Decision-making can be the most difficult piece when you have so many issues to attend especially being in management. So as for Chris Smith an executive assistant to the CEO of Faith Hospital who needs to come up with solutions to solve the issues that are making this business plunge. One issue that needs to be seen is that stakeholders need to realize or understand the differences between ethics, laws, beliefs, oaths, etc. Another issue is we have particular patients who refuse to take certain medical services, and there are particular staff members who refuse to provide certain services. In these cases, some feel that medical intervention can go too far into conflict with their religious beliefs or personal moral opinions.

There is a case in our Neo-Natal Ward, where Child Protective Services is in the process of taking custody of the baby and threatening to file charges against us because of the way we provided services or failed to provide services. An additional issue is that there is three staff members in the ICU initiated Do Not Resuscitate (DNR) directives. When that went about there became one problem and that there was no written orders to that effect. Some of the qualified staff members are driven by a personal decree that says ‘we have to do all that we can.’ In another recent event, staff members did not follow DNR directives even though these were in place. All three events had the support of the patients’ families.

A new issue is that one of our hospital pharmacists is filling uninsured prescriptions by accepting payment in installments. Two of our counselors are treating some of their clients pro bono--unauthorized! At the other end of the range, some staff members care so much about Faith’s survival that they refuse to serve patients unless they confirm insurance coverage first. A further issue is that one of our residents is ordering unproductive exams for the terminally ill. There a lot of issues here especially about wonderful collaborations with insurance companies and the regulators--HMOs, PPOs, and other TLAs--you know, three letter acronyms such as AMA, AHA, HHS, etc. Who gets covered, how much and when we get paid, seem to be totally out of our hands at times.

Some issues deal with cost such as how much our costs have increased compared to last year. One year ago, our costs were $217.00 per patient per day. But, on the last report that was received from accounting, that figure had risen to $240.00. But, the financial analyst for an evaluation, and he indicated that we’ve had a 7% decrease in patient population. Roughly 28% of our costs are fixed costs--costs that do not vary with the fluctuating patient population. This tells me that our costs do not change proportionally with the number of patients that we treat. If we can’t do something to increase the patient count, then we will have to make some tough cost-reduction decisions. Assuming that we are not able to increase our patient count, we will have to reduce our fixed cost to break even.

As I have stated the issues that need to be solved. I believe the best solutions are to fix issues with stakeholders and make a policy for them to understand the differences between ethics, laws, beliefs and oaths. The best solution is requirement analysis, which involves Information about requirements that normally is collected during the information gathering tasks performed as part of the other core workflows. However, it may be necessary to gather information specifically related to issues with the stakeholders and employees requirements. This can be done, by conducting special workshops, which focus on requirements such as reliability, recovery and policies. Another issue that can be solved is business goals such as fixing costs and gaining patients along with fixing issues with insurance providers by using the activity model as input, this task identifies business goals associated with activities. Each activity in the activity model is reviewed and any business goals associated with the activity are identified. In addition to activities, essential information requirements, functional requirements, the conceptual model, business rules and use cases can assist with the identification of business goals. Another helpful tip is using business goals as input; this task structures the goals into a hierarchical model. Each business goal is reviewed and decomposed into a number of more detailed, lower-level goals if appropriate. Goals associated with use cases and duplicated goals can be removed from the hierarchy. Using the goal hierarchy as input, this task identifies requirements associated with the quality of service provided by the application. Each low-level business goal is reviewed and any quality of service requirements associated with the goal is identified. In addition, Matrices can be used to trace the work issues to the sources of information used as input to the workflow. Matrices that compare activities with goals and goals with requirements can provide useful validation of and change issues into a successful outcome. Matrices can also be used to crosscheck the consistency of work issues and problems. Matrices that compare non-functional requirements to information requirements, business rules and use cases can be useful for ensuring that all of these problems and cases are completed and dealt with.
The reason for my proposed solution is that when you are dealing with so many issues and people who need and feel differently about requirements sometimes you need to analyze all requirements that you are trying to change to make everything better for everyone. So I propose the requirements analysis technique because I feel that there are so many things you could fix with this one tool. Because there are low-end and high-end issues that can be completed and thought out properly with this technique. For Chris, she was really good at critical thinking analysis and I believe she would of used this technique because not only do you solve policy issues but; you can solve issues here especially about wonderful collaborations with insurance companies and the regulators. Plus, you will be able to understand what your problem is with cost analysis as well.

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