HA 545 Two Replies with References

Prompt 1: Considering the situation at St. Mary’s Hospital where beds are running out, discuss the ethical implications of premature patient discharge. How should administrators balance the need for bed availability with the quality of patient care? Reflect on the role of healthcare plans and the key performance indicators in guiding these decisions.

Healthcare administrators have a duty to balance an organization’s sustainability with safe, equitable, and patient centered care (Langabeer, 2021). St. Mary’s Hospital is functioning under straining circumstance at the moment, with staff shortages, deteriorating debt, scheduling difficulties, and a chaotic emergency room [ER] environment..., just a few of the mentioned inconveniences being dealt with (Tucker, 2026). Compounded unto, the video “Practice & Principle, Discharge” brings harsh ethics, financial, management, organizational, and empathy decision making options on and delivering patient care.

In the case of Joan, financial pressure or insurance authorization should not be the final determinants of discharge, no matter the financial and resource constraints the hospital faces (Buttigieg, 2018). Even though it can be a serious determinant of economic loss and nearing $100k US of extra costs over a 6-month period as seen with Shaikh (2018), the decision should be based on the clinical need, degree and status of functionality of the patient, their safety, available alternatives to care, the hospital’s capacity to provide care and the patient preferences.

Provider healthcare plans influence organization resource allocation through coverage limits, pre-authorization requirements, and incentives for lower costs recommendations, though they should never supersede clinical judgement, and although Joan being medically stable, the complete uselessness of her right arm post-stroke puts her in substantial functional disadvantage especially given she is caretaking for three younger souls (Tucker, 2026). Post stroke care guidance emphasizes early, intensive, multidisciplinary rehabilitation and coordinated interplay (Gittler, 2018), and evidence also indicates that carefully selected early-supported-discharge programs can reduce hospitalization without worsening outcomes, so as long as appropriately structured rehabilitation and transitional support to care are used (Farombi, 2025; Jee, 2022).

The board should therefore pursue the safest alternative and not simply the cheapest one, especially if outpatient therapy can begin immediately, caregiver education, home-safety assessment, and care follow-up arranged, making discharge an appropriate option. If those supports are unavailable, one or two additional inpatient days may be justified, and the board should have the authority to adjust expenses to ease the financial burden unto Joan. Most importantly, board members must make this decision objectively, as personal relationships or undisclosed preferences, as illustrated by Kenny’s change in position, undermine ethical governance and fair allocation of scarce resources (Langabeer, 2021). Therefore, key organization performance factors should focus on patient safety, clinical outcomes, functional improvement, care coordination, patient experience, access-, length of stay-, and readmissions- rates, including resource utilization, and financial sustainability, as sustained by the Agency for Healthcare Research and Quality [AHRQ] in identifying important dimensions of healthcare quality notably- safety, effectiveness, patient-focus, care coordination, and affordability (AHRQ, 2025).

References:

Agency for Healthcare Research and Quality. (2025, Sept.). About AHRQ. Accessed September 4, 2026. https://www.ahrq.gov/cpi/about/index.html.

Buttigieg, S. C., Abela, L., & Pace, A. (2018). Variables affecting hospital length of stay: a scoping review. [Variables affecting hospital length of stay] Journal of Health Organization and Management, 32(3), 463-493. https://doi.org/10.1108/JHOM-10-2017-0275.

Farombi, T. H., Khan, H. T., Lawal, M., & Akinyemi, R. (2025). Impact of intermediate home-based care on functional health of older adults with stroke in low-income and middle-income countries: A systematic review. Journal of Alzheimer’s Disease Reports, 9. doi:10.1177/25424823251318227.s

Gittler, M., & Davis, A. M. (2018). Guidelines for Adult Stroke Rehabilitation and Recovery. Jama, 319(8), 820–821. https://doi.org/10.1001/jama.2017.22036.

Jee, S., Jeong, M., Paik, N.-J., Kim, W.-S., Shin, Y.-I., Ko, S.-H., Kwon, I. S., Choi, B. M., Jung, Y., Chang, W., & Sohn, M. K. (2022). Early Supported Discharge and Transitional Care Management After Stroke: A Systematic Review and Meta-Analysis. Front. Neurol. 13:755316. doi: 10.3389/fneur.2022.755316.

Langabeer, J. R., & Helton, J. (2021). Health Care Operations Management- A systems perspective, 3rd Ed. Jones & Bartlett Learning.

Shaikh, S. A., Robinson, R. D., Cheeti, R., Rath, S., Cowden, C. D., Rosinia, F., Zenarosa, N. R., & Wang, H. (2018). Risks predicting prolonged hospital discharge boarding in a regional acute care hospital. BMC Health Services Research, 18. https://doi.org/10.1186/s12913-018-2879-2.

Tucker, B. (2026, Sept.). Practice & Principle, "Discharge"- week 2 discussion [video]. Operations & Management in Healthcare Organizations- OC_HA545_202608FAIOL_OL-B. West Coast University, Master of Healthcare Administration program (online).

Nadia Aboukhadijeh

Prompt 1:

At St. Mary’s Hospital, the shortage of available beds puts pressure on administrators to discharge patients as quickly as possible. However, premature discharge can create ethical concerns if a patient is sent home before they are medically stable or have the resources needed for recovery. The hospital’s need for available beds is important, but patient safety and quality of care should not be sacrificed to improve bed availability.

According to Langabeer and Helton (2021), health plans use medical management to determine medical necessity and review whether patients continue to require inpatient care. Evaluations can help make sure that patients remain hospitalized when necessary while preventing unnecessary use of hospital resources. This shows that administrators can manage bed capacity without discharging patients who still need treatment.

Key performance indicators can also help administrators make balanced decisions. The Agency for Healthcare Research and Quality (AHRQ) explains that quality indicators can be used to track inpatient quality, patient safety, and avoidable events. Measures such as length of stay and bed utilization can help administrators determine whether increased patient flow is improving hospital operations or creating problems.

Overall, administrators should balance bed availability with the individual needs of each patient. Using data is important, but it should support clinical judgment rather than replace it. A hospital can improve patient flow and use its resources effectively while making sure patients are ready for discharge. In my opinion, the best approach is to use KPIs to identify opportunities for improvement while keeping patient safety and quality of care at the center of the decision-making.

References

Agency for Healthcare Research and Quality. (n.d.). Quality indicators. https://qualityindicators.ahrq.gov

Langabeer, J. R., II, & Helton, J. (2021). Health care operations management: A systems perspective (3rd ed.). Jones & Bartlett Learning.