¶ … budget template that is being produced for Shatin Hospital, which is a rehabilitation hospital. This hospital is run by the Hospital Authority, which is the main health care provider in the country. The proposal is basically highlighting the issue of labor and increase stress on the hospital administration staff. The project proposal is therefore to reform one pair of the geriatric and the medical wards into a nurse led ward. Justifications for change

The current hospital that I am working in is located in Shatin, Hong Kong where the aging population and the lack of hospital beds are creating a lot of strain on the delivery of health care . There is a crucial shortage of labor and the nurses and the doctors are being overworked to quite an extent.

Need for Service

The need for service is present because the rehabilitation hospital that is present works in sync with a regional acute hospital as a partner in the same area. The patients are therefore transferred from the acute hospital to our hospital. As the name suggest, our hospital is just a rehabilitation hospital and no medical emergencies are admitted here. Keeping this in mind, the acute hospital does receive many medical emergencies and they are always short of beds. Due to their bed crisis, they are always asking us for more beds.

In order to understand this project in more detail, it is only necessary to be aware of the costs of the involved factors. Currently, there are 10 total wards in the medical and the geriatric (M&G) department. Each ward consists of 25 beds in total. Every ward is being managed by one doctor, one advanced practice nurse and nine nurses. As of now, there are only nine doctors and one of the doctors has resigned from the workforce. Furthermore, every pair of ward is under the control and administration of one ward manager. It is of important notice to note that the nurse led wards are in charge of the chronic health problems. This means that the nurses have to take special care of the wound management, feeding and end of life care.

Issues that affect

It is a known fact that the world population is expanding and aging. According Arias & Curtin et.al (2008), the population segment that is growing and increasing the most comprises of individuals of ages 65 and above. Furthermore, it is also known that people are opting to having children later or not having any children at all. Cooper et. al (2002) went on to forecast, that by the year 2020, there would be thirty percent deficit for the number of physicians required. This can be attributed to the economic expansions and the growth of the population in relation to the growth of the health care workforce. It was also stated that there is a shortage of specialists and that is further creating a lot of stress on the medical forces today (Cooper, 2002)

Coming to the more specific issue, it is seen that this problem is quite severe when it comes to the health care delivery system in Hong Kong. It has been estimated that the percentage of people above 65 will double from 12.7% in the year 2009 to about 28% by the year 2039 (Census and Statistics Department, 2009) As it would be known, the hospital authority plan that was published in 1992 provided a decent structural method for the goals and the targets for the service. Nonetheless, with the aging population, the burden on the facility has increased to quite an extent (Hospital Authority, 2008) As mentioned before; the age segment that is increasing the most is people above 65. Most of these people are affected by chronic conditions such as malignancies, heart failure and other chronic conditions. In total, the physicians collectively are treating around 8.9 million patients every year (Pak-Yin)

Problems with existing practice

Seeing how the population is increasing quite exponentially, there is a set number of beds, doctors and nurses required to overcome this gap (Kronick et.al, 1993). The truth is that the major burden is placed on the staff that is present in the hospitals (Rogers & Hwang et. al, 2004). Due to this reason, the patient safety and the quality of life of the employees is also affected (Holden et.al, 2011) Public expectations of the health care delivery in the country are quite high. People expect to be attended right away. They expect that their needs and their comforts would be taken care of when they come to the hospital.

The existing practice is being over worked...

Even though hospitals are successful in treating patients, the system needs to be improved a lot. Many people are being forced to switch to private health care delivery. This form of health care delivery is not affordable for the majority of the population. Due to this reason, a discrepancy in quality of medical care is again noted. Therefore, in order to enhance the quality of health care and reduce the stress of work on the employees, certain changes are required.
Changes required

As mentioned earlier, there is a lot of patient load in the acute hospitals. Along with that, there is a lot of stress on the workforce in the hospital. We are hoping to turn one pair of the wards into nurse led wards. This would reduce the burden and cut down the costs of the hospital as well. Due to this reason, the nurses and the HCAs present in the hospital need to be trained accordingly.

Changes brought upon by proposal

The increased burden of chronically ill patients is placing a strain on the economy of the country and the quality of health care. This proposal will go on to reduce the need for hiring more doctors. This would not only cut down the cost but it would make the health care service more effective. It should be noted that this proposal would train the nurses that are already present in the hospital. The revenue that has been saved in this process would then be channeled to the cost of new equipment.

Government policy issues affected

Hospital Authority is already working to develop training initiatives so that clinical management and competence can be attained. According to the annual report of the year 2012-2013, there have been 300 students enrolled in the Higher Diploma Nursing Program (Hospital Authority, 2013) This shows that the government initiatives right now are all aiming to reduce the burden of work load and improve the delivery of health care.

On a national level, governments are realizing the need for increased services for chronically or terminally ill patients. The idea of nurse led wards would further back up the efforts that have been initiated by the government. If this implementation and proposal is successful, it is likely that the cost of training of these HCA and nurses is covered by the government.

Again, it should be emphasized that this is national problem and government policy would surely back up the proposal if it succeeds.

Benefits of the Change

The entire idea here is to reduce the stress on the employees and ensure that the patients are still given the sort of care that they need. A study was carried out in Hong Kong that included individuals from older nursing homes who were enrolled in an end of life care program. The objective of the study was to enhance the end of life care for these residents. The physicians and the researchers involved were attempting to design the most effective care pathway for these patients. This way, physicians were hoping to bypass the visit to the acute medical wards and the emergency room and took the patients directly to the extended care facility. The study revealed that about 40% of the patients can be managed in an extended care service without affecting or compromising the quality of survival and care (Hui & Ma et.al, 2014) This research therefore provided the stimulus for community outreach services and ER to work in collaboration to improve the health care delivery to chronically ill patients.

Keeping this study in mind it is seen that these patients can work totally fine even without the presence of an acute setting hospital or an emergency service. This further backs up and promotes our proposal because our proposal is working to enhance the service of the rehabilitation center. We are hoping to increase our services by having the nurse led wards and trained nurses. This would not only reduce the workload but also improve the quality of service that we have to offer (Cohen & Deliens, 2012)

If rehabilitation centers like the one we have are improved, many elderly patients that would initially go to acute hospitals would directly come to these centers. This would therefore improve the overall objective of the hospital authority. Not only would the EOL programs be improved but the burden in the acute hospitals can also be reduced. Hui & Ma et.al (2014) have showed that the quality of care and survival rates are not affected. Therefore, it…