300-500 words You are in a health care policy internship program in a Senator’s office in Washington, D.C. The Senator wants to develop policy that requires all health care organizations that rece
Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 1 Policy Analysis and Development Introduction: You are in a health care policy internship program in a Senator’s office in Washington, D.C. The Senator wants to develop policy that requires all health care organizations that receive federal funds to implement the recommendations presented in the Institute of Med icine reports on quality care. You will develop a policy, so that it can become proposed legislation . To do so, you must collect data, describe the problem, describe solutions and related ethical issues, examine the cost -benefit analysis, identify stakehol ders (such as lobbyists from American Hospital Association, health care providers, health care corporations, pharmaceuticals, insurers, etc.), and impact. Based on this information, you will create a policy description that will be the foundation for a bil l. Characters: 1. Student 2. Peter Shackley 3. Gretchen Wilde 4. Senator Marian Powers Locations: 1. Intern Desk 2. Conference Room at Senator’s :eadquarters 3. Chief of Staff ’s Office 4. Restaurant Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 2 Scene 1: Policy Analysis and Development In this scene , the student meets with the Senior Policy Staff Member Peter , their mentor, on a conference call with the Senator to learn about the Senator’s desire to create a new healthcare policy requiring health care organizations to follow the =nstitute of Medicine’s recommendations regarding quality health care in order to qualify for federal funding . The student gathers preliminary information about the situation and expected delivery of the policy description . Location Conference room Scene setup Peter and Marian are seated in the conference room . On -screen characters Peter Shackley, Marian Powers Off -screen characters N/A On screen text: Your mentor, Peter , wants to have you meet with Senator Powers regarding a new healthcare policy . Peter: Good morning! Thank you for meeting with us. The Senator has an exciting new project and I think it would be just the thing for you to get started with. I will let her explain more. Senator? Senator: :ello, everyone. = don’t have a lot of time so =’m going to jump right in. As you know, we face something of a health care crisis in this country. Costs are up, and the quality of care patients receive is not necessarily keeping pace. =t’s a tough situation and = want to see what we can do to improve it. Peter: One of the ideas we had is to requ ire health care organizations to follow better guidelines in order to qualify for federal funding for Medicare. Student can click either option to continue. STUDENT CHOICE 1 Are the current guidelines not adequate ? STUDENT CHOICE 2 Is this really a big problem? Senator Response : One problem right now is that hospitals and other health care providers just have a hard time keeping up. As technology advances, our ability to care for more people, and care for them better, needs to be constantly improving. A nd it is – but we can do more to make this more efficient. The Institute of Medicine is continually publishing recommendations that would improve the quality of care and help make it more affordable. I want a policy that will require any organization to ab ide by these recommendations in order to qualify for federal funds. Student must click choice 2 to continue. STUDENT CHOICE 1 Sure, =’ll get started right away. Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 3 STUDENT CHOICE 2 OK . What do you need to see in a policy recommendation from me? STUDENT CHOICE 3 Sounds easy. =’ll write up a report listing the recommendations to follow . PETER RESPONSE 1: Alright. What’s your plan? Response 1 kicks student back to options. SENATOR RESPONSE 2: =’m glad you asked. There are a few steps you need to follow, including gathering data, identifying stakeholders, key factors, and actually writing the policy. Peter, you’re more familiar with the strategy part of this. C an you expand on what is needed? Response 2 moves student to next statement from Peter . PETER RESPONSE 3: A policy recommendation is a lot more than a list of ideas. Response 3 kicks st udent back to options . PETER (after choice 2 selected): Sure. What would you like to know about first? Gathering data, identifying stakeholders, key factors, or writing the statement? STUDENT CHOICE 1 Tell me about gathering data. STUDENT CHOICE 2 How do I identify stakeholders? STUDENT CHOICE 3 What are the key factors? STUDENT CHOICE 4 How do I put together the actual statement? Student must select all four options before continuing. PETER RESPONSE 1: Gathering data should be pretty clear. In order to write a policy, you obviously need to know what you’re talking about. Normally, you’d spend a lot of time doing research to find what information is out t here already regarding the current state of the health care system, what regulations are already in place, and what recommendations the Institute of Medicine has that we want these organizations to implement. But in order to save time, why don’t we meet af ter this meeting to talk about a lot of this. = don’t want to waste the Senator’s time going through everything, but = already have a great deal of information I can share with you. PETER RESPONSE 2: Identifying stakeholders is critical because the policy recommendation needs to discuss how the policy, if implemented, is going to affect different groups. Health care obviously has huge implications on every level from individual patients to hospitals to insurance providers. You could argue that this policy w ill affect almost everyone to some extent. What you 'll need to do is look at the Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 4 groups that are most directly affected and describe how they are impacted by this policy. You should talk to Gretchen about this – =’ll see if she has time to meet with you la ter today. She will be able to help you identify the stakeholders. PETER RESPONSE 3: After you identify stakeholders, you need to identify the key factors for each stakeholder. A key factor is basically the position each stakeholder takes on an issue. This can be a political economic, practical, legal, or any other sort of position. Obviously, different groups are going to be concerned with different factors. Patients will be most concerned with economic and health positions – how can they get the best heal th care at the lowest cost? Hospitals might be more concerned with practical considerations. I s it even possible for them to provide the best health care without major disruptions to th ose procedure s? And insurance companies, lobbyists, and anyone else aff ected by the policy will each have their unique perspective. PETER RESPONSE 4: First, you’re going to need to develop a problem statement that defines the main issue. Next, give some background on the problem: why was this topic chosen for analysis? Includ e as much detail as you need to assess options, but also keep the language at a level that is appropriate for your audience. After that, the landscape section identifies your key stakeholders and factors. Next, provide a few options for solving the problem , identifying the option and assessing how feasible it is. Finally, pick ONE option and choose that as your recommendation. SENATOR RESPONSE 4: This is the part that concerns me the most directly. I have a packed schedule today but I will see if I can clea r up 15 minutes to meet with you later, because I want to make sure we get this part right. After selecting all options, continue below . Student can pick any option to continue. STUDENT CHOICE 1 I see. So, I need to start with a problem statement. STUDENT CHOICE 2 OK. I will get started right away. PETER: Senator, did you have anything else to add? SENATOR: No, n ot right now. I have a committee meeting in about three minutes so I will let you two get to work. PETER: OK, great. Thanks for your help, Senator. Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 5 Scene 2: Gathering Data In this scene, the student and Peter discuss the types of data relevant to the policy description that the student will write later . Location Conference room Scene setup Peter is seated at the table On -screen characters Peter Off -screen characters None On screen text: Peter wants to talk with you about the data you need to cover in your policy description . As you gather information, take notes about key issues you hear. PETER: OK, now that the Senator is gone, let’s go over some of the basic information you need to be familiar with. The Senator’s main concern is that Medicare is the country’s largest single provider of health coverage, but with the cost of health care constantly ris ing, there is an increasing gap between the money spent on care and the quality of that care. Student can click either option to continue. STUDENT CHOICE 1 : I can see how that would be a problem. STUDENT CHOICE 2: I can't see how that would be a problem. PETER: =t’s a huge problem! Quality health care is expensive, and investing in new systems and processes can be a big risk for health care organizations. Our challenge with th e policy is to figure out how to encourage them to promote quality and value in health care while managing those risks. STUDENT So what is the main problem we are looking at? PETER: Well, a few big problems come to mind. The IOM shows that medical errors are a huge burden, both financially and obviously on a more personal level, where they can cause harm to patients. Some hospitals simply don’t have the resources to invest in all of the current technology, and so they can’t provide the best care available. Also, any policy we come up with needs to be measured, and we need t o figure out how to do that. STUDENT Let’s talk about medical errors. What causes them in the current system? Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 6 PETER: There are a number of causes. Many hospitals, particularly in the ER, are overwhelmed with patients and jus can’t give individuals enough time. This leads to errors. A lot of highly skilled and qualified nurses are not able to perform to their full ability due to regulations, which makes the doctors even more overburdened. Also, if hospitals could more easily share patient files electronically, it would be far easier to evaluate a patient’s situation when they go to see their provider. Which of these would you like to discuss? Student must select all three choice s before continuing. STUDENT CHOICE 1 How do we lessen the burden on health care providers in general? STUDENT CHOICE 2 What do you mean when you say some nurses aren’t allowed to perform some procedures? STUDENT CHOICE 3 Tell me about the electronic files. PETER RESPONSE 1: Well, this is a particularly hard o ne. We can’t just create more hospitals to ease the burden – that’s too expensive and doesn’t address the underlying problem. We need a systematic way of streamlining the process of handling patients as efficiently as possible while ensuring that patients receive the care they need. In the past, errors were managed in a reactive way. After an error occurred, it would be analyzed, typically someone was blamed, and the organization would implement risk management to avert it in the future. Also, peer review s ystems let doctors evaluate each other’s performance s, but again, this is reactive. What we need to do is think forward. How can we reduce the possibility of human error? Standardizing procedures is a start. Also, we can make reporting errors mandatory and decrease the blame culture . We can tie organizations’ payments to those reports. Also, we need to make sure that whatever policy we create has built -in flexibility, so that it doesn’t become obsolete in two years when the situation changes. PETER RESPONSE 2: This is an example of an inefficiency in the system. Right now, nurses are allowed to perform certain tasks, and often only those tasks. But a number of them are more qualified than that – however, the regulations were set at a time where doctors were required to do what the nurses can today. As a result, you have patients waiting for a doctor when they could very likely be treated sooner by a qualified nurse. If we could remove this restriction in a safe, manageable way, it would help lower costs while making the system more efficient. PETER RESPONSE 3: Let’s say you have a patient in Arizona who gets sick while on vacation in Florida. =f the patient’s primary care physician in Arizona only has paper files, then the doctor in Florida has to request a fax, which takes time, burdening both offices. On the o ther hand, if they have an electronic file, it might only take a phone call and an email to get the doctor in Florida all of the information on that patient. Or, even better, if they both used a centralized database that held patient data, the Florida offi ce could access the file directly, and even update it with the patient’s new information. =t would Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 7 create a seamless way of making sure that ANY doctor’s office had access to that patient’s most current health information, and would reduce the risk of misd iagnosis or accidentally prescribing something potentially dangerous. STUDENT Why do some hospitals not have the same resources? PETER: Hospitals are often funded by local communities. A wealthier community is simply going to have access to more money a nd resources than a poorer one. This also applies to rural communities, which may not have the same level of technology that a state of the art urban facility will have. This often leads to less wealthy people receiving lower quality health care. When you add in the fact that people in poorer communities probably need MORE health care than those in wealthier communities, the problem becomes even more obvious. This also leads to certain ethnicities being stuck with lower quality health care, leading to dispa rities in health care that the IOM talks about in some of its reports. We want our policy to help fight this trend, so that we can get the best quality health care to the greatest number of people possible. STUDENT How would we best handle measuring health care performance? PETER: Measuring a health care organization’s ability to meet the =OM recommendations is obviously going to be critical. If we tie federal payments to compliance, we need a combination of things. First, we need an organization that over sees that they are complying. Second, we need to encourage full disclosure s on the part of the participating organizations. Finally, we need to ensure that any trends we notice in these measurements can be acted upon. What works? What doesn’t? :ow do we co ntinually move forward? Student must select all three options before continuing. STUDENT CHOICE 1 What sort of organization would we want to oversee the policy? STUDENT CHOICE 2 How do we encourage organizations to report on themselves, particularly when things go wrong? STUDENT CHOICE 3 What do you mean when you talk about trends? PETER RESPONSE 1: Well, since the goal is to be MORE efficient, we probably don’t want to create a new department. It would probably fall under the Department of Health. PET ER RESPONSE 2: One option is to provide increased payments for self -reporting. And when a hospital fails to meet all requirements, we have systems in place to help them get to where they need to be. We could coordinate with third party auditors to help org anizations identify their own weaknesses and enact plans to address them. Also, by sharing data on successful programs, we can help the less successful ones do better. The goal is for health care organizations to work WITH us, not to view us as adversaries . Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 8 PETER RESPONSE 3: For example, let’s say we notice that urban hospitals around the nation are suffering from overly long ER wait times. We can pool data from those hospitals to see why. Is it just that they have too many patients? Or is there something organizationally that we notice they have in common that is causing inefficiencies? By getting them to share this data and looking at it from multiple perspectives, we might be able to help find strategies that will improve quality of health care across th e board. This is called benchmarking and can be very useful. STUDENT That all makes sense. PETER: Good. =t’s a lot to take in at once. We have one othe r important area to consider. E thical concerns. Student must select option 2 to move forward. STUDENT CHOICE 1 = don’t see how providing better health care causes ethical problems. STUDENT CHOICE 2 Such as what happens if an organization fails to meet recommendations and then loses funding? STUDENT CHOICE 3 Right. This all sounds great, but who is going to pay for it? PETER RESPONSE 1: You have to realize that implementing organizational changes like thi s will affect a lot of people, not just patients. =t’s easy to talk about making things better and more efficient, but it isn’t going to work unless we t ake everyone affected into consideration. Response 1 kicks student back to options, with the remaining options available. PETER RESPONSE 2: Right. We can’t make a policy that doesn’t allow organizations to TRY to improve themselves incrementally. We can’t expect them to do this overnight – that would be unreasonable and would hurt a lot of people. Response 2 moves student forward. PETER RESPONSE 3: Well, that’s an economic concern, not an ethical concern. Response 3 kicks student back to options, with the remaining options available. Student can select either option. STUDENT CHOICE 1 It seems that it would be difficult to take everyone's interests into consideration. Thank you for walking me through all of this, Peter. STUDENT CHOICE 2 It's obvious we have a lot of people to consider. Thanks for your help with this. Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 9 PETER You’re welcome. = have an article = can send you on some of the other ethical concerns that might be relevant to this policy. =’ll send it to you when = get back to my desk. STUDENT Sounds good. Thanks again. Note: An email button flashes on screen for learner to click. EMAIL FROM GRETCHEN WILDE Hello, = heard you are working on the Senator’s new health care policy description.
When you get a chance, swing by my office. I have a few things I would like to talk about regarding stakeholders. Thanks, Gretchen Wilde Chief of Staff to Senator Powers Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 10 Scene 3: Meeting with Chief of Staff In this scene, Gretchen helps the student to identify some of the key stakeholders who would be affected by this policy . Location Chief of Staff’s office Scene setup Gretchen is seated behind her desk On -screen characters Gretchen Wilde Off -screen characters None On screen text: The Senator’s Chief of Staff wants to talk with you about the new policy . As you gather information, take notes about key issues you hear. Gretchen There you are! Have a seat. I know you are probably overwhelmed right now but =’m going to add a few more things for you to think about. Student OK, any help I can get is appreciated. What did you want to talk about? Gretchen Two things, mainly. Any new policy that stands a chance of getting approved is going to need a detailed cost analysis done first. Second, I want to make sure that you understand the stakeholders that we need to consider before moving forward. STUDENT Let’s talk about the cost analysis. GRETCHEN Implementing changes costs money. When we are talking about an industry as broad as health care, and with as many concerned parties as we are, we are potent ially talking about huge amounts of money. STUDENT Any costs incurred should be offset by improvements in procedures and better health care, right? GRETCHEN Sure, that’s the idea. But before we implement anything, we have to analyze how much it will actually cost, and make sure that we aren’t just throwing money away. =f we cause hospitals to spend MORE money that they don’t have, and if they are unable to jus tify that with noticeable improvements, they simply won’t cooperate. We have 3 major safety net hospitals in our state. These are hospitals that primarily serve vuln erable patients, either with no funds or limited funds to pay for care. = don’t want to for get these hospitals. I know their CEOs will be down on me pretty quick if they get wind of change that may impact their budgets that are mostly in the red. The plan needs to be financially responsible. Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 11 Student can click either option to continue. STUDENT CHOICE 1 How do I know if my plan is going to be cost -effective? STUDENT CHOICE 2 Don’t worry; = promise that whatever = come up with will make sense. GRETCHEN RESPONSE Well, as you develop the policy, you need to consider the financial impact it will have. :owever, we don’t expect you to have this data right now – you only started on this project a little while ago! But when you make your recommendation to the Senator, I would like you to touch on how you would perform the cost analysis. Consider where costs might increase and how those costs will be offset by savings, or justified in improved health care. STUDENT I want to talk about stakeholders. GRETCHEN Stakeholder s are anyone who is affected by the policy. When you consider that Medicare is the single biggest payer of health care in the country, this means there are a LOT of stakeholders. Not just patients, either – everyone who is affected. I tell you what – =’ll name a few possible groups and you can tell me if you think they are stakeholders or not. First, what about insurance providers? Student can click any option to continue. STUDENT CHOICE 1 Insurance providers are not directly affected by the quality of health care, so they don’t need to be considered. STUDENT CHOICE 2 Insurance providers are indirectly affected only because the new policy may require them to cover more people. STUDENT CHOICE 3 Insurance providers are directly affected because if the co st of health care increases, they will incur greater financial burden. GRETCHEN RESPONSE 1 What? Of course they are affected. If the cost of health care increases, they are one of the main groups who have to pay for the increased cost. They are definitely a party you should consider when writing your recommendation. Let’s look at another group – nursing staff. GRETCHEN RESPONSE 2 Well, we aren’t making a policy for that reason here. Their main concern is that if the cost of health care increases, they are one of the main groups who have to pay for the increased cost. They are definitely a party you should consider when writing your recommendation. What about the nursing staff? GRETCHEN RESPONSE 3 Exactly. If the cost of health care goes up, so does the co st of insurance. That directly impacts them and you will want to consider them in your Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 12 recommendation. What about the nursing staff? Student can click any option to continue. STUDENT CHOICE 1 We are looking at big -picture changes to hospital procedures, not trying to micromanage the nurses. They shouldn’t be affected. STUDENT CHOICE 2 The new policy should help nurses to do their job more effectively and efficiently, so they are definitely stakeholders but if a hospital decides it has to cut nursing sta ff in order to meet the new quality improvement demands then this will not help either. STUDENT CHOICE 3 Hospital administration would definitely be affected, and on a hospital by hospital basis may implement changes. But on the broad scale, nurses should be unaffected. GRETCHEN RESPONSE 1 Big picture changes affect EVERYONE in the system. Nurses are part of the front line helping patients – they are definitely going to be affected. Try to think about how when you write your policy. OK, one more example – what about the public at large? Not individual patients, but the overall public. GRETCHEN RESPONSE 2 Exactly, nurses are part of the front line helping patients. T hey are definitely going to be affected. Try to think about how when you write your policy. OK, one more example. Wha t about the public at large? Not individual patients, but the overall public. GRETCHEN RESPONSE 3 While that might be true to a point, it doesn’t mean the nurses aren’t directly affected as an overall group. Nurses are part of the front line helping patients. They are definitely going to be affected. Try to think about how when you write your policy. OK, one more example. W hat about the lawm akers? Student can click any option to continue. STUDENT CHOICE 1 Changes to public policy certainly affect lawmakers, who will want to look out for the best interest of their constituents. STUDENT CHOICE 2 Lawmakers are interested in getting votes and should be completely behind us, whatever we do, as long as it helps. STUDENT CHOICE 3 This isn’t a legal concern. = don’t think we need to take Washington into consideration. GRETCHEN RESPONSE 1 Right. T hey are clearly going to be concerned, and if they aren’t on our side, the policy goes nowhere. Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 13 GRETCHEN RESPONSE 2 If only it were that easy! In order to get a policy passed, the lawmakers need to be convinced that it is in the best interest of their constituents, and that’s easier said than done someti mes. GRETCHEN RESPONSE 3 You must be new to this town! Every public policy concerns the lawmakers.
We’re asking for a new law, right? We need to make sure the people voting for the law are in support and understand that it is in the best interest of their constituents. STUDENT OK, that makes a lot of sense. What else should I consider? GRETCHEN Well, after you identify your stakeholders, you need to think about what key factors relate to those stakeholders. STUDENT What are key factors? GRETCHEN Different groups are affected by policies in different ways. For example, if we were discussing an educational policy, students would be mos t concerned by academic factors. W ill this policy help them learn more? Districts will be concerned with acad emic an d also financial factors. C an we afford to implement this policy, and will it be worth the cost? The public at large might be con cerned with a business factor. W ill this policy help us generate better workers who can contribute to a better community? All o f th ose things need to be taken into consideration. STUDENT I think I understand. GRETCHEN QUESTION 1 Let’s see if you do. Using the stakeholders we identified before, try to identify some key factors they would be concerned with. First, what would insur ance providers consider to be key factors? Student must click correct option to move on . STUDENT CHOICE 1 (correct) They are most concerned with finances. Student moves to next question. STUDENT CHOICE 2 (incorrect) They are most concerned with quality of health. Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 14 Student kicks back to answer choices. STUDENT CHOICE 3 (incorrect) They are most concerned with implementing the policy. Student kicks back to answer choices. GRETCHEN RESPONSE 1 Exactly. They are going to be looking at what the new policy will do to insurance rates above anything else. GRETCHEN RESPONSE 2 :mm, well they are concerned with that, but = wouldn’t say i t's their main focus. GRETCHEN RESPONSE 3 No, they would not be directly impacted by how the hospitals implement the policy. GRETCHEN QUESTION 2 OK, next . What about the nursing staff? Student must click correct option to move on . STUDENT CHOICE 1 (incorrect) They are most concerned with finances. Student kicks back to answer choices. STUDENT CHOICE 2 (correct) They are most concerned with quality of health. Student moves to next question. STUDENT CHOICE 3 (incorrect) They are most concerned with implementing the policy. Student kicks back to answer choices. GRETCHEN RESPONSE 1 = am pretty sure a nurse isn’t thinking about the cost of health care when they are saving lives. GRETCHEN RESPONSE 2 Right! Nurses want a system in place that enables them to provide the best care possible in the most efficient way. They want to be able to do their jobs right. Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 15 GRETCHEN RESPO NSE 3 Yes, they would be concerned with this, but I think they might have a more important concern. GRETCHEN QUESTION 3 Finally, what about the lawmakers? Student can click any option to move on . STUDENT CHOICE 1 (correct) They are most concerned with finances. Student moves to next question. STUDENT CHOICE 2 (correct) They are most concerned with quality of health. Student moves to next question. ** STUDENT CHOICE 3 (correct) They are most concerned with implementing the policy. Student moves to next question. GRETCHEN RESPONSE 1-3 This was a trick question. Lawmakers will be concerned with all of these issues.
They want high quality health care for their constituents, but it needs to be balanced by cost. And if the policy will be a huge burden t o implement, it will also affect that cost and quality of health care. Student can click either option to move on . STUDENT CHOICE 1 So , it’s not that each group just has one big concern we need to worry about? STUDENT CHOICE 2 So, it's really just one big concern that each group has? GRETCHEN Nope. I n fact, most groups will be concerned with a variety of key factors. When you make your policy recommendation to the Senator, try to think of at least two factors for each of the stakeholders you list. ST UDENT I think you gave me enough information that I can get to work on the policy. Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 16 GRETCHEN Wait just a se cond. I think it would be helpful for you to think of a few different groups that you can include in your recommendation. I 'll send you a list of some potential stakeholders that we may not have mentioned. You can use anything from that list, or come up with other ideas on your own. The important thing is that whatever groups you identify as stakeholders, you need to describe t he key factors for that group and how the policy will impact them. STUDENT I can do that. GRETCHEN =’m sure you can! OK, = 'll let you go. Thanks for meeting with me on short notice. STUDENT Thank you, Gretchen. On screen text: Looks like you have a few emails. Head back to your desk to review them. Scene 4: Reviewing Information In this scene, the student returns to his desk to review the information sent by Peter and Gretchen . Location Intern Desk Scene setup Student is looking at computer screen. On -screen characters None Off -screen characters None On screen text: Time to check those emails... EMAIL FROM PETER Hello, We talked earlier about some ethical issues that might concern people as we develop the policy recommendation. Here are a few ideas I have that you should discuss. You don’t need to cover all of them, but definitely focus on a couple while you are describing the impact of the policy on stakeholders. • Patient volume vs. safety • Uninsured patients – who pays for them? • Prioritizing patients in ER • Is it right to remove funding from underperforming facilities? • What is the potential impact on the elderly if funding is removed ? • How can we balance costs between affluent and impoverished Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 17 facilities? • How can rural facilities l ive up to state of the art standards? • Can we expect overburdened staffs to do more without adding substantial cost? That’s just a starting point – feel free to discuss other issues that you think up. Just make sure the Senator can see how your suggestions are relevant and how you think potential ethical problems could be addressed. Good luck! Peter EMAIL FROM GRETCHEN Hi there, Thanks for meeting with me earlier. We talked about a few key stakeholders already: • Insurance companies • Nursing staff • Lawmakers In your policy description, I would like you to focus on three DIFFERENT stakeholders and the key factors relevant to them. Here are a few suggestions of other potential stakeholders. • The elderly • The public at large (not individual patients) • Patients not c overed by Medicare • Rural hospitals • Employers who provide insurance • Physicians Remember, you can come up with your own ideas as well. But make sure you can show how they are affected and what their key factors are. Thanks, and good luck! Gretchen Wilde Chie f of Staff to Senator Powers Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 18 EMAIL FROM SENATOR POWERS Hello, I was supposed to meet with an ambassador for a late lunch but he got pulled into a meeting. Come by my office as soon as you get a chance – I have about 15 minutes to spare and I want to talk with you about the policy description before you dive in too far. See you soon, Senator Powers Scene 5: Meeting with the Senator In this scene, the student meets with the Senator to talk about the structure of the policy description that will be written . Location Senator’s office Scene setup Senator seated at desk On -screen characters Senator Powers Off -screen characters None On screen text: The Senator wants to make sure you know how to write the policy . SENATOR There you are , great . My 15 minutes just got cut down to 10, but I think we have time. How is your research going? STUDENT I have a good understanding of the issue and the key stakeholders we need to consider. SENATOR Wonderful. Before you start, I want to go through the parts of the actual policy description you will be writing. Can you remember what they were, in order? Note : Student is given three options, each with a different policy description order. If student selects wrong option, display "Incorrect" and disable that optio n for the next attempt. On screen text : Select the option that has the policy description s in the correct order. Option 1 (incorrect): 1 - Problem Statement 2 - Landscape 3 - Background Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 19 4 - Recommendation 5 - Options Option 2 (correct): 1 - Problem Statement 2 - Background 3 - Landscape 4 - Options 5 - Recommendation Option 3 (incorrect): 1 - Background 2 - Problem Statement 3 - Landscape 4 - Options 5 - Recommendation SENATOR Good work . Now, let’s go over a few things. Obviously, the problem statement is where you describe the issue we are trying to address. One thing I want to stress is that you shouldn’t put your recommendation here – it will bias the entire policy description and won ’t be very effective. We want this to look methodical and unbiased, so just focus on the problem. STUDENT That makes sense. What else should I know? SENATOR QUESTION 1 Well, let’s see what you DO know. Where would you discuss key factors? Student must select correct answer to proceed. STUDENT CHOICE 1 (correct) In the Landscape section, with the stakeholders. Student moves to next question. Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 20 STUDENT CHOICE 2 (incorrect) In the background section, where we talk about why the problem was chosen. Student kicks back to answer choices. STUDENT CHOICE 3 (incorrect) In the recommendation section, where we give a solution. Student kicks back to answer choices. SENATOR RESPONSE 1 Very good! OK, next question. SENATOR RESPONSE 2-3 Hmm, no, that doesn’t sound right. Try again? Student must select correct answer to proceed. SENATOR QUESTION 2 How many options should you recommend? STUDENT CHOICE 1 (correct) Only one. Student moves to next question. STUDENT CHOICE 2 (incorrect) At least two. Student kicks back to answer choices. STUDENT CHOICE 3 (incorrect) As many as would be feasible. Student kicks back to answer choices. SENATOR RESPONSE 1 Right! L ist a few options, and then select the best one for the actual recommendation. Good work! SENATOR RESPONSE 2-3 :mm, no, that doesn’t sound right. Try again? SENATOR QUESTION 3 OK, last question for now. True or false : Y ou should focus on just one key factor per stakeholder. Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 21 Student must select correct answer to proceed. STUDENT CHOICE 1 (incorrect) True. I will only pick the most important. Student kicks back to answer choices. STUDENT CHOICE 2 (correct) False. Some groups will have many serious concerns that need to be addressed. Student moves to next question. STUDENT CHOICE 3 (incorrect) As many as would be feasible. Student kicks back to answer choices. SENATOR RESPONSE 1 Not quite right. Try again. SENATOR RESPONSE 2 Perfect! For this policy description, =’ll have you focus on only a couple of factors per stakeholder, but you are exactly right. STUDENT OK, thanks for your time. Is there anything else? SENATOR I th ink you are on the right track. =’ll send you links to some reports you can review to gain even more perspective, if you want. I gotta take this. Sorry to rush you out. I am looking forward to seeing your policy description. STUDENT Thank you, Senator On -screen text : This sounds important – you better get going and start writing that policy description! Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 22 Scene 6: Assessment If all previous scenes have been completed, a 10 -question assessment is presented to the student. It's time to check your knowledge. Answer the following 10 questions to show what you know about health care policy. Good luck! The student answers the questions and then sees the assessment results. Assessment Results Here are your results. Click Save Results if you are satisfied with the outcome. Or you can click Try Again if you want to try and improve your score. NOTE: The student can retry the assessment by clicking the Try Again button, or can continue to final scene by clicking the Continue button. Scene 7: Making Your Recommendation In this scene, the student will craft an email to the Senator, with a recommended policy description. The recommendation will include each aspect of the policy, as gathered in previous meetings. Location : Intern Desk Scene setup: Student is seated at the desk On -screen characters : None Off -screen characters: None On -Screen text: The Senator sent you an email… NOTE : Student can click on links in email to view PDFs. EMAIL Senator Powers [[email protected]] _________________________________________________________________________ As promised, here are some reports you can review. My advice is to skim through and just read the summaries to save time : Institute of Medicine. (1999), To err is human. Washington, DC: National Academies Press. (Opens To Err is Human 1999 report brief.pdf) Institute of Medicine. (2001), Crossing the quality chasm. Washington, DC: National Academies Press. (Opens Quality Chasm 2001 report brief.pdf) Health Care Policy Navigate 2 Scenario : Policy Analysis and Development March 2, 2018 23 Institute of Medicine. (2003), Heal th Professions Education: A Bridge to Quality . Washington, DC: National Academies Press. (Opens Bridge to Quality.pdf) And, in general, a good website to bookmark is: Agency for Healthcare Quality and Research (URL: http://www.ahrq.gov/) Good luck! Senator Marian Powers The student can read these and close the email window when they are ready to continue. On -screen text : After gathering information from the Senator’s staff and sorting through it with your mentor, it’s time to write the policy description. Keep your response within 250 -500 words. NOTE: Show a close up of the student’s computer screen with a new email open. The “To:” section is filled with the Senator’s name and the subject is already filled in: “Healthcare Policy Description .” On -screen t ext : Type your recommendation in the body of the email below. Don’t forget, you can use the notes you’ve taken throughout your interviews. Be sure to back up your recommendation with the analysis of the information gained from the Senator’s staff. There wi ll be five sections to fill out . • Problem statement • Background: Why is this issue a problem? • Landscape: Identify stakeholders and their key factors • Options: List three possible options and briefly assess each • Recommendation: Choose one of the previous options and describe why it is the best solution. NOTE: The student will be given an option to “ Send ” the email after writing it. After the student submits the email, the computer screen fades to the previous view of the student’s office. On -screen text: Congratulations! Your recommendation to the Senator has been sent! THE END