuation of prices in certain markets. Arbitrage is common in the trade of stocks, bonds, securities, and currencies.
The reason is that the price of these items of trade is usually determined in advance and therefore, the arbitrageurs are guaranteed of a certain amount of profit. For example, if the price of a certain currency like the United States (US) dollar falls in a certain market, the arbitrageurs buy it in huge quantities and sell it in other markets where the price and demand are high. As a result, they are able to make huge profits within a short time (Vashisht 2005).
Even though arbitrage is a good business, it has its challenges. One of the major challenges is that it is not sustainable because it depends on the fluctuation of prices in different markets. Since it is not always guaranteed that the prices would vary, the arbitrageurs stay out of business until such a time when an opportunity presents itself. In other words, the arbitrageurs do not have control of the factors which shape their business.The other major challenge is that the business requires huge capital. As a result, few people are able to venture into it and that is why it is mostly done by financial institutions such as banks.
The economies of many countries are influenced by the elasticity of supply and demand. Supply comprises the producers and suppliers of goods and services while demand comprises the consumers of the goods and services. In general economic principles, when the supply of goods and services is high, the demand is usually low. The concept of price shapes the relationship between supply and demand. The reason is that the price of goods and services is usually low when the supply is high. However, the price goes up when the supply is low. On the other hand, the price of goods and services is usually high when the demand is high and the supply is low (Blythe 2006).
In a competitive market, demand curve is a strategy used to determine the price of goods and services depending on their quantity. In an ideal situation, the price of a certain good or service fluctuates depending on the quantity supplied. If the quantity is low, the price goes up (Fortlewis.edu: ECON 262: Demand elasticity n.d). According to Sparknotes LLC, the demand curve is used to monitor the variation of price and quantity with the aim of establishing an economic equilibrium, where the quantity demanded by consumers at a certain price is equal to the quantity supplied or produced (Sparknotes LLC: Demand 2015).
The demand curve is drawn by plotting price against quantity, with price at the vertical axis and quantity at the horizontal axis (Emmanuel, Slemrod & Giertz 2012). One characteristic of the demand curve is that it usually slopes from left to right (Economics concepts.com: Law of Demand 2015). The shape of the curve is attributed to the fact that when the price of commodities falls, the demand increases (Emmanuel, Slemrod & Giertz 2012).
It is a pricing strategy in which similar goods or services belonging to the same company are sold at different prices in different regions. It may also refer to the selling of similar goods or services to different buyers at different prices. Price discrimination is attributed to various reasons (Mortimer 2007). For instance, when there are many customers of a particular good or service in a certain market, the price of that good or service goes up.
On the other hand, if the demand of a certain good or service is low, the price goes down because there are few people willing to buy that good or service. However, in many cases, price discrimination is based on the ability of customers to pay for goods and services at certain prices. It is also based on mutual agreement between buyers and sellers. In some cases, sellers may lower the price for customers who purchase goods and services in bulk.
The concept of own price explains the relationship between the price of goods and services with their demand. It measures how the demand of goods and services responds to a 1% change in the price. Its strength is that it is capable of giving accurate measurements when the changes in price and demand are below 20%. However, its capability to give accurate measurements decreases when the changes in price and demand are above 20%.
The concept of income elasticity of demand explains the relationship between demand of goods and services with income. It is obtained by dividing the percentage change in income by the percentage change in demand. Its strength is that it is capable of predicting the future demand of specific goods and services. Its weakness is that it does not give suggestions for stabilising the income of people in various income brackets.
The concepts of own price and income elasticity of demand are useful to managers of big firms. The reason is that they enable the managers to make wise investment decisions and increase competitiveness. As the manager of a family owned hotel in Edinburgh, I would use these concepts to increase the competitiveness of the hotel and boost its profits. For instance, I would use the concept of own price to set fixed prices for the services of the hotel. I would also conduct a research to establish the income bracket of the regular customers of the hotel and come up with marketing strategies which target the customers in that income bracket. As a result, the hotel would realise growth and stability.
Armstrong, G & Kotler, P 2009, Marketing: An introduction, Pearson Education Company, Prentice Hall.
Blythe, J 2006, Principles & practice of marketing, Cengage Learning, Farmington.
Charyulu, K 2011, Rural marketing, Pearson Education, Pearson, GA.
Economics concepts.com: Law of Demand 2015, Web.
Emmanuel, S, Slemrod, J & Giertz, S.H 2012. ‘The elasticity of taxable income with respect to marginal tax rates: a critical review’, Journal of Economic Literature, vol. 50, no.1, pp. 3-50.
Ferrell, O.C & Hartline, M 2010, Marketing strategy, Cengage Learning, Farmington.
Griffiths, A & Wall, S 2011, Economics for business & management, Pearson Education, Prentice Hall.
McAleese, D 2004, Economics for business: competition, macro – stability and globalisation, Pearson Education, Prentice Hall.
McEachern, W.A 2011, Economics: A contemporary introduction, Cengage Learning, Farmington.
Mortimer, J.H 2007, ‘Price discrimination, copyright law, and technological innovation: evidence from the introduction of DVDS’, The Quarterly Journal of Economics, vol. 122, no.3, pp. 1307-1350.
Mulhearn, C & Vane, H 2012, Economics for business, Palgrave MacMillan, Great Yarmouth.
Sparknotes LLC: Demand 2015, Web.
Vashisht, K 2005, A practical approach to marketing management, Atlantic Publishers & Dist, New Delhi.
Brain Malpractice Verdict For Brain Surgery
Issue of Integrity
The news clip chosen for this response is linked to a $20 million negligence verdict against Arkansas Children’s Hospital for the surgery performed on the wrong side of the brain of a 15-year old boy. As a result of the surgery, the boy was left severely brain-damaged. The case directly relates to the issue of integrity, which is a personal quality associated with demonstrating moral and ethical principles at work. The surgeon lacked professional integrity and attention to verify the exact location on which the brain surgery should have been performed. Moreover, the Arkansas Children’s Hospital lacked the integrity to pay attention to the actions of their employees and monitor their operations.
With regard to legal actions, the surgeon can be sued for negligence since he had a duty of care before the patient. Medical negligence can be proven if the defendant had the duty of care, which was breached. For determining whether the surgeon showed negligence when performing the surgery, it is necessary to conduct a three-stage test and satisfy the following three components:
- A person had a duty of care over another.
- A duty breach was established.
- Legally recognized harm was caused as a direct result of the breach (Bryden & Storey, 2011).
Explanation and Discussion
The story was chosen for discussion because it showed that negligence and lack of integrity of a healthcare professional could cause serious harm to a patient. In the current clinical setting, integrity is displayed through exhibiting reliability and answering to patients who depend on health care professionals. This means taking responsibility for any errors, correcting them, and, if necessary, apologizing to patients (Levinson, Ginsburg, Hafferty, & Lucey, 2014).
Bryden, D., & Storey, I. (2011). Duty of care and medical negligence. Continuing Education in Anaesthesia, Critical Care & Pain, 11(4), 124-127.
Levinson, W., Ginsburg, S., Hafferty, F., & Lucey, C. (2014). Understanding medical professionalism. New York, NY: McGraw-Hill.