HCM 700 Module 2 Organizational Assessment Paper Example

Reading the Vital Signs: An Organizational Assessment of Willow Creek Care Center

[Student Name]

Southern New Hampshire University

HCM 700: Healthcare Administration Capstone

Module Two Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Reading the Vital Signs: An Organizational Assessment of Willow Creek Care Center

Willow Creek Care Center's board knows the facility is struggling. What it lacks is a single picture that shows how its problems relate. This assessment assembles performance data from public and internal sources, compares them with benchmarks and research and identifies the underlying pattern. Its purpose is diagnostic: the solution comes later, once the causes are clear.

Organization Profile

Willow Creek is a 120-bed nonprofit skilled nursing facility founded by a regional church federation in 1974. Its mission is to provide "dignified, loving care for elders and those recovering from illness." It operates a 36-bed short-term rehabilitation unit, a 60-bed long-term care unit and a 24-bed secured memory care unit. Average daily census last year was 97, or 81% occupancy. Medicaid paid for 64% of resident days, traditional Medicare for 14%, Medicare Advantage for 9% and private payers for 13%.

Data Sources

The assessment uses federal Care Compare ratings and measures, the payroll-based staffing journal Willow Creek files with Medicare each quarter, the facility's most recent cost report and standard inspection, human resources records of hires, departures and exit interviews, the finance office's monthly statements and the annual resident and family satisfaction survey. Using several sources guards against relying on any single measure, each of which has known weaknesses.

Quality Ratings

Willow Creek holds two stars overall on the federal five-star system, with two stars for health inspections, two for staffing and three for quality measures. The pattern matters: quality measures, based largely on resident assessments, are middling, while the two components tied to people, staffing levels and inspectors' observations, are weak. Families increasingly consult these ratings, and two hospital discharge planners have told the admissions director that they now steer patients elsewhere.

Table 1. Federal Five-Star Ratings

Note. Care Compare, most recent quarter; state averages rounded.

Staffing Levels

Payroll records show total nurse staffing of 3.52 hours per resident day, compared with a state average of 3.81, and registered nurse staffing of 0.42 hours against 0.67. Weekend staffing drops about 12% below weekdays. Bostick et al. (2006) reviewed studies of nursing home staffing and concluded that higher total staffing, and registered nurse staffing in particular, was associated with better quality. Willow Creek's gap is not only a number on a rating; it likely shapes the care residents receive.

Turnover and Vacancy

Nursing staff turnover reached 94% last year. Certified nursing assistants accounted for most departures, and 22 of 64 budgeted aide positions are vacant. Nearly half of those who left did so within 90 days of hire. Exit interviews most often cited short staffing that made shifts unsafe, pay below the local hospital and warehouse employers, unpredictable schedules and supervisors who rarely recognized good work. The pattern points to a revolving door at the entrance: the facility hires steadily but cannot keep new aides long enough for them to become skilled.

Agency Dependence

To fill gaps, Willow Creek bought $1.9 million in agency nursing last year, 21% of nursing labor spending and about 18% of nursing hours. An agency aide costs about $48 an hour, compared with roughly $25 for an employed aide including benefits. Agency staff rarely know residents, care plans or unit routines, and several work only a few shifts. The money spent on agency hours equals roughly the cost of raising every employed aide's wage by $6 an hour.

Clinical Outcomes

Among short-stay residents, 25.8% return to a hospital within 30 days, above state and national averages. Mor et al. (2010) described the revolving door of rehospitalization from skilled nursing facilities, finding that nearly a quarter of Medicare patients discharged to these facilities were readmitted within 30 days at great cost, and that rates varied widely between facilities and regions. Among long-stay residents, antipsychotic use is 17% and falls with major injury are 4.1%, both worse than state averages, while pressure ulcer rates are close to average.

Inspection Findings

The most recent standard inspection produced 14 deficiencies, compared with a state average of about nine. Citations included failure to implement care plans, infection control lapses during a respiratory outbreak and a finding that staffing was insufficient to meet residents' needs on two night shifts. Each of these citations connects to staff who are new, temporary or stretched thin.

Financial Performance

Revenue was $14.6 million and the operating loss about $450,000, a margin of minus 3.1%. The state Medicaid rate averages $248 per resident day, below Willow Creek's cost of about $286, so each Medicaid day loses money, and Medicaid pays for nearly two-thirds of days. Medicare and private payers cover the gap only partly. Staffing shortages have also cost revenue: the admissions office declined 38 hospital referrals last year because units lacked staff to accept them.

Resident and Family Experience

In the annual survey, 71% of families said they would recommend Willow Creek, down from 84% three years ago. Comments praised long-serving aides by name and criticized frequent new faces, slow call-light responses on weekends and missed personal preferences. One family member wrote that their mother "has to explain herself to a stranger every morning." Families notice staff stability even when they do not use the word turnover.

The Pandemic Context

Willow Creek's workforce problems deepened after 2020 but did not begin then. Xu et al. (2020) examined staff shortages in nursing homes during the pandemic and found that facilities with COVID-19 cases among residents or staff and those with lower quality ratings were more likely to report shortages. Willow Creek fits that description, which suggests the shortage is partly the product of conditions the facility can change rather than purely a regional labor market problem.

A Causal Map

The data fit together in two loops. In the first, turnover creates vacancies, vacancies are filled with expensive agency staff, agency costs produce losses and losses prevent wage and staffing improvements that would reduce turnover. In the second, turnover and agency use weaken care, which raises rehospitalizations, inspection deficiencies and falls, lowering star ratings and referrals, which reduces occupancy and revenue. Both loops pass through workforce instability.

Table 2. Key Findings and Links to Workforce Instability

Note. Compiled by the author from the sources listed above.

Priorities

The assessment points to three priorities: retaining aides, especially in their first 90 days; replacing agency hours with employed staff; and reducing avoidable rehospitalizations, which affect residents, ratings and Medicare revenue. The first two are tightly linked, and progress on them should make the third easier.

Conclusion

Willow Creek's weak ratings, losses and rising rehospitalizations are not separate problems. They share a root in an unstable workforce that feeds on itself through agency costs and declining reputation. The Milestone One problem statement will define that root precisely and review what research says about breaking the cycle.

References

Bostick, J. E., Rantz, M. J., Flesner, M. K., & Riggs, C. J. (2006). Systematic review of studies of staffing and quality in nursing homes. Journal of the American Medical Directors Association, 7(6), 366-376. https://doi.org/10.1016/j.jamda.2006.01.024

Mor, V., Intrator, O., Feng, Z., & Grabowski, D. C. (2010). The revolving door of rehospitalization from skilled nursing facilities. Health Affairs, 29(1), 57-64. https://doi.org/10.1377/hlthaff.2009.0629

Xu, H., Intrator, O., & Bowblis, J. R. (2020). Shortages of staff in nursing homes during the COVID-19 pandemic: What are the driving factors? Journal of the American Medical Directors Association, 21(10), 1371-1377. https://doi.org/10.1016/j.jamda.2020.08.002