Student Name Capella University NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Lobbying for Change To,  Dr. James,  Health Commissioner, Albany, NY 12237. Dr. James,  I am writing to advocate for urgent action regarding the persistent staffing shortages in the Mount Sinai Hospital (MSH) Geriatric Unit in New York. This issue critically impacts patient safety and the wellness of healthcare professionals. Overwhelmed nurses face burnout, leading to higher turnover rates, increased medical errors, and reduced patient satisfaction (Bae, 2022). These challenges disproportionately affect vulnerable populations in Harlem, exacerbating health disparities and straining the healthcare system.  The issue of MSH’s Geriatric Unit staffing shortages will yield huge positive outcomes. Increased nurse-to-patient ratios will improve patient safety, decrease medical errors, and improve health outcomes in Harlem’s aging population. Additionally, it will decrease nurse burnout, increase job satisfaction, decrease turnover rates, and result in a stable, experienced workforce. It will decrease costly reliance on temporary staff and readmissions. The shortages will put more and more healthcare workers under stress, increasing turnover and operational costs and suffering patient care. Harlem and vulnerable communities nationwide will wait longer, receive limited quality care, and experience worsening health disparities (Griffiths et al., 2021). MSH may also be subject to legal trouble when it fails to achieve staffing standards, as the institution’s financial stability and reputation can be at risk. NHS FPX 6008 Assessment 4 Lobbying for Change MSH’s Geriatric Unit, like many other hospitals around the country, faces a critical national healthcare crisis with projected shortages of 275,000 more registered nurses nationwide and 40,000 more in New York by 2030 (Haddad et al., 2023). The shortage increases the probability of medical errors, higher infection rates, and poorer patient outcomes, especially in vulnerable communities such as Harlem (Griffiths et al., 2021). The turnover costs of nurses are $21,515 to $88,000 per nurse, and recruitment and training costs further strain hospital budgets (Bae, 2022). At institutes, staff shortages result in staff burnout, increased costs with temporary workers, and legal risks of breaking nurse-patient ratios. Harlem has higher readmission rates (75.5%) and premature death rates (21.4%) compared to other parts of the city, a result of poor staffing and health disparities (MSH, 2023). Workforce imbalances affect both access to healthcare and financial sustainability statewide and nationally. Proposed actions include investing in professional development, establishing retention strategies, optimizing resource allocation, and using technologies such as Epic’s EHR system (Judson et al., 2022). These measures enable ethical care, foster diversity, and are aligned with equity in health. The recommended changes uphold ethical principles by promoting patient safety, equity, and nurse well-being, ensuring fair access to quality care for diverse populations. NHS FPX 6008 Assessment 4 Lobbying for Change Personal and professional experiences with staffing shortages at MSH’s Geriatric Unit have highlighted the critical need for adequate nurse-to-patient ratios. Witnessing burnout and patient safety risks firsthand informed resource planning focused on retention strategies and professional development. These experiences also shaped a proactive risk analysis, prioritizing workforce stability and financial sustainability. Please consider these proposed changes to address the staffing crisis in the Geriatric Unit at MSH, as they are important for ensuring the well-being of both healthcare providers and the vulnerable populations we serve. Thank you. Sincerely, Brianna  References   Bae, S.-H. (2024). Nurse staffing, work hours, mandatory overtime, and turnover in acute care hospitals affect nurse job satisfaction, intent to leave, and burnout: A cross-sectional study. International Journal of Public Health, 69(1607068). https://doi.org/10.3389/ijph.2024.1607068  Griffiths, P., Saville, C., Ball, J. E., Jones, J., & Monks, T. (2021). Beyond ratios – flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study. International Journal of Nursing Studies, 117(117), 103901. https://doi.org/10.1016/j.ijnurstu.2021.103901 Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2023). Nursing shortage. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493175/ NHS FPX 6008 Assessment 4 Lobbying for Change Judson, T. J., Pierce, L., Tutman, Mourad, M., Neinstein, A. B., Shuler, G., Gonzales, R., & Odisho, A. Y. (2022). Utilization patterns and efficiency gains from use of a fully EHR-integrated COVID-19 self-triage and self-scheduling tool: A retrospective analysis. Journal of the American Medical Informatics Association, 29(12), 2066–2074. https://doi.org/10.1093/jamia/ocac161 MSH. (2023). Community health needs assessment. The Mount Sinai Hospital. https://www.mountsinai.org/files/MSHealth/Assets/MSH/MSH-&-MSQ-CHNA-2023.pdf

Student Name Capella University NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Business Case for Change Slide 1 Hi, I am _______. Today, I will present a business case about St. Vincent Medical Center (SVMC)’s rehospitalization issue. Slide 2 Rehospitalization due to environmental factors, such as poor air quality and inadequate housing, is a significant challenge affecting healthcare systems nationwide (Chapman et al., 2022). At SVMC, this issue leads to increased readmission rates and financial strain, particularly impacting vulnerable populations in South Los Angeles. This presentation will focus on the feasibility of proposed solutions, including enhanced air quality monitoring and patient education, and discuss their potential benefits, costs, and equitable implementation strategies to address these pressing environmental health concerns. Issue Summary Slide 3 Rehospitalization due to environmental issues is a significant healthcare economic challenge at SVMC, particularly in urban areas like South Los Angeles. Factors such as poor air quality, inadequate housing conditions, and exposure to toxic substances contribute to chronic diseases like asthma, cardiovascular diseases, and diabetes. These conditions often lead to frequent hospital readmissions, placing a substantial financial burden on the healthcare system (Chapman et al., 2022). For example, chronic respiratory disease, which is exacerbated by environmental factors, accounts for approximately 800,000 hospitalizations annually in the U.S., with 20% of these patients being readmitted, often for conditions unrelated to their initial illness (Neira et al., 2021). This cycle of readmission not only increases healthcare costs, exceeding $13 billion but also leads to poorer health outcomes for patients. The high levels of pollution in Los Angeles, mainly ozone and particulate matter, further aggravate these health issues, making this an urgent problem that needs addressing (ALA, 2023). Impact on Individuals and the Community Slide 4 The impact of this issue is far-reaching, affecting me, my colleagues, the organization, and the Hispanic and Black community at large. As a healthcare practitioner at SVMC, I see firsthand the strain this problem places on our resources and staff. The increased workload due to managing chronic conditions and frequent readmissions leads to burnout and job dissatisfaction among my colleague healthcare professionals. A notable consequence is the high turnover rates, with 1.6 times more physicians and one-third of the nursing staff considering leaving within two years (Kelly et al., 2020). This not only disrupts the continuity of care but also exacerbates the strain on the remaining staff. For the organization, these frequent readmissions result in financial penalties and a tarnished reputation, which can be detrimental in the long run (Murray et al., 2021). The Hispanic and Black community, particularly low-income and minority groups in South Los Angeles, suffers disproportionately due to socioeconomic disparities. Poor air quality and substandard housing conditions exacerbate chronic health issues in these populations, leading to a vicious cycle of poor health and economic instability. Addressing these environmental determinants is crucial for promoting health equity and improving the quality of life for Hispanic and Black communities. This initiative is not just about economic savings; it is about fulfilling our ethical responsibility to provide equitable and quality care to all patients (Betancourt et al., 2024). Feasibility and Cost-benefit Considerations Slide 5 Feasibility Addressing the issue of rehospitalization due to environmental factors at SVMC is both feasible and practical. The implementation of air quality monitoring systems and community health initiatives can be integrated into existing hospital operations. For example, setting up air quality sensors in high-risk areas and providing air purifiers in patient homes, especially for those with respiratory conditions, can be achieved with a moderate investment (Wimalasena et al., 2021). The estimated cost for installing air quality monitoring equipment and initial patient education programs is around $500,000. Additionally, the integration of environmental health data into patients’ Electronic Health Records (EHRs) requires an initial investment of approximately $200,000. Still, it is feasible, given the hospital’s existing IT infrastructure (Chen et al., 2020). Cost-Benefit Analysis The financial burden of rehospitalizations due to environmental issues is substantial. For instance, managing chronic respiratory diseases exacerbated by poor air quality costs the U.S. healthcare system over $13 billion annually (Neira et al., 2021). At SVMC, the cost associated with readmissions for conditions like asthma and cardiovascular diseases is significant, with each readmission costing approximately $11,200 per patient. Reducing the readmission rate by 10% could save the hospital an estimated $1.12 million annually. The “State of the Air 2023” report highlights that improving air quality could potentially reduce hospitalizations related to respiratory and cardiovascular conditions by 15%, translating into substantial cost savings (ALA, 2023). The upfront costs of implementing these preventive measures are expected to be recouped within 3-5 years through reduced readmission rates and improved patient health outcomes. Slide 6 Mitigating Risks to Financial Security Potential Risks and Mitigation The primary financial risks include the high initial costs of implementing air quality monitoring systems and patient education programs, potential funding shortfalls, and the difficulty in quantifying the Return On Investment (ROI) for preventive measures. Additionally, there is a risk of penalties from regulatory bodies if readmission rates do not improve sufficiently (Zavorka & Paar, 2022). To mitigate these risks, SVMC should implement a robust financial planning and risk management strategy. This includes setting up a dedicated fund to cover the initial investment and potential shortfalls, establishing partnerships with government and non-profit organizations to secure additional funding, and developing clear metrics to measure the effectiveness of interventions. For instance, tracking the reduction in readmission rates and patient health improvements can help quantify the ROI. Additionally, engaging with staff and the community to build support for these initiatives can ensure successful implementation and long-term sustainability (Zavorka & Paar, 2022). Proposed Changes to Address Rehospitilization Slide 7 The economic issue of rehospitalization due to environmental factors, such as poor air quality and inadequate housing, poses a significant challenge to SVMC. To address this, we propose a comprehensive strategy that includes enhanced air quality monitoring, patient education on environmental health, and collaborations with community organizations to improve living conditions (Neira et al., 2021). This plan involves installing

Student Name Capella University NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Needs Analysis for Change Homelessness in California presents significant economic challenges, straining healthcare resources, increasing costs, and worsening health disparities. Limited access to preventive care leads to higher emergency visits and hospitalizations, further burdening the system. Vulnerable populations, including those with chronic illnesses and mental health conditions, are disproportionately affected. Urgent action, including investment in affordable housing, integrated healthcare services, and policy reforms, is necessary to improve outcomes and promote health equity. Summary of Homelessness as Economic Issues Homelessness in California is a critical economic issue, straining healthcare resources, increasing costs, and exacerbating health disparities. In 2023, 337,735 people were homeless in California, with 73.4% unsheltered, 55% men, and 45% women (CHCF, 2024). People experiencing homelessness (PEH) face barriers to care, leading to higher rates of chronic illness, such as hypertension (30.1%), diabetes (11.1%), heart disease (15.1%), and pulmonary illness (25.2%) (Statista, 2024). These health issues contribute to increased hospitalizations, emergency visits (37.2%), and readmissions (27.4%), further burdening healthcare providers and facilities (Miyawaki et al., 2020). The cost of providing shelter services is also significant, averaging $208,000 per bed and $278,000 per unit (Hoover Institution, 2023). This issue directly impacts my work as a nurse by increasing patient complexity, requiring additional care coordination, and straining hospital resources. It affects colleagues by contributing to burnout and challenges organizations by raising operational costs due to frequent readmissions and uncompensated care. Communities experience worsening public health outcomes, increased healthcare disparities, and economic strain. The rationale for addressing homelessness lies in its widespread impact on healthcare access, cost, and equity. PEH accounted for 3.4% of hospital admissions and 2.8% of emergency visits in 2020 (CHCF, 2024). Unprotected PEH have a 2.7 times higher chance of death than the general population (Liu et al., 2020). A major contributing gap is the lack of integrated healthcare services, affordable housing, and social support systems, preventing effective intervention. Addressing this gap through policy reforms, expanded healthcare access, and housing initiatives is essential to improving outcomes and reducing economic strain. Socioeconomic or Diversity Disparities Homelessness in California disproportionately affects minority populations, with Black, American Indian, and Pacific Islander Californians experiencing significantly higher rates of housing instability. Black Californians, who make up only 5.3% of the state’s population, represent 26.6% of unhoused individuals assisted by homeless service providers. Similarly, American Indian/Alaska Native individuals account for 1.2% of the unhoused population despite comprising only 0.03% of the state’s total population (Davalos & Kimberlin, 2023). These disparities stem from historical and systemic inequalities, including discriminatory housing policies, economic instability, and limited access to high-wage jobs. Addressing these disparities requires targeted interventions such as expanded affordable housing, economic support programs, and policies that dismantle structural barriers contributing to homelessness among marginalized communities. Evidence-Based Sources for Combatting Homelessness Addressing homelessness among minority populations requires evidence-based strategies to mitigate systemic disparities and improve housing stability. Research highlights the connection between racial inequities, economic insecurity, and homelessness. A study by Sandu et al. (2021) underscores that housing-first approaches significantly improve long-term stability for marginalized population groups. The lack of affordable housing disproportionately affects renters of color, as they are more likely to have extremely low incomes. According to the National Low Income Housing Coalition (2023), 19% of Black households, 17% of American Indian or Alaska Native households, and 14% of Latino households fall into this category, compared to only 6% of White non-Latino households. A study by Olivet et al. (2021) found that expanding rental assistance programs could reduce homelessness among Black and Latinx individuals. Implementing evidence-based strategies, such as permanent supportive housing and job training programs, is critical to closing the racial gap in homelessness rates and fostering long-term economic stability for affected populations (Aubry et al., 2020). Opportunities and Predicted Outcomes Expanding housing-first initiatives and rental assistance programs in California can significantly reduce homelessness among minority populations, leading to economic and social benefits. Research indicates that stable housing lowers healthcare costs by decreasing emergency room visits and hospitalizations, disproportionately high among unhoused individuals (Olivet et al., 2021). Additionally, permanent supportive housing has been shown to reduce interactions with the criminal justice system, further alleviating public expenditures (Aubry et al., 2020). By addressing the root causes of homelessness through evidence-based interventions, California can reduce the economic burden on healthcare systems and social services while improving health outcomes for vulnerable populations. Furthermore, increasing access to affordable housing and job training programs can enhance financial stability and economic mobility for historically marginalized communities. Expanding rental subsidies and workforce development initiatives can empower these populations to achieve long-term economic independence, reducing reliance on emergency shelters and public assistance programs (Sandu et al., 2021). These targeted interventions promote equity and contribute to a stronger, more resilient economy by fostering stable employment and increasing consumer spending within communities. Conclusion Addressing homelessness in California, particularly among minority populations, requires a multifaceted approach that integrates housing-first strategies, rental assistance, and workforce development programs. By tackling systemic disparities and expanding access to affordable housing and healthcare, the state can alleviate economic burdens on healthcare systems, reduce recidivism rates, and improve long-term stability for vulnerable populations. Implementing evidence-based interventions promotes health equity and fosters economic growth by empowering individuals to achieve financial independence. Through targeted policies and community-driven initiatives, California can create a more inclusive and sustainable solution to homelessness, ultimately benefiting affected individuals and society. References Aubry, T., Bloch, G., Brcic, V., Saad, A., Magwood, O., Abdalla, T., Alkhateeb, Q., Xie, E., Mathew, C., Hannigan, T., Costello, C., Thavorn, K., Stergiopoulos, V., Tugwell, P., & Pottie, K. (2020). Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: A systematic review. The Lancet Public Health, 5(6), 342–360. https://doi.org/10.1016/s2468-2667(20)30055-4  Olivet, J., Wilkey, C., Richard, M., Dones, M., Tripp, J., Beit-Arie, M., Yampolskaya, S., & Cannon, R. (2021). Racial inequity and homelessness: Findings from the SPARC study. The ANNALS of the American Academy of Political and Social Science, 693(1), 82–100. https://doi.org/10.1177/0002716221991040  NHS FPX 6008 Assessment 2 Needs Analysis for

Student Name Capella University NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date  Identifying a Local Health Care Economic Issue This assessment identifies a local healthcare economic issue and its impact on a specific community or population. Furthermore, the paper discusses the rationale for choosing this issue as the subject’s topic. Later, it will discuss how this issue impacts diverse groups, particularly low-socioeconomic communities. Lastly, it will identify a gap contributing to this issue based on substantial evidence.  Local Health Care Economic Issue The shortage of healthcare staff is a critical healthcare economic issue that has far-reaching consequences on the overall functioning of healthcare systems. This issue is multifaceted and is affected by several factors, such as the growing demand for healthcare services due to the increasing population and the prevalence of chronic diseases (Itodo et al., 2020). Another major factor is high turnover rates due to stressful and challenging situations in healthcare organizations, causing workforce attrition (Willard-Grace et al., 2019). This healthcare economic problem impacts populations and communities. The American Hospital Association has called this a “national emergency” in the U.S., as the workforce shortage has reached 1.1 million by the end of 2022 (Johnson, 2022).  Due to the COVID-19 pandemic, more than 1,100 healthcare workers were convinced to leave this field, exacerbating the worsening health situation among U.S. communities (Johnson, 2022). The Tampa General Hospital has encountered this issue lately, and my personal experience facing this issue is shared in a subsequent section.  Healthcare workers’ shortages can lead to additional costs due to the unmet needs of patients and worsening health conditions. This adds up to the financial burden of the U.S. community and impacts their well-being and economic state. This issue will affect future healthcare staffing as about 121,000 physicians will be shortened by 2030 (Harp, 2023).  The Rationale for Selecting Shortage of Healthcare Staff  I have selected this issue of insufficient healthcare workforce as a healthcare economic issue for several reasons. This issue is highly relevant to patient care and well-being. As the number of healthcare workers continues to decline, patients experience a lack of timely access to healthcare, which impacts their health, causing adverse health outcomes (Mascha et al., 2020). Moreover, this issue has shown economic implications as healthcare is not just about patients but is an economic driver. The inadequate healthcare workforce has wide-reaching consequences on productivity, workforce stability, and overall community economic health (Sharifi et al., 2021).  Personal experiences and values also inspire the selection of this issue. For instance, my experience at Tampa General Hospital of Florida was similar, where I saw nurses and several physicians quitting and leaving their healthcare field. Consequently, patients and organizations encountered negative implications such as increased morbidity and mortality rates and reduced return on investment. According to the Florida Hospital Association, this shortage of nurses will reach 59,000 by the year 2030 (USF Foundation, 2023). Moreover, the equity in healthcare that ensures equitable access to healthcare services and the duty of the healthcare workforce to value the well-being of patients are some values that inspired me to select this issue. Impact of Shortage of Healthcare Staff on Diverse or Low Socioeconomic Groups  Compared to the high number of patients, insufficient healthcare staff has specifically impacted patients, staff in the organization, and community members. When the healthcare staff is limited, the work burden on staff increases, and there are greater chances of work burnout and turnover rates (Chemali et al., 2019). This issue impacted my work and colleagues in my organization as we were limited in number, and the patient load was high. This increased our working hours, leaving no time to take a break. Ultimately, my colleagues and I made some medication errors that were timely caught, and adverse events were prevented. Moreover, it caused my colleagues to quit their jobs, and turnover rates were further enhanced. The organization faced many issues, such as near-miss events and reduced quality of care delivery. This also reduced patient satisfaction and caused economic instability.  This issue, particularly, impacts diverse groups and patients from low socioeconomic backgrounds. Community members of diverse backgrounds, such as culturally different people, are unable to receive timely care as they require a culturally competent healthcare workforce. However, a limited healthcare workforce cannot satisfy the needs of a culturally diverse community (Billings et al., 2021). Similarly, patients with financial crises encounter delayed treatments due to financial constraints. Healthcare disparities aggravate the worsening of health conditions among diverse groups. This leads to delayed diagnosis and treatments and increased risks of poor health outcomes and mortality rates (Adugna et al., 2020). Gap Contributing to Shortage of Healthcare Staff The identified gap contributing to the shortage of healthcare staff is the growing disparity between escalating requirements for healthcare services and an insufficient supply of qualified and trained healthcare professionals. This gap is not just theoretical but supported by the World Health Organization (WHO) as it estimated an emerging shortfall of 10 million healthcare workforce by 2030 among low- and lower-middle-income countries. (World Health Organization, 2019). Another identified gap is the poor well-being of healthcare professionals due to limited staffing and the increased number of patients on them. Due to these factors, healthcare professionals are prone to physical and mental ailments, impacting their well-being. As a result, many healthcare professionals deem it appropriate to quit and further increase the turnover rates (McDougall et al., 2020).  All this leads to a healthcare workforce shortage at hospitals and impacts community individuals as they cannot receive essential health services and confront pandemic challenges with the help of professionals. The community’s economy is also affected badly as the healthcare costs continue to increase while workforce productivity is at stake. This further leads to economic burdens on the community. Conclusion The healthcare economic issue discussed in this paper is the need for more healthcare staff in America. The issue has particularly impacted my healthcare organization (Tampa General Hospital). The issue resulted in work burnout, delayed care treatments, and high turnover rates.