Week 3 Touchpoint Reflection: Financial and Budgeting Principle

Guidelines for Touchpoint Reflections

A downloadable version of the guidelines, which includes further information, is available for access in the week 1 discussion thread.

Reflection Information

EXPERIENCE

This week’s readings contained a great deal of information on financial and budgeting principles. Some of you may have had some familiarity with the concepts and maybe even experience in working with them. However, there is always something new to learn. Describe your prior experiences with financial and budgeting principles, whether personally or professionally. Include your current involvement in budgeting at your institution.

REFLECTION

What pre-conceived notions related to healthcare financial and budgeting principles did you hold before this week that you understand better now or for which you have a different perspective? Reflect on at least two specific concepts.  How have these new revelations influenced your thinking related to access, availability, and quality of healthcare?

IMPLICATIONS FOR THE FUTURE

• How has your enhanced knowing affected the way you view your proposed project?
• What areas of additional financial or budgeting data gathering have you identified as a need for your plan?

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Experience

            I work as a Patient Care Supervisor in an Acute Care Hospital. Currently, I am taking a Nurse Executive Specialty Track for my MSN that will enhance or develop my knowledge in leadership. As a Patient Care Supervisor, I am tasked with staffing whereby I ensure there is enough staff depending on the census of the unit. Whenever there are bedside procedures, I ensure that supplies are charged. Every day I make sure that we have supplies like juice, jello for the patients, and linens. Therefore, there is need for budgeting for proper planning of the finances involved. I am also regularly consulted by the hospital CFO to report financial information for my unit that would be useful in the budgeting process.

Reflection

            A preconceived notion I held is that budgeting is merely about expenses or how much money is available to be spent. Additionally, I believed that budgeting is a similar process across organizations. However, through this week’s concepts, I now have a better understanding of what budgeting entails. For instance, I am now enlightened that the budgeting process should closely consider organizational goals, mission, vision, and strategic plan. I have also learnt two types of budgeting, that is, incremental and zero-based budgeting. Incremental budgeting is common among public entities while zero-based budgeting is commonly used by private organizations (Menifield, 2017).

Implications for the Future

            The knowledge gained this week has positive implications for the future. In relation to how I view my proposed project, I will take into consideration the influence of financial management on quality outcomes in patient care. An area of financial data gathering that may be useful for my plan concerns patient record keeping. The ability to comprehend the budgeting process is an added advantage for any health care leader (Leger & Dunham-Taylor, 2018).

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After talking to a few other people at our facility I have a better understanding of how the budget is made.  As I had discussed before, we are a state ran facility so we don’t do things as easily.  Our budget is set up by classifications and you cannot take one set of moneys for one classification and put it to another classification.  So, if I have a PRN pool of money I cannot take that money and use it for another full time staff member because that money comes from a separate classification and budget. 

The department director for mental health will lobby and push for moneys to come to our programing in the state, along with many other departments doing the same thig.  A proposal would go to the Office of Administration and be looked at by the Personnel Advisory Board, if approved would then go to the Governor for his/her approval. Once that is approved by the Governor the proposal will go to legislation for a vote.  If the proposal is approved then it goes back to the Department Director who will then divide that up by the various regions of the state based on how he feels it would help those regions.  The Regional Directors would then decide how much of the money would go to each facility and the Chief Operating Officer (COO) would then be able to oversee the budget.  This same process is used in trying to get raises for the workers and any other needs met. 

This system is similar to a global budget where the budget is set for each facility and funded by the state and other payers involved (Sharfstein, Gerovich & Chin, 2017).  Maryland has a global budget for rural hospital networks that also reward facilities for reduction in preventable care and penalized when a patient needs care from another facility.  The biggest difference from Maryland’s Safety-Net Hospitals that are using this system is our facility does not get rewarded when we reduce cost or penalized if a client has to seek emergency medical attention multiple times for removal of a foreign object repeatedly. 

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I read through all the posts and you mentioned some points that stood out to me. One statement in particular is when you mentioned that program has since supported the organization’s popular model, which combines health plans, physicians, and hospitals. Someone who is curious and has a tendency to question many things, I just wonder is the organizations plan, you mentioned, popular for its investors, share holders,  or its other stakeholders such as the patients? Many people may like something but that does not mean the majority of people will find it beneficial to them based on actual value of care and not just value of dollars lining CEO’s pockets? I raise these questions, not to be confrontational, but to elicit thought regarding our definition of value as a culture aiming to lead healthcare in this country. 

I was actually born at a Kaiser Permanent in Oakland, CA. It is amazing how they have grown as a medical institution. Out of all the hospitals and medical establishments Ive been too Kaiser is definitely one of better care and quality, but there is a huge price tag on  the cost of their care even with Insurance. You mentioned patients having to pay high deductibles. I am really looking forward to the day where this whole idea of high deductibles and premiums will be something of the past. I realize this will take a paradigm shift but ideally, people having access to care without hemorrhaging money  to just barely survive this world, would be ideal. How do you think big hospitals like Kaiser permanente would survive if such a paradigm shift were to occur?

 

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