Implementation Plan for a New Economic Opportunity.

Posted: December 5th, 2022

Implementation Plan for a New Economic Opportunity.


Overview Create a detailed implementation plan for an economic initiative. As a master’s-level health care practitioner you may be expected to create budget and implementation plans to ensure that economic opportunities for the organization are rolled out successfully and can be sustained over multiple years. Additionally, it is important to be able to envision how an economic initiative could be used for different contexts and purposes to keep the investment a viable and positive asset to your organization or care setting.


Suggested Resources Budget Development These articles may be helpful in helping you to create a budget: Mukherjee, T., Al Rahahleh, N., Lane, W., & Dunn, J. (2016).Implementation Plan for a New Economic Opportunity. The capital budgeting process of healthcare organizations: A review of surveys. Journal of Healthcare Management, 61(1), 58–77. Danna, D. (2016). Learning and mastering the operating budget. Retrieved from Pritchard, G. (n.d.). How to develop an operating budget for a nursing unit. Retrieved from Budget Templates Review the following: Missouri Department of Health & Senior Services. (n.d.). Budget preparation worksheet [PDF]. Retrieved from Parkland. (n.d.). Budget template [XLSX]. Retrieved from Year_FY2017.xlsx Parkland. (n.d.). Developing a budget. Retrieved from Strategy Development and Implementation This document is designed to give you questions to consider and additional guidance to help you successfully complete the Implementation Plan for a New Economic Opportunity assessment: This is an example of an implementation plan for a strategy to expedite the care of a subset of the population: Agency for Healthcare Quality and Research. (n.d.). Improving patient flow and reducing emergency department crowding: A guide for hospitals – Appendix C: Example implementation plan. Retrieved from This web page provides a step-by-step guide to conducting and economic reviews of interventions: The Community Guide. (n.d.). Economic reviews. Retrieved from This is a systematic review of nursing-related studies assessed for quality of economic evaluation methodological criteria: Cook, W. A., Morrison, M. L., Eaton, L. H., Theodore, B. R., & Doorenboz, A. Z. (2017). Quantity and quality of economic evaluations in U.S. nursing research, 1997–2015: A systematic review. Nursing Research, 66(1), 28–39. This is a review of the quality of and specific challenges related the economic evaluation of medical devices: Kirisits, A., & Redekop, W. K. (2013). The economic evaluation of medical devices: Challenges ahead. Applied Health Economics and Health Policy, 11(1), 15–26. This resource discusses variations in the intrinsic costs of dialysis modalities as well as other factors, such as variation by country, available health care infrastructures, the timing of dialysis initiation, and renal transplantation: Klarenbach, S. W., Tonelli, M., Chui, B., & Manns, B. J. (2014). Economic evaluation of dialysis therapies [PDF]. Nature Reviews. Nephrology, 10(11), 644–652. Quantifying Costs, Risks, Benefits, and Impact of Health Care Initiatives This study analyzes nationally representative data in the United States regarding how people prioritize health programs for children versus older adults: Eisenberg, D., Freed, G. L., Davis, M. M., Singer, D., & Prosser, L. A. (2011). Valuing health at different ages. Applied Health Economics and Health Policy, 9(3), 149–156. This resource addresses the cost and benefits of medical interventions: Hauber, A. B., Fairchild, A. O., & Johnson, F. R. (2013). Quantifying benefit-risk preferences for medical interventions: An overview of a growing empirical literature. Applied Health Economics and Health Policy, 11(4), 319–329. Scenario The senior management members have sent you their thanks and notes on your feasibility study for your proposed economic initiative. They have determined that your proposal has the potential to benefit the organization in both the short and long term. The last step in this process is to complete a thorough implementation plan for your proposed initiative. This plan will need to include a budget of relevant expected material, staffing, and capital costs over the first five years of the initiative (see the Resources for some examples and guides about budget planning), as well as projected earnings from the initiative for the care setting. You must also include a plan and timeline for rolling the initiative out, an analysis of how it may impact other aspects of the care setting, an explanation how it can remain viable in the face of environmental changes, and sufficient relevant supporting evidence. Directions In your 6–10-page plan, you have been asked to be sure to address the following. Note: The bullet points below correspond to grading criteria in the scoring guide. Be sure your work is, at minimum, addressing each of the bullets below. You may also want to read the scoring guide and the Guiding Questions: Implementation Plan for a New Economic Opportunity document, linked in the Resources, to better understand the performance levels that relate to each grading criterion: Create a budget for relevant expected costs and earnings or benefits over the first five years of a proposed economic initiative. Propose a plan to roll out your economic initiative that will enable your care setting to successfully implement it in an ethical and culturally equitable way that will ensure achievement of quality or service improvements. Analyze how your proposed initiative, once implemented, may impact other aspects of your care setting and ways in which negative impacts could be mitigated. Explain strategies you have integrated into your proposed economic initiative that will ensure it can remain a viable asset to your care setting in the face of dynamic environmental forces.Implementation Plan for a New Economic Opportunity. Justify the relevance and value of the quantitative and qualitative economic, financial, and scholarly evidence you used to support your recommendations throughout your plan. Communicate your business and implementation plan in a logically structured and concise manner, writing content clearly with correct use of grammar, punctuation, and spelling. Effectively support your plan and recommendations with relevant economic data and scholarly sources, correctly formatting citations and references using current APA style. Example Assessment: You may use the assessment example, linked in the Assessment Example section of the Resources, to give you an idea of what a Proficient or higher rating on the scoring guide would look like. Additional Requirements Your assessment should meet the following requirements: Length: 6–10 double-spaced, typed pages (not including title page and reference list). Your paper should be succinct yet substantive. Be sure to include a separate title page and reference list. Your completed budget plan should be included as an appendix within your final submission. APA format: Resources and citations are formatted according to current APA style. Resources: Cite 3–5 authoritative and scholarly resources. Be sure to include specific economic data and support as part of your cited resources. Assessment 3 Context Economic Decision Making As part of economic decision making, all health care leaders are expected to conduct a basic cost-benefit analysis (CBA). If you have not yet had the opportunity to conduct a CBA in the workplace, it is important to become familiar with this highly relevant tool for economic decision making. You may also find that this tool is helpful in your daily life. There are many factors to consider in making a sound economic decision. You must consider the major risk categories associated with the alternative, the time value of money, and the strategic fit over a long-term planning horizon. Some of the questions you need to consider are: ? Does the recommended alternative break even at year two, and become more profitable thereafter? What is the relative value of the income from the investment if one considers the time value of money? What about the organizational context? ? Will the organization’s focus and strategy change? ? Will sufficient funds be available to support the project past the breakeven point in year two? Will the chosen alternative be at risk for obsolescence? The Role of Health Care Executives Economic decision making has many facets: legal issues, industry standards, risks, financial components, strategic alignment, and dynamic external environmental factors. Similarly, health care executives have many professional roles, responsibilities, and conduct expectations. Legal standards represent the bare minimum standard that is expected of health care professionals. Health care executives are sometimes held to higher standards than business people in other industries, as they are charged with protecting human lives and assuring patient safety. They are also expected to act in the best interests of others, and to serve as moral agents. Health care executives have fiduciary obligations, and an explicit code of conduct from the American College of Healthcare Executives (ACHE).

An Implementation Plan and Cost-Benefit Analysis for a Proposed Dialysis Unit in the Organization to be Managed by A Nephrology Nurse Practitioner

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An Implementation Plan and Cost-Benefit Analysis for a Proposed Dialysis Unit in the Organization to be Managed by A Nephrology Nurse Practitioner

The healthcare economic opportunity initiative identified and ratified by senior management in my organization is a hemodialysis unit to cater for the growing numbers of our patients who increasingly require dialysis due their falling eGFR (estimated glomerular filtration rate). The majority of these patients are from the diabetes and hypertension outpatient clinics (Klarenbach et al, 2014). This paper outlines the implementation plan for this economic initiative, starting with a provisional projected working budget for the first five years of the unit’s operation.Implementation Plan for a New Economic Opportunity.

The Projected Budget and Earnings (Revenue)

This is the projected five-year budget taking into account the expected material costs, staffing costs, and other capital costs (Danna, 2016; MDHSS, n.d.; Pritchard, n.d.). In the budget, five dialysis machines are to be acquired from Fresenius Medical Care at a cost of USD 7,000 per piece. The water plant to be used to purify the water for the hemodialysis will be installed at a projected cost of USD 5,000. The surgical supplies and dialysis disposables such as the tubes, dialyzer, acid concentrate, and bicarbonate bag are estimated to cost USD 30 per patient per session of dialysis. On labor or human resource, six registered nephrology nurses are to be hired on full-time basis with their full-time equivalent (FTE) hours being 40 per week and 2,080 per year. This means that they will be working eight hours a day, five days a week, and 52 weeks in a year (Brown et al., n.d.). To assist them, three nursing assistants will also be hired on a full-time basis with the same FTE hours. The annual salary of each of the registered nephrology nurses will be USD 60,000 and that of each of the nursing assistants will be pegged at USD 24,000. Each of the nephrology nurses and the nursing assistants are expected to take one annual leave (non-productive time) for each of the five years. It is assumed that none of them will take a sick leave (non-productive time).

Like with all budgets, there are several assumptions made in this budget. The current number of patients requiring dialysis and who will begin with three sessions each per week are twenty. It is assumed, for budgetary purposes, that this number will remain constant for the rest of the first year of operations. From the second year, it is assumed that the number of dialysis patients will increase by five per year up to the fifth year. There will therefore be 20 patients in the first year, 25 in the second, 30 in the third, 35 in the fourth, and forty in the fifth year. Additionally, it is assumed that the rent, cost of surgical supplies and dialysis disposables, cost of overheads, and salaries will remain constant for the first five years of operation of the dialysis unit. The table below shows the projected budget described above.Implementation Plan for a New Economic Opportunity.

Table 1: Estimated budget for a five-bed dialysis unit

  Proposed Dialysis Unit Budget for 5 years  
I. Direct start-up costs Y 1 Y 2 Y 3 Y 4 Y 5
  Dialysis machines 35000  
  Water plant 5000  
  Rent 2400 2400 2400 2400 2400
  Disposable surgical supplies 93600 117000 140400 163800 187200
II. Other direct costs    
  Overheads (water, power…) 1200 1200 1200 1200 1200
  Miscellaneous 600 600 600 600 600
III. Labor    
  6 Registered dialysis nurses    
  i. Productive time 330000 330000 330000 330000 330000
  ii. Non-productive time 30000 30000 30000 30000 30000
  3 Nurse assistants    
  i. Productive time 66000 66000 66000 66000 66000
  ii. Non-productive time 6000 6000 6000 6000 6000
  Totals     569800 553200 576600 600000 623400
  GRAND TOTAL       2923000


The revenue is expected to come from the cost of dialysis per patient per session as a package. Some of the patients are Medicare patients while others are covered by private payers. There are also a few who will pay out-of-the-pocket because they are not insured. For the purposes of budgeting, the revenue per dialysis session for each patient has been pegged at an average of USD 250. This amount multiplied by three sessions per week for the 52 weeks of a year gives a revenue figure of USD 39,000. This will be the revenue per patient per year. It is assumed that all the patients will have ready vascular access for use in the form of fistulae or grafts. The following is the revenue projection for the dialysis unit.

Table 2: Projected revenue for the first five years of the dialysis unit

    Total Revenue for 5 Years    
  Y 1 Y 2 Y 3 Y 4 Y 5
Each patient per year 39000          
  20 patients 780000  
  25 patients   975000  
  30 patients   1170000  
  35 patients   1365000  
  40 patients   1560000
  Total             5850000


From the above table, it can be seen that the projected profit before tax after the five years will be USD 2,927,000. The venture neatly breaks even at the end of the third year with a cumulative revenue amount of USD 2,925,000. This is USD 2,000 above the estimated expenses of USD 2,923,000 for the entire five years. This economic initiative is therefore viable as it is possible that it would generate even higher revenues. This is from the fact that there will be occasions in which some patients will require emergency dialysis, such as those with fluid overload and pulmonary edema or those in the intensive care unit (ICU) with acute kidney injury (AKI) of sudden onset (Hammer & McPhee, 2018). There will also be visitors to the town who will from time to time require transient dialysis. All these are sources of revenue that are probable but which cannot be included in the projections because of their uncertainty.

The Plan and Timeline for Rolling Out the Project

The plan for this project is to have the dialysis unit as a separate department in the healthcare organization. It will be run as a part of the larger organization, but have its separate departmental budget. The person who will manage its day-to-day operations will be the resident nephrology nurse practitioner. Because of the issue of cost at the start, the three nurse assistants who will be recruited will have to be experienced nurse assistants who have worked for some years in a dialysis unit. This is because they will be expected to be able to prepare the hemodialysis machines before the nephrology nurses connect the patients to the machines. This includes testing the machine, lining it, and priming it with normal saline. In doing this, the cost of hiring dialysis technicians will be avoided in the short term. As the number of patients increases, however, there may be need later to recruit a dialysis technician or two. But that will be subject to the prevailing workload at that time.Implementation Plan for a New Economic Opportunity.

To adhere to the ethical standards required, patients who will be commencing dialysis for the first time will be required to give informed consent for the procedure. Everything concerning the procedure and what to expect will be explained to them in detail before the very first session.  The staff of the unit will also be required to be holistic in their approach and be culturally sensitive. Autonomy (letting the patient decide their care), beneficence (doing only good to the patient), nonmaleficence (avoiding causing intentional harm to the patient), and justice (fairness and equity) as bioethical principles will be practiced at all times (Page, 2012). For instance, there will be no favoritism based on race in the allocation of dialysis machines and scheduling. Allowing favoritism will propagate racial inequalities in access to healthcare and breach the ethical principles of justice, beneficence, and nonmaleficence. In doing all these, therefore, the new dialysis unit will succeed in offering the best quality hemodialysis care possible.

In terms of the project timeline, the process of acquiring the equipment, transportation to the location, and installation is expected to take two weeks. After that, the testing of the equipment and calibration of the machines will take another one week. Finally, the recruitment and orientation of the unit staff will take one week. In all, the project from start to completion will have a timeframe of one calendar month.

Impact on Other Aspects of the Care Setting

As a separate unit but part of the wider organization, the dialysis unit will operate in close collaboration with other departments, particularly the pharmacy and the supplies department. In order to avoid crowding the intensive care unit, no hemodialysis machine will be permanently stationed in the ICU except the continuous renal replacement therapy or CRRT machine operated by the ICU nurses. When required, therefore, a machine will be wheeled to the ICU to dialyse the concerned patient then later returned to the renal unit. This will be done while observing all the infection prevention protocols as laid down in the organization’s standard operating procedures (SOPs). The dialysis unit will therefore impact the ICU and vice versa. Effective communication between the ICU nurses and the renal nurses will therefore be essential in ensuring that quality and seamless services are provided. The dialysis unit will also impact the pharmacy in that the pharmacist will need to ensure a constant stock of medications used in hemodialysis such as heparin. Additionally, the diabetes and hypertension outpatient clinics will henceforth maintain a close working relationship with the renal unit. This will be desirable so that they may promptly refer any patient whose eGFR may be showing signs of decline to the renal unit for further evaluation and examination by the nephrologist or nephrology nurse practitioner. All these interactions with the unit will be facilitated by the organization’s robust electronic health records (EHR) system. Any negative impact on other operations such as the diversion of substantial amounts of water to carry out dialysis will be mitigated by advance planning. In this respect, a large water holding tank will be installed for the unit in the event that other departments get starved of this important resource.Implementation Plan for a New Economic Opportunity.

Assuring Viability in the Face of Ever-Changing Environmental Factors

The viability of the dialysis unit will be assured by maintaining the highest standards of dialysis care possible. This will make the patients stick to the unit and also encourage others they know to come and do dialysis there. This will translate to more revenues hence better viability. Changes in the pricing of dialysis disposables, if that happens, will be absorbed by ensuring greater efficiency and minimisation of wastage.Implementation Plan for a New Economic Opportunity.

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