BUSI 494 Week 4 Discussion Board Forum 2 Example

Discussion Board Forum 2: Choosing a Growth Strategy

BUSI 494 Healthcare Administration Capstone, Discussion Board Forum 2

Thread by [Student Name]

The group, the hospital and the replies to other groups are composites; the textbook, Scripture and the peer-reviewed sources cited are real.

Our group's case is a 250-bed hospital that runs above 90% occupancy most weekdays. Emergency department patients wait for beds, sometimes for a full day, elective surgeries are postponed and ambulances are sometimes diverted to hospitals farther away. A bed tower would cost far more than the hospital can borrow, and the board has asked for a growth strategy that adds capacity without major construction. Before choosing, our group listed what the hospital's leaders most needed from a growth strategy: added capacity within two years, little new debt, a clear advantage over the regional competitor and acceptable risk to patients. With those needs in mind, we considered three alternatives: building a smaller addition over five years, acquiring a nearby 60-bed hospital with spare capacity and launching a hospital-at-home program that treats selected acutely ill patients in their own homes with daily clinician visits, remote monitoring and home infusion.

Moseley (2018) describes growth strategies as choices about how an organization expands its services, and differentiation as offering something that competitors do not, in a way that customers value enough to choose it. Judged against cost, speed, competitive advantage and risk, the addition is too slow and too expensive, and the acquisition would bring a distant facility with its own staffing problems and a likely antitrust review. Hospital at home is the only option that adds capacity quickly at modest cost while also creating a service no competitor in our market currently offers. Every patient treated at home frees an inpatient bed for someone who needs it, so even a small program eases emergency department boarding and allows more elective surgery, which is where much of the hospital's margin comes from.

The evidence supports the model for carefully selected patients. Levine et al. (2020) assigned 91 emergency department patients at random to be treated either at home or in the hospital, across one academic and one community site. Treating the acute illness at home cost 38% less after adjustment, home patients had far fewer laboratory orders, imaging studies and consultations, they were more physically active during recovery and only 7% were readmitted within 30 days, compared with 23% of usual-care patients. Vakkalanka et al. (2026) compared 4,174 Medicare hospital-at-home admissions with 11,697 matched traditional admissions in hospitals operating under the federal waiver and found much lower in-hospital mortality and fewer emergency department visits after discharge, with no significant difference in readmissions. The authors also found that 11 hospitals accounted for about half of all hospital-at-home admissions, which suggests most hospitals have not yet scaled the model and that early movers can still differentiate.

The strategy has risks, and the board deserves to see them before approving it. Federal payment for hospital at home has depended on a waiver that Congress must periodically extend, patient selection must be careful and families carry more of the burden at home. Staff will also need new skills, from home safety assessment to coordinating supplies and couriers. Our recommendation is to start with a small program of five to eight patients a day, focused on conditions such as heart failure, pneumonia and cellulitis, and to expand only as outcomes and payment remain favorable. The program's results should be reported to the board quarterly alongside occupancy, boarding times and readmissions, so leaders can judge whether it is working as a capacity strategy and not only as a clinical innovation. The cheapest bed a hospital can add is the one already in the patient's home.

Isaiah records God saying, "Behold, I am doing a new thing" (English Standard Version Bible, 2001/2016, Isaiah 43:19). Health care leaders are called to stewardship, and sometimes stewardship means trying a new model of care instead of pouring scarce capital into the old one.

Reply to Group 2

Group 2, your thread supported hospital at home but questioned whether families can handle the demands of caring for an acutely ill relative, especially when programs require a caregiver to be present. That concern is supported by evidence and deserves a place in any program design. Duhamel et al. (2026) assessed 125 caregivers within the first 48 hours of hospital-at-home episodes and found that 61.6% already reported high caregiver strain, which was linked to prior caregiving experience and limited psychosocial resources. Levine et al. (2020) showed that the model can lower costs and readmissions, but those benefits depend on a stable home setting. Moseley (2018) reminds strategists that implementation depends on the people who carry out a strategy, and in this case some of those people are family members. A program could screen caregivers at admission, offer respite visits and provide a 24-hour nurse line, so that no family feels it is carrying the episode alone. The psalmist says that God settles the solitary in a home (English Standard Version Bible, 2001/2016, Psalm 68:6), and a program that brings hospital care home should also support the household that receives it. Would your group include caregiver screening in the admission criteria, or treat it as a service offered after admission? The answer shapes both who can enroll and how much support staff must provide.

Reply to Group 4

Group 4, your thread asked why, if hospital at home performs so well, so few hospitals have adopted it at scale. Vakkalanka et al. (2026) found that only 68 of 313 hospitals with federal waivers had at least 12 Medicare hospital-at-home admissions in their study period and that 11 hospitals accounted for about half of all such admissions, which confirms how uneven adoption has been. Part of the explanation is financial uncertainty, which makes boards hesitant to invest, since federal payment has depended on temporary waivers, and part is operational, since the model requires new staffing, logistics and technology. Levine et al. (2020) also noted that their trial involved highly selected patients, and many eligible patients declined, which limits how quickly any hospital can grow a program. Moseley (2018) notes that the strategies most likely to create lasting advantage are often those that are hardest for competitors to copy, which suggests that the difficulty of building a program is part of its strategic value. Jesus taught that when we host a feast we should invite the poor, the crippled, the lame and the blind (English Standard Version Bible, 2001/2016, Luke 14:13), and as programs grow, leaders should make sure patients without stable housing or caregivers are not quietly excluded. How would your group measure whether a program is reaching patients equitably?

References

Duhamel, S., Iktelat, A., Lerner-Shikory, M., Zarbiv, E., Lustman, A., Sabar, R., & Eilat-Tsanani, S. (2026). Caregiver burden at the onset of acute hospital-at-home. Journal of the American Geriatrics Society, 74(8), 2338-2348. https://doi.org/10.1111/jgs.70573

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Levine, D. M., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C. T., & Schnipper, J. L. (2020). Hospital-level care at home for acutely ill adults. Annals of Internal Medicine, 172(2), 77-85. https://doi.org/10.7326/M19-0600

Moseley, G. B., III. (2018). Managing health care business strategy (2nd ed.). Jones & Bartlett Learning.

Vakkalanka, J. P., Young, T. L., Bianchi, G., Ullrich, F., Carter, K. D., Mohr, N. M., & Gutierrez, J. (2026). Outcomes associated with hospital at home vs traditional inpatient stay. JAMA Network Open, 9(5), e2610810. https://doi.org/10.1001/jamanetworkopen.2026.10810