After reviewing your benchmark evaluation, senior leaders in the organization have asked you to draft a policy change proposal and practice guidelines addressing the benchmark metric for which you advocated action.
In their request, senior leaders have asked for a proposal of not more than 2–4 pages that includes a concise policy description (about one paragraph), practice guidelines, and 3–5 credible references to relevant research, case studies, or best practices that support your analysis and recommendations. You are also expected to be precise, professional, and persuasive in justifying the merit of your proposed actions.
When creating your policy and guidelines it may be helpful to utilize the template that your current care setting or organization uses. Your setting’s risk management or quality department could be a good resource for finding an appropriate template or format. If you are not currently in practice, or your care setting does not have these resources, there are numerous appropriate templates freely available on the Internet.
Note: The tasks outlined below correspond to grading criteria in the scoring guide.
In your proposal, senior leaders have asked that you:
· Explain why a change in organizational policy or practice guidelines is needed to address a shortfall in meeting a performance benchmark prescribed by applicable local, state, or federal health care laws or policies.
. What is the current benchmark for the organization? What is the numeric score for the underperformance?
. How might the benchmark underperformance be affecting the quality of care being provided or the operations of the organization?
. What are the potential repercussions of not making any changes?
· Recommend ethical, evidence-based strategies to resolve the performance issue.
. What does the evidence-based literature suggest are potential strategies to improve performance for your targeted benchmark?
. How would these strategies ensure improved performance or compliance with applicable local, state, or federal health care laws or policies?
. How would you propose to apply these strategies in the context of your chosen professional practice setting?
. How would you ensure that the application of these strategies is ethical and culturally inclusive?
. Does your policy encompass the key components of your recommendations?
· Analyze the potential effects of environmental factors on your recommended strategies.
. What regulatory considerations could affect your recommended strategies?
. What organizational resources could affect your recommended strategies (for example, staffing, finances, logistics, and support services)?
. Are your policy and guidelines realistic in light of existing environmental factors?
· Propose a succinct policy and guidelines to enable a team, unit, or the organization as a whole to implement recommended strategies to resolve the performance issue related to the relevant local, state, or federal health care policy or law.
· Identify colleagues, individual stakeholders, or stakeholder groups who should be involved in further development and implementation of your proposed policy, guidelines, and recommended strategies.
. Why is it important to engage these colleagues, individual stakeholders, or stakeholder groups?
. Do your proposed guidelines help colleagues, individual stakeholders, or stakeholder groups understand how to implement your proposed policy?
. How might engaging these colleagues, individual stakeholders, or stakeholder groups result in a better organizational policy and smoother implementation?
. Are your proposal and recommended strategies realistic, given the care team, unit, or organization you are considering?
· Communicate your proposed policy, guidelines, and recommended strategies in a professional and persuasive manner.
. Write clearly and logically, using correct grammar, punctuation, and mechanics.
· Integrate relevant sources to support your arguments, correctly formatting source citations and references using current APA style.
. Did you cite an additional 3–5 credible sources to support your analysis and recommendations?
Draft a written proposal and implementation guidelines for an organizational policy that you believe would help lead to an improvement in quality and performance associated with the benchmark metric for which you advocated action in Assessment 1.
Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.
In advocating for institutional policy changes related to local, state, or federal health care laws or policies, health leaders must be able to develop and present clear and well-written policy and practice guidelines change proposals that will enable a team, unit, or the organization as a whole to resolve relevant performance issues and bring about improvements in the quality and safety of health care. This assessment offers you an opportunity to take the lead in proposing such changes.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
· Competency 2: Analyze relevant health care laws and regulations and their applications and effects on processes within a health care team or organization.
. Propose a succinct policy and guidelines to enable a team, unit, or the organization as a whole to implement recommended strategies to resolve the performance issue related to the relevant local, state, or federal health care policy or law.
· Competency 3: Lead the development and implementation of ethical and culturally sensitive policies that improve health outcomes for individuals, organizations, and populations.
. Recommend ethical, evidence-based strategies to resolve a performance issue related to health care policy or law.
· Competency 4: Evaluate relevant indicators of performance, such as benchmarks, research, and best practices, for health care policies and law for patients, organizations, and populations.
. Explain the need for creating an organizational policy or practice to address a shortfall in meeting a prescribed metric benchmark.
· Competency 5: Develop strategies to work collaboratively with policy makers, stakeholders, and colleagues to address environmental (governmental and regulatory) forces.
. Analyze the potential effects of environmental factors on recommended strategies.
. Identify colleagues, individual stakeholders, or stakeholder groups who should be involved in further development and implementation of proposed policy, guidelines, and recommended strategies.
· Competency 6: Apply various methods of communicating with policy makers, stakeholders, colleagues, and patients to ensure that communication in a given situation is professional, clear, efficient, and effective.
. Communicate a proposed policy, guidelines, and recommended strategies in a professional and persuasive manner, writing content clearly and logically, with correct use of grammar, punctuation, and spelling.
. Support arguments effectively with relevant sources, correctly formatting citations and references using current APA style.
ORGANIZATIONAL ETHICS DECISION-MAKING PROCESS IN HEALTH CARE
Health care leaders are responsible for adhering to both laws and industry expectations or professional standards for ethical behavior. Health care laws are great in number, and many are quite complex. Health care fraud and abuse is one example of the need for ethics management resources and guidelines for problem solving. Both government and industry leaders have acknowledged this widespread problem. The following “Organizational Ethics Decision-Making Process,” provided by the American College of Healthcare Executives (2010) is one of many tools available to assist health care leaders in solving ethical problems in the workplace.
In the following scenario, we address a health care legal issue from an ethics perspective. Specifically we apply the American College of Healthcare Executives’ Organizational Ethical Decision Making Process (ACHE, 2010) to a workplace health care issue.
Toni is a senior executive within a large, not for profit, integrated delivery health care system, or IDSHS. She serves on a team that selects consultants for the acquisition of a physician-owned group pediatric medical practice, which will be essential for the future success of the new pediatric service line. Acquisition of this successful group pediatric practice will result in a quasi-monopoly within the service community and will provide Toni the opportunity to direct awards for lucrative vendor contracts. A long-standing, established board member quietly suggests to Toni that there might be ways to minimize the cost of acquiring the group practice by folding the cost into other categories within the delivery system, such as the Medicaid cost report. The board member points out that Medicaid provides a good deal of funding to the IDSHS and that the pediatric practice will support these patients. However, Toni is concerned that putting the acquisition under the Medicaid cost report would suggest that the pediatric practice would only see Medicaid patients, which is not the case for this practice.
The board member also reminds Toni that she’s in a strategic position to assume the COO role of the new pediatric campus, and that he’s counting on her to lead the hospital out of its economic strife.
Toni has had a successful career of 15 years with IDSHS. This opportunity would mean higher compensation, higher visibility in the community, and increased influence to implement her strategic vision for the organization. It would also place her in a position of high influence for selection of future business partners and vendors whom she believes are essential for implementing her vision for the new campus.
After presenting at the last board meeting, Toni visits with a prospective business partner for the new campus, Gerald, a friendly business associate of Toni’s husband and a prospective construction industry vendor. Gerald offers Toni the opportunity for her and a few board members to visit three completed facilities. Each trip is to a desirable location, and the visit itineraries include elaborate dining and deluxe hotel accommodations. Toni has also been informed that her spouse is welcome, since the visits are scheduled on weekends. Toni is conflicted, yet she has known Gerald for years. He is a respected, successful health care construction vendor in the community.
Toni is a member of the health care executive professional organization within her region which expects its members to uphold and advocate for its industry’s standards and regulations. She reflects upon the possible implications of transferring costs for acquisition of the medical practice and associated new facility. Without the support of the influential board member, she may not have upward mobility within the organization. Without the pediatric practice acquisition, there won’t be sufficient referrals to feed the new facility. Toni knows that a great number of the expected future patients are covered by the State Children’s Insurance Program/Medicaid and there are stringent criteria for allocating costs within state and federally administered programs. Toni is concerned about a potential misstep in allocating costs. Additionally, she’s neither a lawyer nor a certified public accountant. Toni is currently enrolled as a new master’s student in a master’s of health administration program at an innovative online learning university.
The next board meeting is only a week away, and Toni must respond to the board member’s suggestion, and the invitation to visit the completed facilities. She contemplates her course of action. Toni does not want to break any laws, yet she’s unclear as to what laws might apply. Toni also recalls the ethics decision-making tool presented at a past health care professional association meeting. She decides to apply the tool in hopes of developing additional perspective. As part of her reflection, Toni determines that it will be necessary to incorporate both legal and ethical considerations into her problem-solving exercise. To this end, she opens her online MHA e-books, Hammaker’s 2011, “Health Care Management and the Law,” and Carroll’s 2009, “Risk Management Handbook for Health Care Organizations,” to review legal topics, and review the ACHE professional code of conduct, and ethics resources for health care executives. She clicks the link to an ethics resource: “Organizational Ethics Decision Making Process.” As she reads, it becomes increasingly evident that laws and ethics are closely entwined for health care executives, and that simple solutions are not necessarily easily obtained.
Let’s follow along as Toni tries to solve the problem regarding what course of action to take, as well as her response to the board member.
An Organizational Ethics Decision-Making Process
Step One: Clarify the Ethical Conflict
Step Two: Identify All of the Affected Stakeholders and Their Values
Step Three: Understand the Circumstances Surrounding the Ethical Conflict
Step Four: Identify the Ethical Perspectives Relevant to the Conflict
Step Five: Identify Different Options for Action
Step Six: Select Among the Options
Step Seven: Share and Implement the Decision
Step Eight: Review the Decision to Ensure it Achieved the Desired Goal
Clarify the ethical conflict
Toni might wish to consider her situation from multiple perspectives, and to consider her dilemma using a systems-based perspective. She needs to identify areas of legal and ethical concern.
· The potential monopoly within the service area: antitrust implications?
· The potential for questioning Toni’s desire to influence vendors for personal gratuities: kickbacks?
· The concern of inappropriate cost shifting and or reporting: violating state and federal laws?
· The concern of influence peddling for self-gain in the form of a promotion: misuse of position in direct violation of the ACHE code?
· Lack of disclosure of personal interest: failure to report a potential conflict of interest, a clear violation of the ACHE code?
· The potential for violating Sarbanes-Oxley: systematic planning with a board member in violation of the legal expectations for fiduciaries?
What other areas of potential legal and ethical considerations might Toni consider?
Identify all of the affected stakeholders and their values.
Toni knows that many stakeholders have interests in the acquisition of the new pediatric practice and each have a unique set of values, responsibilities, and expectations. Toni identified the stakeholders, yet she was unsure of their values. She decides to delineate legal and professional expectations as a minimum standard to assist in her analysis.
Toni: as a member of the senior executive team, Toni has a fiduciary responsibility to the community and to the organization for which she serves. Her role as a health care leader and as a member of her local professional association for health care executives infers a higher level of accountability with respect to ethical conduct. Although her local chapter has not been approved as an official affiliate of the ACHE, the local chapter has adopted the ACHE code of conduct as its guideline for executive behavior.
Board Member: also has a fiduciary obligation to the organization and the community; is held accountable by Sarbannes Oxley law; is also expected to adhere to professional association conduct.
Board of Directors: legally responsible to represent the interests of the community and the organization.
Senior Executives at the IDS including the CEO and CFO: are legally accountable for adhering to all state and federal health care laws.
Physicians in the group pediatric practice: responsible for professional codes of conduct, licensure body requirements, and relevant state and federal laws (anti-kickback, etc.).
The vendor making the visit offer: responsible for federal and state laws relating to bribery and kickbacks.
Employees within the organization: responsible for constructing cost reports and submitting them to state and federal entities; responsible to uphold the organizational mission and code of conduct.
General Counsel, Legal Team, Risk Management Team, Chief Compliance Officer
State and federal government representatives: responsible for identifying fraud and abuse, and applying laws.
Patients and consumers of services as IDSHS: expect costs of services to be legitimate, fair, and reasonable; expect employees and board members to act in the best interests of the patients and communities.
What other stakeholders might Toni consider including?
STEP THREE: UNDERSTAND THE CIRCUMSTANCES SURROUNDING THE ETHICAL CONFLICT
Toni understands that there is potential within her industry for intentional and unintentional fraud and abuse. As she contemplates the complexity of the board member’s suggestion, the referral pattern benefits to acquiring the medical practice, and the offer for the construction trips, she becomes overwhelmed and doesn’t know where to start. She decides to review the current textbook from her MHA course, Hammaker’s 2011, “Healthcare Management and the Law: Principles and Applications,” for insights and identification of applicable laws. Toni reads on page 59 of the book that, quote: “Almost five hundred U.S. hospitals were the subject of FCA [false claims act] investigations at the end of 2008; almost every major pharmaceutical and medical devices company faces qui tam claims.” She becomes uneasy about the possibility that her board representative might not be fully informed or understand the implications of the suggestion regarding acquisition of the medical practice, cost allocation, and related issues. She continues reading on page 62 that, quote: “While board members cannot be expected to understand the overall strategy of the U.S. health care system they should be aware of the principles underlying their business models.” Toni continues to scan her textbook for review of possible applicable laws.
Toni recalls reading a section on “Legal Issues Common to All Health Care Providers” in her textbook, Risk Management Handbook for Health Care Organizations (Carroll, 2009, p. 116).
She has questions regarding the applicability of the following areas to her situation, and takes notes:
· Negligence: general v. professional liability (p. 116).
· Privity (p. 119).
· Contract Negotiation and Approval (p. 121).
· Respondeat Superior (p. 130).
· Vicarious Liability (p. 137).
· Integrated Delivery Systems (p. 143).
· Basic Duties of Healthcare Trustees (p. 160).
· Sarbanes-Oxley Act of 2002 (p. 167).
· No Enrichment at Corporate Expense (p. 162).
· No Usurping Corporate Opportunity: identifies the, “fiduciary duty of trustees,” (p. 162).
· Federal Sentencing Guidelines for Organizations: first paragraph indicates that, “Establishing and maintaining an effective compliance and ethics program is another responsibility of the health care organization’s governing board.” (p. 165).
She also identifies resources for incident reporting and reviews the elements of a Risk Management Program.
· A Risk Management Program (pp. 543-548).
Toni is also concerned that some or all of the following topics she explored in her “Healthcare Management and the Law: Principles and Applications” (Hammaker, 2011) text might apply to her dilemma:
· Anti-Kickback Prohibitions (Hammaker, p. 46).
· Self-Referral Limitations, Stark Amendment (Hammaker, p. 54).
· False Claims Act (Hammaker, p. 55) General Fraud Laws (p. 56) Medicaid and Federal Medical Assistance Percentages (FMAP) in calculating federal matching dollars for State Medicaid funding (Hammaker, p. 116).
· General Fraud Laws (Hammaker, p. 58).
· Anti-Trust Laws (Hammaker, pp. 70-82) “Analyzing Wrongful Conduct… Monopolization… Conspiracies and Restraint of Trade.” (Hammaker, p. 73).
· Charitable Care Standard IRC 56-185 (Hammaker, p.152) Hammaker (2011) states that, “Any surpluses over revenue incurred must never be used to benefit any private shareholder or individual.” (p. 152).
· Community Benefit Standard IRC 59-545 Hammaker (2011) relates that “many tax-exempt hospitals include other costs in their community benefit accounting to the IRS” (p. 152).
After reviewing Hammaker (2011), can you add to Toni’s list?
STEP FOUR: IDENTIFY THE ETHICAL PERSPECTIVES RELEVANT TO THE CONFLICT
Toni’s responsibility as a senior health care executive is to represent the interests of patients, the organization, and her community. Toni reflects upon her fiduciary duty within the not-for-profit IDS to serve stakeholders’ interests, as well as the implied expectations of trust, fidelity, and related ethical concepts. She recalls that according to her professional association, she has a duty to disclose a potential conflict of interest, in this case the vendor is a work-related associate of her husband. She also must avoid any appearance of personal gain, for example, by accepting gratuities in exchange for contracts. Implementing the questionable cost allocation suggestion could result in the possibility of misreporting costs to Medicaid, a state administered and federally matched/funded program.
· Represent patient, organization, and community interests.
· Trust and fidelity.
· Conflict of interest.
· Appearance of personal gain.
· Misreporting costs to a state administered and federally funded program.
STEP FIVE: IDENTIFY DIFFERENT OPTIONS FOR ACTION
Of the options available to Toni, which one would you recommend? What advice would you offer to Toni?
Alternative A: Implement the suggestion by the board member and lead the IDSHS team to implement the cost-allocation suggestion. Your career will be over if you go against a board member. Take the vendor-sponsored site visit trips and include your spouse. You are working on the weekend and this is work related.
Alternative B: Meet with the board member and request a review by IDSHS leadership team of the proposed suggestion. Disclose the potential for conflict of interest regarding the vendor and the sponsored trip. Promptly convey your areas of ethical and legal concern to your immediate supervisor, the CEO.
Alternative C: Call the IDSHS ethics hotline and anonymously report your concerns regarding the board member’s suggestion. It is important not to cause waves unnecessarily in the organization. If nothing is wrong, no harm done. There is no need to mention the vendor sponsored trip because it is a legitimate work-related activity, and irrelevant.
Alternative D: Call the authorities regarding the board member’s intent to commit fraud, and seek protection as a whistleblower. Don’t mention the vendor-sponsored trip because it is a legitimate work-related activity.
Alternative A: Implement the cost-allocation suggestion made by the board members and protect your career.
Alternative B: Request that the IDSHS leadership team review the proposed suggestion. Disclose the potential conflict of the interest. Communicate you ethical and legal concerns to the CEO.
Alternative C: Anonymously report the situation to the IDSHS ethics hotline.
Alternative D: Report the board member’s intent to commit fraud to the authorities and seek protection as a whistleblower.
STEP SIX: SELECT AMONG THE OPTIONS
As Toni’s colleague, you have some familiarity with the organization, yet you share her lack of knowledge regarding individual values of stakeholders. You advise Toni to convey her concerns and request input from several stakeholders on the leadership team at IDSHS. You suggest that Toni promptly clarify the facts by reconfirming with the board member what he is asking her to do, and his awareness of the applicable laws. You also suggest that Toni’s CEO be notified immediately of her social relationship with the vendor and the possibility of a conflict of interest. You might also suggest to Toni that her CEO join the conversation to clarify how the board member suggests proceeding with the acquisition and subsequent cost allocation. The CEO should be aware that Toni believes a leadership team review of the situation is necessary.
Toni may consider expressing her concerns regarding adherence to the health care executive code of conduct. She should consider recusing herself from decision making and voting regarding the construction vendor selection. She might wish to seek the input of the IDSHS legal team regarding appropriate parameters and laws relating to vendor-sponsored site visits. She might ask her CEO or COO to represent the organization for evaluation of the vendor’s ability to perform on the construction project.
You advise Toni to suggest that the following members of the leadership team review the legal and ethical factors relating to the cost allocation and the vendor-sponsored site visit:
Chief Executive Officer, Chief Financial Officer, Chief Legal Counsel, Risk Management Team Member, Ethics Team Member, Business Development, Materials Management/Contract Procurement Director, etc.
Alternative B: Request that the IDSHS leadership team review the proposed suggestion. Disclose the potential conflict of interest. Communicate your ethical and legal concerns to the CEO.
From your review of Hammaker (2011) and other research, can you suggest any other parties that might need to be involved in evaluating this issue?
STEP SEVEN: SHARE AND IMPLEMENT THE DECISION
Once the leadership team has decided upon a course of action, a plan of action should be documented. The board of directors should be informed and involved in any major financial decision relating to the IDSHS. It might be appropriate to ask the board member who made the suggestion to present it to the leadership team prior to the next board meeting. This will provide an opportunity to clarify the request and to educate the board member, if needed. Risk management should document the facts and the actions taken. The RM team should monitor the situation through the CEO until a decision is implemented. Any voluntary reporting should be instituted.
· Risk Management documents facts, plan of action, and actions taken; communicates with CEO.
· Regularly communicate major financial decisions with the board of directors.
· Ask the board member to present to the leadership team to clarify the request.
STEP EIGHT: REVIEW THE DECISION TO ENSURE IT ACHIEVED THE DESIRED GOAL.
Toni decided to clarify the facts, and determined that the board member was operating out of lack of understanding. She arranged for a team meeting to discuss the financing and cost allocation of the pediatric practice acquisition as it related to the construction of the new facility. The general counsel and CFO were instrumental in leading a review of acceptable alternatives that would assure proper practice acquisition and cost allocations which adhered to local, state, and federal laws. A plan of action was proposed, and the leadership team asked the risk management representative to assist in ongoing assessment and monitoring of the entire practice acquisition and construction efforts. It was suggested that the organization voluntarily report their concern regarding a virtual monopoly prior to the acquisition. If it were determined to be in violation of the law, alternative options would be explored. Risk management required that the vendor present on-site presentations, and offered the option to review a video tour of their recently constructed facilities. The general counsel believed that the trips would be considered inappropriate gratuities (i.e., kickbacks), in violation of the law. The ethics representative provided an overview of ethical principles, standards, and expectations for health care executives. The team agreed to have a periodic review of the legal and ethical considerations related to the expansion of the pediatric service line.
The CEO and his/her designees on the leadership team monitor all subsequent action steps with ongoing input from risk management. All proposed action steps are evaluated within a legal and an ethical perspective.
Subject Matter Expert:
Dr. Janet Balke, Adjunct Faculty, SOPSL
Tara Schiller, Christina Adams
Licensed under a Creati
This short briefing outlines issues related to quality-related policy development and the potential solutions offered by new regulations such as the Medicare Access and CHIP Reauthorization Act (MACRA) and the ACA.
· Whitlock, R. (2016, April 15). United States: Talking about the challenge of quality in health care policy development. Mondaq Business Briefing.
Development of Evidence-Based Strategies and Policies
· Brown, L. J., & McIntyre, E. L. (2014). The contribution of primary health care research, evaluation and development-supported research to primary health care policy and practice. Australian Journal of Primary Health, 20(1), 47–55.
This article explores and compares two policies aiming to improve health and social care in Sweden and to test a new conceptual model for evidence-informed policy formulation and implementation.
· Strehlenert, H., Richter-Sundberg, L., Nystrom, M. E., & Hasson, H. (2015). Evidence-informed policy formulation and implementation: A comparative case study of two national policies for improving health and social care in Sweden. Implementation Science, 10, 1–11.
This article provides suggestions on how physicians may participate in evidence-based policy development.
· Rawlins, M. D. (2014). Engaging with health-care policy. The Lancet, 383, S7–8.
This organization works with stakeholders to develop evidence-based measures and guidelines for quality improvement.
· National Quality Forum. (2016). Retrieved from http://www.qualityforum.org
This model is useful for incorporating research evidence into health care policies and practices.
· National Collaborating Centre for Methods and Tools. (2011). Stetler model of evidence-based practice. Retrieved from http://www.nccmt.ca/resources/search/83
Organizational Policies and Implementation Strategies
· Institute for Healthcare Improvement. (n.d.). How to improve. Retrieved from http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
This article compares single- to multi-faceted strategies for evidence-based health care policy implementation, and reveals that this is a controversial topic in the health care industry.
· Harvey, G., & Kitson, A. (2015). Translating evidence into healthcare policy and practice: Single versus multi-faceted implementation strategies – is there a simple answer to a complex question? Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357977/
This study provides details on the implementation of system-wide tobacco control policies.
· Gordon, L., Modayil, M. V., Pavlik, J., & Morris, C. D. (2015). Collaboration with behavioral health care facilities to implement systemwide tobacco control policies—California, 2012. Preventing Chronic Disease, 12, E13.
Policy Proposal Scoring Guide
|Explain the need for creating an organizational policy or practice to address a shortfall in meeting a prescribed metric benchmark.||Does not explain the need for creating an organizational policy or practice to address a shortfall in meeting a prescribed metric benchmark.||Attempts to explain the need for a creating an organizational policy or practice, but the explanation is imprecise or is not clearly related to a shortfall in meeting a prescribed metric benchmark.||Explains the need for creating an organizational policy or practice to address a shortfall in meeting a prescribed metric benchmark.||Explains the need for creating an organizational policy or practice to address a shortfall in meeting a prescribed metric benchmark, acknowledging costs and benefits both of changing and of not changing the policy or practice.|
|Recommend ethical, evidence-based strategies to resolve a performance issue related to health care policy or law.||Does not recommend ethical, evidence-based strategies to resolve a performance issue related to health care policy or law.||Recommends strategies to resolve a performance issue, but the strategies are either not clearly ethical, not clearly evidence-based, or seem unlikely to resolve the issue.||Recommends ethical, evidence-based strategies to resolve a performance issue related to health care policy or law.||Recommends ethical, evidence-based strategies to resolve a performance issue related to health care policy or law, and identifies areas of uncertainty or knowledge gaps.|
|Analyze the potential effects of environmental factors on recommended strategies.||Does not describe the potential effects of environmental factors on recommended strategies.||Describes the potential effects of environmental factors on recommended strategies, but fails to analyze them.||Analyzes the potential effects of environmental factors on recommended strategies.||Analyzes the potential effects of environmental factors on recommended strategies, and proposes mitigation or potential responses to those factors.|
|Propose a succinct policy and guidelines to enable a team, unit, or the organization as a whole to implement recommended strategies to resolve the performance issue related to the relevant local, state, or federal health care policy or law.||Does not propose a succinct policy and guidelines to enable a team, unit, or the organization as a whole to implement recommended strategies to resolve the performance issue related to the relevant local, state, or federal health care policy or law.||Proposes a policy and guidelines, but its applicability to either a group or the implementation of recommended strategies is unclear or weak.||Proposes a succinct policy and guidelines to enable a team, unit, or the organization as a whole to implement recommended strategies to resolve the performance issue related to the relevant local, state, or federal health care policy or law.||Proposes succinct policy and guidelines to enable a team, unit, or the organization as a whole to implement recommended strategies to resolve the performance issue related to the relevant local, state, or federal health care policy or law. Makes explicit links to the evidence that supports the soundness of the proposal.|
|Identify colleagues, individual stakeholders, or stakeholder groups who should be involved in further development and implementation of proposed policy, guidelines, and recommended strategies.||Does not identify colleagues, individual stakeholders, or stakeholder groups who should be involved in further development and implementation of proposed policy, guidelines, and recommended strategies.||Identifies colleagues, stakeholders, or groups who are not the most logical choices to be involved in further development and implementation of proposed policy, guidelines, and recommended strategies.||Identifies colleagues, individual stakeholders, or stakeholder groups who should be involved in further development and implementation of proposed policy, guidelines, and recommended strategies.||Identifies colleagues, individual stakeholders, or stakeholder groups who should be involved in further development and implementation of proposed policy, guidelines, and recommended strategies; suggests collaboration strategies.|
|Communicate a proposed policy, guidelines, and recommended strategies in a professional and persuasive manner, writing content clearly and logically, with correct use of grammar, punctuation, and spelling.||Does not communicate a proposed policy, guidelines, and recommended strategies in a professional and effective manner; does not write content clearly and logically; or does not use correct grammar, punctuation, and spelling.||Provides a proposal that is not consistently professional, effective, clear, and logical, or errors in use of grammar, punctuation, or spelling distract from the message.||Communicates a proposed policy, guidelines, and recommended strategies in a professional and persuasive manner, writing content clearly and logically, with correct use of grammar, punctuation, and spelling.||Communicates a proposal that is professional, effective, and insightful; content is clear, logical, and persuasive; and grammar, punctuation, and spelling are without errors.|
|Support arguments effectively with relevant sources, correctly formatting citations and references using current APA style.||Does not effectively support arguments with relevant sources; does not correctly format citations and references using current APA style.||Cites sources that lack relevance or integrates them poorly, or formats citations or references incorrectly.||Supports arguments effectively, with relevant sources, correctly formatting citations and references using current APA style.||Supports arguments effectively, with relevant sources, correctly formatting citations and references using current APA style. Citations are free from errors.|