Project: Strategic plan for the development of a new service by Angela Baird and Delphia Croff

1. Project: Strategic plan for the development of a new servicebyAngela Baird and Delphia Croff Nurs 440: Nursing Leadership

2. Kent County Men’s Wellness Clinic This health clinic is focused on the wellness of the men of Kent County, Michigan. The areas of men’s health to concentrate on will be the prevention, education, and screening of diabetes, hypertension, and cancer. We have a goal to help the men of Kent County, Michigan understand, meet, and cope with their health care needs.

3. External Assessment • Men tend to disregard symptoms and are hesitant to seek medical care until problems arise. A March 2000 survey by the Commonwealth Fund, found that 24% of men did not see a doctor in 1999. This is three times that of women, about 8% (www.minorityhealth.hhs.gov). • According to the May 2003 article in the American Journal of Public Health, Latino and African American men are considerably less likely to see a physician than White men. And 55% of Latin and 45% of African American men do not see a doctor on a regular basis.

4. Minority men are more likely to be uninsured than White men. Even when health care insurance and income differences are accounted for African American men obtain less preventive services than white men. Such services include flu shots and colonoscopy screenings (www.minorityhealth.hhs.gov). • Cancer and diabetes type II are on the top ten lists of preventable male health threats (www.mayoclinic.com). According to the Center for Disease Control (CDC) 2004 statistics, cancer, heart disease, and diabetes are on the top ten leading cause of death of men in the United States regardless of ethnicity (www.cdc.gov/men/lcod/index.htm).

5. The external environment assessment showed a lack of available clinics with a focus on men’s health. The Kent County Health Department offers multiple programs, but none focused on male only specific health concerns (www.access.kent.com). The Men’s Resource Center of Fountain Hill was the only male only health service located via a Google internet search of the Kent County area.

6. There are very few health education programs targeted for the male perspective. Educational handouts and seminars will be held to inform our patients of diabetes, hypertension, and cancer. We will also conduct health care assessments and screenings for diabetes, hypertension, and cancer. The health screenings will include blood pressure clinics, blood sugar checks (fasting/ non-fasting) via finger stick, and even prostate and colorectal cancer screenings.

7. Internal Assessment • The original programs offered would be small. The early programs will provide informal educational clinics based on one men’s health issue at a time. The original educational clinics programming would be conducted and researched by the licensed professional health care staff. They would continually assess and validate each program for its effectiveness. • Licensed staff would volunteer their time in the early stages to reduce cost, prior to offering staff wages.

8. The clinic has an institution to model after. The Men’s Health and Wellness Center is located in Georgia. This clinic is a center that is all about men and the serious health issues they face. The Men’s Health and Wellness Center offers health programs for all of the major health diagnoses, healthy lifestyle programs and speaking events, nutrition counseling, men’s health expositions, internet access, and internet and radio podcast sessions (www.menshealthandwellness.org).

9. SWOT Analysis • Strengths • Unique selling point for men only. • Staffed by experienced LPN’s, RN’s, NP’s and Doctors. • Located in a central downtown area for cultural diversity and ease of access. • More services free or on sliding payment program. • Location in well know and established area for possible referrals • from the local health department. • Located in a Urban area for word of mouth marketing. • Weaknesses • Few initial services offered. • Start up costs of staff wages, supplies, and IT systems. • Continuing to receive money/donations for supply and staff wages. • Initial location/building cost of buying, leasing, and furnishing clinic. • Opportunities • Prospect of developing male focused satellite clinics in Kent and other neighboring counties. • Opportunity to educate and the advancement of DM, HTN, and Cancer in men. • Opportunity to bring new screening methods and technology to a diverse low-income culture. • Chance to impact the healthcare of male patients diagnosed with DM, HTN and Cancer. • Threats • Affordability of using new technology and services to a diverse and low-income population. • Sustaining chartable donations, business contracts, and patient cash payments for maintaining operating expenses.

10. Missionstatement “Increase the availability of education, health screening, and services to men of Kent County to promote quality of life. Provide early detection and prevention of diabetes, hypertension and cancer through high quality, individualized and compassionate care by nursing professionals.”

11. Philosophy Patients We believe • It is the right of all men to make informed choices concerning their health and treatment to the extent of individual abilities and needs. • Men have a right to high-quality nursing care and opportunities for improving their quality of life. • Men have the right to education for early detection and prevention of diabetes, hypertension and cancer by nursing professionals. • Promotion of health to all men regardless of race, ethnic background or ability to pay.

12. Nursing We believe • The nurse’s goal is to promote a healthy lifestyle to men through community health clinics. • The nurse’s aim is to increase the availability of education, health screening and services to men of Kent County. • It is the nurse’s responsibility to refer men to higher levels of care when appropriate to maintain a healthy quality of life. • The nurse’s goal is to provide education to men of Kent County on the early detection and prevention of diabetes, hypertension and cancer through high quality and compassionate care.

13. Organizational Goals and Objectives Goals • To provide individualized, non-judgmental, and comprehensive prevention, educational, and screening services for Kent county male clients in an outpatient program. • To provide our clients affordable diabetes, hypertension, and cancer screening test in an outpatient clinic. • Ensure quality care of male outpatient clients from a multidisciplinary approach through the use of LPN’s, RN’s, counselors, and physicians.

14. Improve community access to the most current health information on diabetes, hypertension, and cancer for male patients in Kent County. • Develop individualized wellness programs specifically for adolescent and adult male patients in Kent County, MI. • Enhance the male patient health experience through dignity and respect to encourage future return visits to the wellness clinic. • Improve health outcomes of men and reduce negative impacts of diabetes, hypertension, and cancer on men’s health in Kent County, MI.

15. Objectives • Diabetic patients  will be able to monitor and record blood sugar levels, describe sign and symptoms of low and high blood sugar, and understand importance of good diabetes control by the end of their health education program. • Hypertension patients will be able to monitor and record blood pressures, describe signs and symptoms of high or low blood pressure, and understand importance of good blood pressure control by the end of their health education program.

16. Male clinic patients 45 years old and above will be able to describe signs and symptoms of prostate and colorectal cancer and understand when and what tests are used to screen for these common male cancers by the end of their health education program. • Improve patient blood sugar and blood pressure levels by their third visit to the clinic. • Clinic hours consist of 3 hours in the morning Monday-Saturday, 5 hours in the afternoon Monday-Saturday, and 4 hours in the evening Monday-Wednesday-Friday. The clinic will be closed on Sundays. 

17. Organizational Chart for Kent County Men’s Wellness Clinic Clinic Director/Executive Director of Nursing Director of Information Technology Director of Funding/Finance Director of Human Resources Nurse Manager Health Education Programs Healthcare Assessments Cancer Screening Referral to a Higher Level of Care Blood Sugar Via Finger stick (Fasting/Non-Fasting Blood Pressure Clinics Prostate/Colorectal Cancer Educational Handouts and Seminars for DM, HTN and Cancer PCP/Hospital Physician/Nurse Practitioner Physician/Nurse Practitioner RN/LPN RN/LPN

18. Job Descriptions CLINIC DIRECTOR Job description • Ensures delivery of clinic services to patients in collaborations with the physician and policy and procedures. • Applies principles of leadership and human resource skills in supervision and coordination of patients and staff. • Maintains clinic specific standards of practice based on current evidence-based literature and professional standards of practice.

19. Develops clinic quality assurance/improvement in association with the physician and clinical staff. • Maintains supplies and equipment as appropriated for adequate clinic function and budget expectations. Requirements • Minimum Bachelors Degree in Business Management or Bachelor’s degree in nursing with current Michigan RN license.  • Previous supervisor experience preferred. • Demonstrated leadership skills required

20. PHYSICIAN Job description • Evaluates and treats patients (including walk-ins) in an ambulatory clinic setting. • Provides preventative care and education for diabetes, hypertension, and cancer diagnosis. • Writes prescriptions. Requirements • Doctorate Degree in Medicine. • Licensed to practice Medicine.  • Completion of 3 year family practice or internal medicine residency. • Board eligible and or board certified in family practice or internal medicine. • Experience with diverse cultures and incomes.

21. NURSE PRACTITIONER (NP) Job description • Evaluates and treats patients (including walk-ins) in an ambulatory clinic setting. • Provides preventative care and education for diabetes, hypertension, and cancer. • Write prescriptions. • Care guided by clinic physician. Requirements • Licensed in the state of Michigan. • 3 years of family practice or internal medicine experience • Experience with diverse cultures • Must process computer skills • BCLS and ACLS certified • Exceptional, compassionate, and highly motivated individual • Experience with cultural diversity

22. REGISTERED NURSE (RN) Job description • Provide direct patient care under the direction of the physician. • Provide management, follow-up, and mentoring of patients in a clinic wellness program. • Assist patient care services by developing and coordinating implementation of diabetes, hypertension, and cancer education. • Provide health screening for diabetes, hypertension, and cancer diseases for a diverse culture and income level for men. • Implement health risk modification programs.

23. Requirements • Currently licensed as a Registered Nurse in the State of Michigan. • Active BCLS certification. • Exceptional, compassionate, and highly motivated professional. • At least 1 year experience as a Registered Nurse. • Experience in internal medicine, family practice, or medical-surgical nursing preferred. • Must possess computer skills.

24. LICENSED PRACTICAL NURSE (LPN or LVP) Job description • Provide direct patient care under the supervision of the registered nurse. • Assess patients in a clinic setting. • Effective telephone triage and computer skills. • Maintains patient exam rooms and renew prescriptions. Requirements • Current license as a licensed practical or vocational nurse. • Currently BCLS certification. • Exceptional, caring, and dedicated professional. • At least 1 year experience as a LPN/LVN. • Experience as a LPN/LVN in family practice, internal medicine, or medical-surgical nursing preferred.

25. DIRECTOR OF FINANCE Job description • Maintains employee payroll. • Budget preparation, reconciling accounts, and monthly audits of accounts. • Annual forecasting and analysis. • Tax preparation and audit of accounts. • Manages all aspects of facilities accounting and financial reporting. Requirements • Bachelors Degree in Finance. • Masters Degree in Finance or Business Administration preferred. • CPA certification desired. • Minimum of 5 years experience in accounting or finance. • Salary commensurate with experience.

26. DIRECTOR OF HUMAN RESOURCES Job description • Develops job recruiting strategies. • Maintains employee benefits programs and unemployment claim issues. • Ensures compliance with state and federal law governing all areas of HR functions. Requirements • Minimum Bachelors Degree in Human Resources or Business Management, Masters Degree preferred. • Minimum of 5 years recent experience in human resource management. • Salary commensurate with experience.

27. DIRECTOR OF INFORMATION TECHNOLOGY Job description • Maintains computer system administration. • Manages network operations and databases. • Oversees all IT infrastructure problems. Requirements • Minimum of Bachelors Degree in Information Technology, Computer Programming, or Business Administration; Masters Degree preferred. • Minimum 5 years recent computer systems management, medical setting preferred. • Salary commensurate with experience.

28. NURSE MANAGER Job description • Maintains schedules, assignments, and supervise clinic staff. • Coordinates and manages patient care programs. • Ensures compliance of policy, procedures, and clinical practice guidelines. • Ensures clinic compliance of regulatory standards (i.e.: JCAHO, DOH). • Monitor clinic needs of current and expected volume and supply demands. Requirements • Bachelors Degree in Nursing or Administration required. • Masters in Business Administration is desired. • Salary commensurate with experience.

29. Job Advertisement CLINIC DIRECTOR

30. Kent County Men’s Wellness Clinic Come and join a new men’s health clinic in Kent County. This clinic emphasizes on men’s health of all ages and cultures. Conditions include diabetes, hypertension, and cancer. The clinic is currently seeking an exceptional, compassionate, and highly motivated clinic director.

31. Job description Includes delivery of clinic services to patients in collaboration with the physician, policy and procedures. Applies principles of leadership and human resource skills in supervision and coordination of patients and staff, maintains clinic specific standards of practice based on current evidence-based literature and professional standards of practice, develops clinic quality assurance/improvement in association with the physician and clinical staff, maintains supplies and equipment as appropriate for adequate clinic function and budget expectations.

32. Requirements Minimum Bachelors Degree in Nursing or Business Management, previous supervisor experience preferred, and demonstrated leadership skills required. Contact Information Angela Baird, RN or Delphia Croff, RN at: Kent County Wellness Clinic 2010 Wellness Way Dr. Grand Rapids, MI 49505 1-800-555-2010 or 616-555-KENT

33. Advertisement Prices  • Michigan Nurse Magazine offers ad by the page. The price for a ¼ page ad is $850 each x1 insertion and $770 each x 2 insertions. The price for ½ page ad is $1,470 each x 1 insertion and $1,391 each x 2 insertions (prices/insertion). • There are free online ads or classifieds. Businesses can Google online advertising and multiple sources are available. One internet site example is www.webclassifieds.us and www.adleaf.com. Most of these sites ask that you link your website with theirs and they will then advertise. • Monster.com also offers local or nationwide job advertisements. Prices are priced per advertisement for either a 30 day or 60 day duration. The prices are dependent on your location. For Grand Rapids the price is $275 for a 60 day duration and $250 for 30 day duration.

34. Budget Proposal • The number of full-time equivalents (FTEs) to meet objectives will vary depending on the volume of patients that are seen at the opening of the clinic. Preliminary hours of operation are M-W-F from 9a-9p, T-TH-Sat 9a-5p, and closed Sundays and holidays. • If the clinic is off to a slow start, we would need to make adjustments to the FTEs needed. The clinic hours would also be adjusted to be open M-W-F 9a-9p and every other Saturday 9a-1p only.

35. Initially, the most cost-effective staff mix will be one or two MAs, one or two LPNs, one RN, one NP, and one nurse manager. This staff mix is cost-effective because MA and LPN are less expensive to employ than RNs and NPs.

36. Funding and reimbursement would primarily come from grants and donations. There would need to be donations of supplies, medical equipment, computers, printers, and fax machines. This equipment would be the greatest expense. It could be donated as used or new equipment. There are small business and government grants available. I found many on the internet to access and apply. • Here are a few websites located on the internet for small business and government grants: www.usgrantsforfree.com, www.yourfundingguide.org, www.SBA.org, www.sba.gov, www.GovernmentGrantApproval.com, and www.USAFundingApplications.org. Initial fund raising fairs or activities are another possibility.

37. Salaries and benefits are a big expense for any organization, whether they are for profit or nonprofit. Below is a list of median full-time employee salaries/year for the Grand Rapids, Michigan area. The salaries listed are as of March 2010. This information was obtained from www.monster.salary.com. • Medical Director $216,244 • Finance Director $229,977 • Human Resource Director $121,922 • Information Technology Director $164,281 • Nurse Manager $90,846 • Nurse Practitioner $90,606 • Registered Nurse $66,434 • Licensed Practical Nurse $39,137 • Medical Assistant $31,028

38. Considering the high expense of salaries for the finance, human resource, information technology, and clinic director salaries, the men’s wellness clinic will need to partner with another institution. The clinic would operate out of a separate building, but be under the capacity of the parent organization. This association would allow for the high corporate salaries of the director positions to be absorbed by the larger parent organization. • The operating expenses needed in the early stages would be computers, printers, fax machines and general office supplies. There would be a needfor basic medical supplies of needles, syringes, band aids, antiseptic, gauze, lab supplies, blood pressure machines, and other equipment needed to take simple vital signs.

39. The least amount of revenue would come from patients. The services provided for patients are to be billed to the insurance companies and patients may be able to pay out-of-pocket for some services on a sliding scale rate. • The following budget proposal is based on estimations of staff mix needed, supplies, and revenue. This initial budget proposed is for one full-time MA or LPN, one full-time RN, and one full-time nurse manager, and one part-time NP.

40. KENT COUNTY MEN’S WELLNESS CLINIC TWELVE MONTH BUDGET PROPOSAL YEAR 2010 REVENUE Patient revenue $50,000 Insurance payments $100,000 Grant income $150,000 Donations $125,000 Total revenue $425,000 EXPENSES Salary and benefits Regular salary $240,000 Salary overtime $5,000 Benefits ($8,000/employee) $32,000 Total salary and benefits expense $277,000 Supplies General office supplies $12,000 General medical supplies $24,000 Patient charge supplies $6,000 Minor equipment $10,000 Forms $5,000 Total supplies $57,000 Services Laundry service $2,000 Total services $2,000 Building expenses Rent/Lease $18,000 Utilities $10,000 Total Building Expenses $28,000 TOTAL REVENUE $425,000 TOTAL EXPENSES $364,000 REVENUES UNDER/OVER EXPENSES $61,000

41. References References www.accesskent.com www.businessballs.com www.cdc.gov/men/lcod/index.htm www.fountainhillcenter.org www.healthyamericans.org/states www.mayoclinic.com www.menshealthandwellness.org www.minorityhealth.hhs.gov www.monster.salary.com www.nlm.nih.gov/medlineplus Yoder-Wise, P.S. (2007). Leading and managing in nursing. St Louis, MO: Mosby.