NYC Health and Hospitals Corporation: Problems and Solutions


The New York City Health and Hospitals Corporation (NYC HHC) is one of the largest public health systems in the United States. Its goal is the provision of inpatient and outpatient care, as well as home-based services, for both insured and uninsured New Yorkers (NYC Health + Hospitals, n.d.a). There are about 70 locations in the city where acute, post-acute, and long-term care becomes available to the residents, regardless of their payment abilities.

The organization has a properly developed mission to protect the health and welfare of NY citizens. In addition, it shares its vision to integrate the healthcare system, enhance healthy lives, and establish the same standards for all the medical staff (NYC Health + Hospitals, n.d.b). After an interview with organizational leaders and stakeholders, it turns out to be clear that some uncertainties exist, and improvements are required. Several programs and services are developed for clients, and the corporation is not able to cover all costs. Relying on the results of a SWOT analysis, the NYC HHC is defined as an organization with a projected deficit and the need for reorganization using government support and additional funding resources.

Identification of the Problem or Need

Communication with direct participants in the development of a company is one of the most reliable and effective methods to gather information. Recent achievements, improvements, and changes have different effects, and a SWOT analysis along with the FAME approach that focuses on feasibility, appropriateness, meaningfulness, and effectiveness evaluation will help to determine the current needs of the NYC HHC.

At the state level, the chosen organization admits that it needs to be fairly treated by the government to ensure equal distribution of funds to hospitals where insured and uninsured patients receive treatment (Katz, 2018). Financial concerns usually require the improvement of policymaking and the evaluation of available resources on the basis of the SWOT analysis, as recommended by Buttigieg, Schuetz, and Bezzina (2016). The need for additional government support is determined by existing strengths, weaknesses, threats, and opportunities, as it is shown in Table 1.

Strengths:
  • A well-known brand of health care
  • Attention to insured and uninsured patients
  • Promotion of resident equality
Opportunities:
  • A possibility to keep citizens healthy
  • Connection of socio-economic factors with health care
  • Attention to undocumented immigrants
Weaknesses:
  • Dependence on external funding
  • Importance of documenting all patients
  • Lack of resources to develop
Threats:
  • Government services and federal policies
  • Poor immigration control
  • Lack of administration

The SWOT analysis shows that despite the intention to remove inequality and underline the worth of care quality, the NYC HHC, as well as many healthcare facilities, depends on the government and its funding. Immigration leads to an increased number of uninsured patients in New York, and the NYC HHC is one of few organizations where help is offered to all residents, regardless of their registration, social status, and origins. Therefore, organizational leaders want to create a new program to solve the problem of a projected deficit and improve its financial picture. The vision of this project is closely related to the vision and overall goals of the chosen organizations. It is necessary to integrate a well-administrated system in order to enhance equality and healthy lifestyles among patients.

Any change or improvement has its cost, quality standards, and efficiency aspects. In this case, the NYC HHC’s transformation plan should include the analysis of revenues, potential and actual expenses, and expenditures. At this moment, the budget and financial plans show that the revenue of 2018 was $8.6 billion, in 2019 – $8.9 billion, and in 2020 (adopted) – $8.5 billion (Public Authorities Reporting Information System, 2019). The achieved results prove access growth, but the future is not safe due to existing external factors. To address the deficit problem, Mizell, Thrush, and Steelman (2019) recommend the promotion of personal/business finance programs and financial literacy, and Looy and Shafagatova (2016) investigate performance measurement through a learning and growth perspective.

Therefore, the improvement of the cost-effectiveness program for the NYC HHC includes payment reforms, control, and hiring a new team of experts to communicate with the government. Its expected cost for the next year is about $100 million and $50 million in savings. The quality of health care depends on immigration analysis, and its efficiency is determined by the evaluation of the planned and actually achieved financial benefits at the end of the year.

Resources to Address the Problem or Need

The success of a new program for the NYC HHC depends on different factors, and the recognition of resources to address the deficit problem and a new financial program needs to play a crucial role. The analysis of the reports of the corporation should help to identify key resources that can be used at the moment, current supply, and future needs (Buchman et al., 2017). NYC Health +Hospitals (2016) identifies recent changes in the healthcare landscape, demographic shifts, and increased competitive advantage.

According to Safarani, Ravaghi, Raeissi, and Maleki (2018), it is expected that patients pay more for their treatment so the government could establish effective health systems and funding for them. However, in the case of the NYC HHC, payment for treatment is not an obligatory issue for patients at the corporation’s hospitals. Therefore, the government fails to understand true funding resources for this organization.

Organizational assessment is one of the resources to be taken into consideration. Its application results in regular evaluations of quality improvement and the effectiveness of financial initiatives that meet the equity agenda and the limits of governmental funds (NYC Health +Hospitals, 2016). Standardization of policies is a critical process of the improvement strategy in this case. Kwon, Kim, and Martin (2016) admit that annually, corporations lose about $1-2 trillion due to unpredictable healthcare waste, and the lack of standardized processes is the main reason. If enough people and resources are applied to process improvement, there is a possibility to save about $16.5 billion in expenditure (Lacy, as cited in Kwon et al., 2016).

Standardization aims to estimate time to complete tasks, meet requirements, and understand the needs of healthcare facilities (Kwon et al., 2016). Cooperation between the government representative and the corporation is obligatory to compare the goals, expectations, and possibilities of both sides.

The attraction of business analytics and lean concepts as a part of reorganization is another benefit in improvement policies, according to the leaders of the NYC HHC. For example, one of the latest steps taken by the NYC HHC was the elimination of administrative positions to reduce costs but not to impact direct patient care (Katz, 2018). Financial sustainability remains a significant element of the work of the NYC HHC team, and if there is a chance to control deficit-related problems by means of employment changes, the company uses it.

Identification of Relevant Data, Collection, and Analysis

Relevant data about a projected deficit the NYC HHC faces today may be discussed in organizational reports and peer-reviewed articles. For example, Birs et al. (2016) admit that despite the important role of free medical care for uninsured people, many clinics experience a funding decrease and fiscal deficit and consider small facility fees as a solution. The authors used a retrospective secondary analysis of surveys among patients and developed a descriptive statistical analysis with the help of the Pearson Chi-square test to prove the validity and reliability of the research methods. The investigations of budget deficits require statistical data to be obtained from reports and direct communication with participants (employees and patients).

To guarantee the validity, researchers consider the p-value being <0.05 in two-sided tests and use SPSS statistics models (Birs et al., 2016; Sabaté, Fillat, & Escario, 2018). The main parameters to be addressed in such research include patient satisfaction, the quality of care, and the assets or revenues of an organization.

In this project, the goal is to develop a program for the company to improve its cooperation with the government and introduce a transformational plan to reduce a projected deficit. The material from the NYC HHC reports will be the basis for qualitative analysis, and the information obtained from employees will be used as a part of quantitative analysis. In total, a mixed research method has to be applied. Its validity and credibility will be checked by means of Chi-square tests or a Hansen test where -value is recognized. In this type of research, major biases emerge because of subjective information shared by the participants and small sample size (due to the impossibility to involve all the employees of the corporation).

As soon as the reasons for a deficit are clearly identified, and a program is developed, it can be introduced to the government with specific steps and funding changes being properly discussed. The solutions to potential problems are based on the ability of the leaders to control the staff, share credible financial information, and apply to a transformational leadership style where all team members are involved.

Stakeholder Buy-In

In any change process, there are the people who support it and who resist it. A primary investigation of the NYC HHC shows that its leaders work hard to motivate employees, recognize patients’ needs, and combine financial and healthcare aspects. However, despite the intention to improve the situation in the corporation, change may have its positive and negative outcomes, as well as specific barriers to implementation.

Key stakeholders who could support change and implement a new cost-effective program to reduce the budget deficit are the leaders, managers, and patients (in case it does not negatively influence care quality). At the same time, this program requires some staff changes and reorganization (to hire several experts for cooperation with the government). Therefore, the same way administrative employees have already lost their jobs, some healthcare workers (nurses or doctors) may be fired due to the necessity to predict serious financial losses. The part-time staff and assistants could resist change because of employment instability in the country.

The government is another key stakeholder to resist change because the NYC HHC aims to increase funds in the healthcare sphere. If no solid statistical data or alternatives are offered, the government will hardly accept change. As a result, leaders, financial experts, and business analytics have the most influence on positive changes related to the problem of the projected deficit.

At the same time, despite the necessity to create a strong plan of work, analyze credible data, and involve professionals, some implementation barriers cannot be ignored. The lack of cooperation between healthcare representatives is one of the potential threats (Kwon et al., 2017). Another aspect to be recognized is the system of insurance that is available to modern patients. Many hospitals experience financial challenges due to delayed payments from insurance companies (Safarani et al., 2018). Neither the government nor the healthcare facility could influence the work of these organizations, and the waste of time is the only outcome. The prediction of this outcome is possible if the government and the NYC HHC reduce the impact on insurance companies on organizations where free care is combined with paid services.

Conclusion

In general, the idea of developing a new program using additional governmental support is one of the best solutions for the NYC HHC at this moment. Improved cooperation and reorganization are required to reduce a projected deficit and find money to continue free care services for insured and uninsured patients. In New York, many immigrants could contribute to its economic development, and the government should be interested in attracting such labor power. Therefore, this project and the discussion of the cost-effectiveness implementation plan by means of standardization and lean policies are worth conducting. The healthcare sector undergoes considerable changes regularly, and one change in the corporation is a significant step for the city, as well as for the country.

References

Birs, A., Liu, X., Nash, B., Sullivan, S., Garris, S., Hardy, M.,… & Pasarica, M. (2016). Medical care in a free clinic: A comprehensive evaluation of patient experience, incentives, and barriers to optimal medical care with consideration of a facility fee. Cureus, 8(2). Web.

Buchman, T. G., Coopersmith, C. M., Meissen, H. W., Grabenkort, W. R., Bakshi, V., Hiddleson, C. A., & Gregg, S. R. (2017). Innovative interdisciplinary strategies to address the intensivist shortage. Critical Care Medicine, 45(2), 298-304.

Buttigieg, S. C., Schuetz, M., & Bezzina, F. (2016). Value chains of public and private health-care services in a small EU island state: A SWOT analysis. Frontiers in Public Health, 4. Web.

Katz, M. H. (2018). Report to the board of directors. Web.

Kwon, I. W. G., Kim, S. H., & Martin, D. G. (2016). Healthcare supply chain management; strategic areas for quality and financial improvement. Technological Forecasting and Social Change, 113, 422-428.

Mizell, J., Thrush, C., & Steelman, S. (2019). The business of medicine – A course to address the deficit in financial knowledge of fourth year medical students. Journal of Medical Practice Management. Web.

NYC Health + Hospitals. (n.d.a). About NYC Health + Hospitals. Web.

NYC Health + Hospitals. (n.d.b). Mission & values. Web.

NYC Health +Hospitals. (2016). Plan to enhance equitable care. Web.

Public Authorities Reporting Information System. (2019). Budget report for New York City health and hospitals corporation. Web.

Sabaté, M., Fillat, C., & Escario, R. (2019). Budget deficits and money creation: Exploring their relation before Bretton Woods. Explorations in Economic History, 72(2019), 38-56. Web.

Safarani, S., Ravaghi, H., Raeissi, P., & Maleki, M. (2018). Financial challenges of teaching hospitals and providing solutions. Journal of Education and Health Promotion, 7. Web.