BUSI 691 Week 6 Discussion Board Forum 3 Example

Discussion Board Forum 3: Strategic Initiatives and Innovation in Health Care Delivery

BUSI 691 Healthcare Administration Capstone, Discussion Board Forum 3

Thread by [Student Name]

The health system, its capacity figures and the other groups are composites; the textbook, Scripture and the peer-reviewed sources cited are real.

Our group studied Harbor Health, a two-hospital system whose medical beds ran at 94% average occupancy last year. Emergency patients waiting for beds now board an average of nine hours, and elective surgeries are canceled several times a month. Leadership has proposed a $310 million tower with 120 new beds, which would take four years to open. Our group asked whether hospital at home, in which carefully chosen patients sick enough for admission are treated by hospital teams in their own homes, could provide some of that capacity sooner and at lower cost.

Walston (2018) stresses that strategic initiatives succeed when they fit both the environment and the organization's capabilities, and that execution requires the right people, systems and resources aligned with the strategy. The environment favors hospital at home: patients prefer to recover at home, Medicare has permitted hospital-level payment for acute care at home under a federal waiver and remote monitoring technology has matured. Harbor's capabilities are mixed. It has a strong home health agency, a paramedic program and a virtual nursing center, but no experience delivering acute care outside its walls and a payer mix in which commercial insurers have not yet agreed to pay for it. Its culture is another consideration. Physicians who have practiced only in the hospital may hesitate to manage acutely ill patients they cannot see in person several times a day, and nurses will need new skills in assessment by video and in coordinating home deliveries. Walston's emphasis on aligning people with strategy suggests that recruiting a small group of enthusiastic physicians and nurses to lead the program will matter as much as the technology.

The evidence on outcomes is encouraging. In the trial by Levine et al. (2020), 91 adults who came through the emergency department needing admission, mostly for heart failure, infections or lung disease, were assigned at random to be treated at home or on a ward. After adjustment, treating an episode at home cost 38% less, who had far fewer lab orders and imaging studies, were more physically active while ill and were readmitted within 30 days less often, 7% compared with 23%. The trial was small and the patients highly selected; 63% of eligible patients declined. Arsenault-Lapierre et al. (2021) pooled nine randomized trials with 959 patients who had chronic diseases and presented to the emergency department. Mortality did not differ between hospital-at-home and in-hospital care, while readmission risk was 26% lower and the risk of long-term care admission was much lower, although treatment lasted about five days longer on average.

Our group recommends that Harbor open a 20-bed virtual unit within twelve months, starting with heart failure, pneumonia, cellulitis and urinary tract infection. Each virtual bed would free a physical bed, so the unit could add roughly the capacity of a small hospital floor at a fraction of the tower's cost. Execution would require a physician-led team, twice-daily nursing or paramedic visits, a 24-hour command center, home delivery of medications and equipment, and payment agreements with Medicare and at least two commercial insurers. The board should not cancel the tower, but it could delay and resize it after a year of data shows how many patients the virtual unit can safely serve.

When Jesus entered Peter's house and found Peter's mother-in-law sick with a fever, he touched her hand, the fever left her and she rose and served him (English Standard Version Bible, 2001/2016, Matthew 8:14-15). Healing has always been able to happen at a kitchen table as well as in a ward, and a hospital that brings its care home is following a very old pattern.

Reply to Group 2

Group 2, your thread argued that hospital at home suits urban systems but not rural ones, because distances are long and patients may lack broadband or caregivers. Those are real obstacles, and Walston (2018) would remind us that an initiative must fit the setting where it is carried out. Recent evidence suggests the model can travel, with adjustments. Desai et al. (2026) interviewed 38 patients who received rural home hospital care in a randomized trial at three rural sites in the United States and Canada, with twice-daily nurse or paramedic visits and daily remote physician visits. Patients were satisfied overall, citing rapport with the care team, safe care and comfort at home, better sleep and nutrition, while noting that the technology had a learning curve. Rural trust matters as well; Van Sandt et al. (2026) found rural residents often skeptical of local care and willing to travel past local facilities, which suggests a home program run with a respected regional hospital might win more confidence than a new local building. We would suggest starting with patients within a set driving radius and using paramedics for visits. Isaiah describes the Lord tending his flock like a shepherd, carrying the young ones close and leading the nursing ewes with care (English Standard Version Bible, 2001/2016, Isaiah 40:11), and care that comes to rural patients where they live reflects that gentleness.

Reply to Group 5

Group 5, your thread recommended remote patient monitoring for all heart failure patients discharged from your system, with daily weights and blood pressure sent to nurses, expecting a large drop in readmissions. The idea fits the call in Walston (2018) to use technology in service of strategy, but the evidence suggests that design determines results. Ong et al. (2016) assigned 1,437 heart failure patients aged 50 and older, admitted to six academic medical centers in California, to telemonitoring with health coaching calls or usual care; 180-day readmissions did not differ, 50.8% versus 49.2%, although quality of life improved. Koehler et al. (2018) randomized 1,538 patients in Germany to a more intensive remote management program with a 24-hour telemedical center and found fewer days lost to unplanned cardiovascular admission or death, 4.88% versus 6.64%, and lower all-cause mortality. We would suggest your plan include round-the-clock clinician response and clear protocols for acting on data, not monitoring alone. Proverbs contrasts the naive person who trusts every claim with the sensible one who watches where each step lands (English Standard Version Bible, 2001/2016, Proverbs 14:15), and building on the stronger trial's design is that kind of prudence. Starting with the patients at highest risk of readmission would also concentrate the program's cost where the potential savings are greatest.

References

Arsenault-Lapierre, G., Henein, M., Gaid, D., Le Berre, M., Gore, G., & Vedel, I. (2021). Hospital-at-home interventions vs in-hospital stay for patients with chronic disease who present to the emergency department: A systematic review and meta-analysis. JAMA Network Open, 4(6), e2111568. https://doi.org/10.1001/jamanetworkopen.2021.11568

Desai, M. P., Findeisen, S. M., Blitzer, S. C., Barthel, M. F., Grinman, M. N., Wicker, M., Dykes, P., Harrison, S. M., Amrhein, S. C., & Levine, D. M. (2026). Hospital care at home for adults living in rural settings: A qualitative evaluation. The Journal of Rural Health, 42(3), e70199. https://doi.org/10.1111/jrh.70199

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

Koehler, F., Koehler, K., Deckwart, O., Prescher, S., Wegscheider, K., Kirwan, B. A., Winkler, S., Vettorazzi, E., Bruch, L., Oeff, M., Zugck, C., Doerr, G., Naegele, H., Störk, S., Butter, C., Sechtem, U., Angermann, C., Gola, G., Prondzinsky, R., . . . Stangl, K. (2018). Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): A randomised, controlled, parallel-group, unmasked trial. The Lancet, 392(10152), 1047-1057. https://doi.org/10.1016/S0140-6736(18)31880-4

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: A randomized controlled trial. Annals of Internal Medicine, 172(2), 77-85. https://doi.org/10.7326/M19-0600

Ong, M. K., Romano, P. S., Edgington, S., Aronow, H. U., Auerbach, A. D., Black, J. T., De Marco, T., Escarce, J. J., Evangelista, L. S., Hanna, B., Ganiats, T. G., Greenberg, B. H., Greenfield, S., Kaplan, S. H., Kimchi, A., Liu, H., Lombardo, D., Mangione, C. M., Sadeghi, B., . . . Better Effectiveness After Transition-Heart Failure (BEAT-HF) Research Group. (2016). Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: The Better Effectiveness After Transition-Heart Failure (BEAT-HF) randomized clinical trial. JAMA Internal Medicine, 176(3), 310-318. https://doi.org/10.1001/jamainternmed.2015.7712

Van Sandt, A., Line, K., Gruber, A., Meier, C., Carpenter, C., & Loveridge, S. (2026). Rural emergency hospitals: Emerging patterns of adaptation and community perception. The Journal of Rural Health, 42(1), e70112. https://doi.org/10.1111/jrh.70112

Walston, S. L. (2018). Strategic healthcare management: Planning and execution (2nd ed.). Health Administration Press.