Decision Making

Being forced to eliminate or introduce clinical services within any health care facility because of a budget cut can be extremely difficult and stressful. The appropriate decision-making steps need to be implemented to ensure success to the final outcome. This paper will discuss how one can use the Informed Decision Toolbox to effectively determine which clinical services can be introduced or eliminated in a county clinic with a budget cut of 15%. The best tool used for the decision as well as how the toolbox affects accountability and knowledge transfer will also be discussed.

As a manager in a county clinic that provides health care to Medicaid patients, clinical services can become expensive for the facility. Within the clinic, numerous services are offered including: blood pressure screenings, blood sugar testing, pregnancy tests, flu/shingles/HPV vaccinations, yearly examinations for women, free antibiotics for patients, and affordable prescription drugs. Multiple services are offered at the clinic to alleviate the community traveling to different health care facilities for their health care needs. "It is believed that integration of care leads to greater public access, including more equitable access for people from different communities and socio-economic backgrounds, a more convenient and satisfying service, and better health overall" (Dudley & Garner, 2011, para. 2). It is difficult for one to eliminate any of these services because of the budget cut, so Rundall's Informed Decision Toolbox came in to play to aid in finding the most logical answer. According to Rundall (2007), "The Informed Decision Toolbox (IDT) is an integrated set of tools that assists healthcare managers and policymakers in finding and assessing research evidence and in adapting and applying research evidence to important decisions in their organizations" (p.3). Rundall (2007) also goes on to explain that useful evidence made for decision making is based upon the "four As" which include: accessibility, accuracy, applicability, and actionability.

In step one of the IDT, all information needs gathered regarding the question at stake in order to properly frame the question as a manager. Being the manager in this situation, all clinical services offered should be taken into consideration as a possibility of being eliminated. Services that are used most by the community should not be considered during the budget cut; people rely on the clinic for their care and eliminating a clinical service that is needed the most could put many people at harm.

Step two of the toolbox helps to ensure that all sources of the information are found. For example, in order to effectively determine which clinical services could be eliminated or introduced to handle the health care needs of a Medicaid population records need to be pulled to see how many people used what services throughout the year. Making calls to other clinics in the area can give an idea of what clinical services are being offered and what is not from building to building. This would give the manager an idea on what should be in the running to be eliminated and what services should stay. The community should also be involved with this decision because after all, the health clinic is for them and only they know what is needed most in regard to their care. As a health care clinic manager, one must improvise ways to continue quality care without going over budget; contacting medical supply manufactures for donations on basic equipment is a good place to start. This equipment can include, but is not limited to items such as: stethoscopes, blood pressure cuffs, thermometers, scales, blood glucose monitors, and etc. Contacting drug companies for samples of medications or working out a deal with the company on medications at a bundle price will help with the budget constraint. Free antibiotics and a consistent $10 prescription drug cost has always been standard and will continue regardless of budget cuts. Another idea is to ask physicians and nurses from local hospitals and doctor's offices to possibly volunteer their time at the clinic. "Many doctors look forward to volunteering because it allows them to escape the bureaucracy of managed healthcare and allows them to practice what they deem to be 'pure medicine' (Smaritan House, 2011, para. 4). Because of the 15% budget cut, this would most definitely be beneficial to the clinic. Flyers can be made and distributed to health care facilities to explain the need for help in the county clinic. Whether the RNs are current or retired, they