Plateau University Hospital is a large academic medical center in a major urban area. In order to survive in a competitive and economically challenging geographic market, Plateau built upon a strategy of inpatient volume growth. Each time the volume group, it increased capacity through savings in reduced length of stay (LOS). This allowed the hospital to meet its ambitious budgetary goals and realize the desired growth and profit targets.

To accomplish this, Plateau has made some dramatic strides in efficiency over the past five years. However, executives feel that much of the low-hanging fruit has been picked and further progress and additional opportunities for length of stay reductions will require greater creativity. When looking at further opportunities to reduce length of stay while maintaining their mission to deliver high-quality patient care, Plateau leadership is exploring the idea of building upon their small hospitalist group. Currently, there is a four-person hospitalist group, which manages the inpatients of a small proportion of the hospital-owned office group practices. These hospitalist have a reduced length of stay compared to other doctors and are perceived to deliver high-quality and accessible care. Is there more opportunity here?

Plateau leadership has begun to read about the growth in hospitalist programs across the country and has heard about their potential to improve efficiency and quality of inpatient care. On the other hand, they also have heard that these programs have potential problems with hiring and retention as many doctors see them as temporary “burnout jobs” for recent graduates. The current crop of four doctors seems to fit this profile. Before hospitalist have been working a lot of weekends and route is low. While they are running their own program, they reportedly have insufficient support or leadership.

To take on the challenge of building a hospitalist group, the hospital hires and energetic but inexperienced physician leader. Dr. Angel Young is ambitious, and he realizes he got the job largely because others may not have wanted the position. However, he sees this as a real turnaround opportunity. After the first few meetings with the hospitalist group, young realizes he has an uphill battle. In spite of the negatives associated with their current situation, the four hospitalist are still resistant to change and appear resistant to Young’s new authority.

Young immerses himself in the job and tries to experience the hospitalist role as the four practitioners do. He is a hands on leader who studied the workflow and processes in which his group operated. He also networks with leaders at other hospitals enjoins national hospitalist groups to develop a better understanding of the landscape for this growing specialty. He knows that in order to be successful, he needs support from both the hospital administration above and from the four hospitalist below. After a few months, he is able to list the challenges and opportunities associated with building a successful hospitalist program.

Challenges

• Low morale-“ignored,” “overworked,” “underpaid”

• Difficult personalities-“us versus the world” culture

• Resistance to change • Revolving door of leaders-“why trust this one?”

• Reputation as “burnout job”

• Lack of administrative structure-no organized schedule, no moonlighting (coverage) pool for nights and weekends

• Loosely supervised and inefficient-no real boss, no metrics, little accountability

• Rapid growth-no strategic plan to recruit and retain hospitalists providers Opportunities

• Harness institutional need for hospitalist services

• Provide attention to hospitalist/gain trust

• Job redesign-make it sustainable with possibility for upward mobility

• Create room for career development-add academic opportunities, research support

• Create administrative structure-take-out of hands of frontline physicians

• Process improvement-remove irritants in the system

• Create proper incentives-bonus plan with quality and efficiency measures

• Utilize information technology capabilities-improve workflow and provide data to drive productivity

• Expansion-infused new people and attitudes

With support from Plateau administration, young begins to tackle these challenges and initiate the change campaign. However, young does not move too quickly and impulsively with respect to change. He knows he needs a few “short-term wins” to begin the cultural change process and build support from both the group and his bosses. Developing a fair bonus plan with proper incentives is an effective early step that garners significant support. In addition, monthly hospitalist lectures are added to the hospitals lecture schedule. This conveys a concern for career development and provides a venue for education and teambuilding among the hospitalist.

Equally important among Young’s early steps is quickly building a moonlighting pool. This effort wrestles away a large chip of informal power that the hospitalist previously wielded. Through a new call system and some strategic process improvements, the hospitalist are also able to be more efficient and productive. The number of admissions per FTE increases and the length of stay for the hospitalist patients improves. These positive results attract additional support from hospital administration to help energize the initial push and withstand any resistance around the change efforts.

While the first six months are rough and not without tension and resistance, the initiative seems headed in the right direction. Young works with his hospitalist group to ensure that they maintain their initial momentum by communicating about goals and accomplishments, encouraging teamwork, in creating a strategic vision for the hospitalist service at Plateau University Hospital.

Case Questions

1. What are the challenges a new leader faces when trying to implement change?

2. How can Dr. Young best approach this difficult group of doctors?

3. What are the key elements in building a successful hospitalist program, and how can Plateau build a sustainable model that will be attractive enough to recruit and retain positions?

4. What kinds of data and metrics might a hospitalist leader need to run his group and track progress and success?

5. What is senior leadership looking for from Dr. Young and his group, and how can they best deliver on these expectations in order to ensure ongoing support and resources for their program?

Eastern University had the following transactions at the beginning of its academic year:

Student tuition and fees were billed in the amount of $7,000,000. Of that amount, $4,500,000 was collected in cash.

Pell Grants in the amount of $2,000,000 were received by the university.

The Pell Grants were applied to student accounts.

Student scholarships, for which no services were required, amounted to $450,000. These were applied to student tuition bills at the beginning of each semester.

Required:
Prepare journal entries to record the above transactions assuming:
a. Eastern University is a public university.
b. Eastern University is a private university.

choose the correct words to complete the sentences.

Part A: Academic Vocabulary

1. Doctors need to be able to communicate quickly with patients who experience anxiety/probability/tendencies between appointments.

2. There is an irrational/apparent/anxious connection between patients' stress levels and wait time for doctors to provide them with test results.

3. The patients' appointments, phone calls, and stress are all probable/demonstrated/triggered by new symptoms or increased pain.

4. Patients' fears can seem irrational/logical/probable because there may not be a good reason to think they need immediate medical attention.

5. From the patient's point of view, the logic/triggered/demonstrated thing to do might be to contact the doctor and make sure everything is fine.

6. Since many patients have a probability/tendency/trigger to worry about medical issues, doctors have begun to use social media such as blogging to help patients outside of office hours.

7. Some doctors send mass email notifications of new blog posts to reduce the probability/anxiety/logic that patients will seek time-consuming answer to general questions

. 8. To help patients with anxiety, some doctors provide triggers/logic/demonstration of the anxiety-reducing techniques described in their posts and messages.

Part B: Academic Collocations

Complete the paragraph with the correct forms of the academic phrases in the box.

basic logic clearly demonstrate high probability

Irrational tendency    logical conclusion

There are several ways that parents can help children who are victims of cyberbullying. While................ would say that staying connected to bullies online is unhealthy, children might not realize this without their parents help. They can also monitor their children's Internet use and try to stop their ..........................to stay connected to bullies on social media. While some parents can help their children, research............................. that many teenagers need outside help, perhaps from a school counselor or psychologist. Without this help, there is a.............................that cyberbullying will continue. The...................is that the problem of cyberbullying needs to be prevented because it is doing so much harm to these young people.

Eastern University had the following transactions at the beginning of its academic year:

Student tuition and fees were billed in the amount of $7,000,000. Of that amount, $4,500,000 was collected in cash.

Pell Grants in the amount of $2,000,000 were received by the university.

The Pell Grants were applied to student accounts.

Student scholarships, for which no services were required, amounted to $450,000. These were applied to student tuition bills at the beginning of each semester.

Required:
Prepare journal entries to record the above transactions assuming:
a. Eastern University is a public university.
b. Eastern University is a private university.

IMPORTANT!!! Please answer it precisely. It is expected to use academic knowledge and language. Use your own words, do not copy paste.

Suppose you are a microbiologist living in late 1800ies and early 1900. You suspect that the microorganism called Mycobacterium leprae might be responsible for the disease called leprosy. You had heard about a researcher called Robert Koch and his postulates, and you would like to follow his approach to test if leprosy is caused by Mycobacterium leprae. Explain stepwise and in detail the experimental procedure that you would follow. Please also explain what kind of results you would expect in each step of your procedure.

IMPORTANT!!! Please answer it precisely. It is expected to use academic knowledge and language. Use your own words, do not copy paste.

Please explain in detail how the microbiology information about the infectious diseases and their epidemiology, aseptic techniques of microbiology (sterilization, disinfection, antimicrobial techniques and agents) helped you during the COVID-19 pandemic. Please give detailed examples of how you used your microbiology and/or scientific knowledge in helping/informing people in your family and/or your community and/or how different was your behavior and attitudes than the others (non-microbiology/molecular biology people) around you during the COVID-19 pandemics and the lockdown period.

9. The table below represents the college degrees awarded in a recent academic year by gender. Choose a degree at random.

Find the probability that it is a) A bachelor’s degree b) A doctorate or a degree awarded to a woman c) A doctorate awarded to a woman d) Not a master’s degree e) doctorate awarded to a man. Answer in a,b,c,d,e format. (IE A=, B=, etc).

             Bachelor’s Master’s Doctorate

Men 542,731 201,322 27,390

Women 785,334 311,267 21,680

A university wishes to evaluate the claim that car ownership affects academic achievement in ungrad students. the university randomly sampled 50 undergrad students who owned cas and 50 who didn't.GPAS for these students are shown in the accompanying excel worksheet. conduct a hypothesis test at the .05 level to determine whether GPAS are different for car owners and non car owners.

a.State hypothesis

b,choice statstical test and jusitfy choice and assumptions.

11. Suppose a school principal is trying to increase academic outcomes by providing snacks to students. She is allocating her money between two snack inputs: bananas and yogurt. She has a budget of $400. A carton of bananas costs $40, and a bundle of yogurts costs $50.

a) Draw the principal’s budget constraint, putting bananas on the x-axis and yogurts on the y-axis. Write down the equation for the budget constraint.

b) Suppose productive efficiency occurs at the point where she consumes 5 cartons of bananas and 4 bundles of yogurts. Label this point “PE” and draw the corresponding isoquant line at the point of efficient allocation.

c) Suppose the school district implements an input policy that specifies schools must spend their budget on providing at least 4 cartons of bananas to students. How will this change the way the principal allocates between bananas and yogurt? Explain.

d) Suppose that instead of an input policy, the school district implements a total resource policy and give the school a budget of $500 instead of $400. How does this change the amount of bananas purchased at the point of productive efficiency? How does this change the number of yogurts purchased? What is the slope of the isoquant at the new point of productive efficiency?

According to the website www.collegedrinkingprevention.gov, “About 25 percent of college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall.” A statistics student is curious about drinking habits of students at his college. He wants to estimate the mean number of alcoholic drinks consumed each week by students at his college. He plans to use a 99% confidence interval. He surveys a random sample of 55 students. The sample mean is 3.69 alcoholic drinks per week. The sample standard deviation is 3.56 drinks.

Construct the 99% confidence interval to estimate the average number of alcoholic drinks consumed each week by students at this college.

( ,  )

Your answer should be rounded to 2 decimal places.