Applications of Strategic Management and Future Delivery Theories
B1. HCAHPS Scores/ State and National Averages
|Hospital||State Average||National Average|
|Patients who reported that their nurses “Always” communicated well||84%||81%||81%|
|Patients who reported that their doctors “Always” communicated well||84%||83%||82%|
|Patients who reported that they “Always” received help as soon as they wanted||73%||69%||70%|
|Patients who reported that staff “Always” explained about medicines before giving it to them||65%||66%||66%|
|Patients who reported that their room and bathroom were “Always” clean||80%||76%||76%|
|Patients who reported that the area around their room was “Always” quiet at night||68%||64%||62%|
|Patients who reported that YES, they were given information about what to do during their recovery at home||89%||87%||87%|
|Patients who “Strongly Agree” they understood their care when they left the hospital||60%||54%||54%|
|Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)||85%||73%||73%|
|Patients who reported YES, they would definitely recommend the hospital||88%||70%||72%|
B2.Comparison to Other Hospitals
|Hospital 1||Hospital 2||Hospital 3||State Average||National Average|
|Patients who reported that their nurses “Always” communicated well||84%||80%||74%||81%||81%|
|Patients who reported that their doctors “Always” communicated well||84%||79%||77%||83%||82%|
|Patients who reported that they “Always” received help as soon as they wanted||73%||66%||55%||69%||70%|
|Patients who reported that staff “Always” explained about medicines before giving it to them||65%||62%||54%||66%||66%|
|Patients who reported that their room and bathroom were “Always” clean||80%||73%||64%||76%||76%|
|Patients who reported that the area around their room was “Always” quiet at night||68%||61%||60%||64%||62%|
|Patients who reported that YES, they were given information about what to do during their recovery at home||89%||87%||84%||87%||87%|
|Patients who “Strongly Agree” they understood their care when they left the hospital||60%||55%||47%||54%||54%|
|Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)||85%||75%||64%||73%||73%|
|Patients who reported YES, they would definitely recommend the hospital||88%||76%||64%||70%||72%|
B3.Survey Response Rates
|Hospital||Number of completed surveys||Survey response rate|
Baptist Health Lexington received more surveys and scored higher than UKMC and STJ Hospitals.
B4. Demographics and Services Provided
The Baptist Health is located in Lexington, Fayette County Kentucky. Fayette County borders serval small rural counties such as Bourbon, Clark, Jessamine, Madison, Scott, and Woodford Counties. BHL is a sister hospital to eight other hospitals. It’s a 391-bed tertiary care facility, known for its medical research and education center. The Lexington facility employees approximately 1200 employees including the CEO, CNO, CFO, middle management, physicians, Advance Practice Nurse Practitioners, Physician Assistants, register nurses, certified nurse assistants, occupational therapist, social workers, dietitians, surgical, radiology, and pharmacy techs and non-clinical staff such as security, registration, housekeeping, and etc. The Baptist Health family has more than 500 physicians on staff representing more than 50 medical specialties (Baptist Health Lexington, 2020). The parent facility is located in Louisville, Kentucky. Baptist Health offers a variety of access points such a Medical Group Offices, Urgent Care Centers, Occupational Medicine, Physical Therapy, diagnostics and pharmacies throughout Kentucky and Southern Indiana. The hospital also offers services such as women’s health, cancer, heart, mother and baby care, orthopedics, neurosciences, behavioral health, outpatient surgery, clinical laboratories and many other services (Baptist Health Lexington, 2020). BHL is committed to helping the community and is active in community health initiatives such as weight loss program, smoking sensation classes, childbirth classes, diabetes education and nutritional services as well as participates in community activities (Kentucky Public Health, 2017).
Baptist Health Lexington serves Lexington-Fayette and surrounding counties for primary and secondary care. Lexington is the second largest city in Kentucky. It is a mixture of urban, suburban, and rural areas. Lexington is known for it’ beautiful horse farms, Keeneland Race track and the Kentucky Horse Park. Lexington also houses 3 major Universities, University of KY, Bluegrass Community & Technical College and Transylvania University (City-Data, 2020).
BHL provide services for a culturally diverse patient population. The hospital sees patients across the life span, from all economic and cultural backgrounds. The 2018 census showed that Fayette County has a population of 324k people and represents 7 different ethnic groups. These included 229k White (NON-Hispanic), 47k Black or African American(NON-Hispanic) ,12.5k Asian (NON-Hispanic), 12.1k White (Hispanic), Multiracial 10.7k, 8.67k (Other Hispanic), and 2.34k Multiracial (Hispanic) residents (Kentucky Public Health, 2017). The average household income in 2017 was $56,137. For people 25 and over there are 92.3% have completed high school, 43.6 % have a Bachelor’s degree or higher, 17.6 % have a professional degree and 5.4% are unemployed (City-Data, 2020).
B5a. Cultural Dynamics
There are many environmental and community factors that can influence the HCAHPS score. One such influence is the cultural dynamics in and around the service area. Some cultural dynamics that could potentially influence the HCAHPS scores are language barriers. Communication is the substance of many of these survey questions. That being said, these surveys are generally distributed by mail and in the English language. If English is not their first language then the translation may be difficult for the patient and their family to understand how to answer the question. Secondly, communicating through technology may not be widely accepted or a receptive way of communication to some cultures. Additionally, nurses take every opportunity to provide information and education to the patient throughout their hospital stay. Therefore, there are times such as taking the patient to the bathroom or hygiene activities that it may not be appropriate to have the language line or IPad for communication. Lastly, some cultures or religions frown upon showing pain or asking for substances to relieve that pain. It’s important to communicate these cultural beliefs. However, these examples can result in the patient being dissatisfied with their care can influence the scores a hospital receives.
B5b. Educational Dynamics
BHL patients embody a wide-range of educational backgrounds that they see. They range from having minimal education to highly educated. According to the World Population review, 47.32% of Kentuckians have a high school education or lower (2020). Patients with minimal education or unable to read or write may misinterpret the survey questions and reflect negatively unintentionally or vice versa on the survey questions. Patiently with lower educational levels may have trouble understanding or follow instructions of the survey questions. Likewise, patient with low educational status may not only answer the questions incorrectly, but may underestimate the significance of the survey and not complete them correctly or at all. Thus influencing the HCAHPS scores the hospital receives.
(World Population Review, 2020)
B5c. Socioeconomic Dynamics
Fayette County resident’s annual income is less than National average, referenced earlier. 30% of Kentuckians are covered under Medicaid. Kentucky is rated fifth poorest state and 18.5 % of Kentuckians are living below poverty level (Kentucky Public Health, 2017). According to the Census, there were 13.5% Kentucky residents that had not graduated high school (City-Data, 2020). Low income, education, and uninsured patients habitually choose between paying their bills such as rent, food, and utilities rather than going to the doctor. Low income or uninsured patients access the healthcare system less frequently because they are unable to afford the medical expenses. This inability to afford healthcare or medications often leads to frequent visits to emergency departments and/ or hospitalizations. Patients that are seen through the emergency department will usually have long wait times, and higher medical cost. This infrequency to access healthcare leads physicians and nurses to believe that the patient is non-compliant with their health and treatment. This may precipitate providers to treat patients that are socially and economically underprivileged differently than patients that can afford to routinely visit their primary physician for preventive care. This leads to more frustration between health care providers and patient. Which results in the hospital receiving low scores or the patient may not complete the survey at all.
B6. Short and Long Term Financial Impact
The survey results have a direct financial impact on the facility. The patient survey contributes in configuring the HCAHP score. The leading short term financial impact is the amount insurance companies, Medicaid or Medicare will reimburse the hospital. Lower scores equals’ lower amount of money the hospital receives. Long term this can lead to loss of patients and cause a domino effect of decrease in staff, such as calling or laying staff off. This can cause patient safety issue and a lack of equipment or services needed to provide quality care. Additionally, hospitals receive payment incentives for collecting and reporting HCAHP data. If critical access hospitals do not report the quality measures then they may receive a lesser incentive payment. Today, more than ever patients are aware of how hospitals are reimbursed for their services. There has been so much information circulated to the public in order to improve the patient experience and this information is just a click away. Knowing the hospital’s rating or HCAHP score helps the patient to choose their healthcare provider. They have the knowledge to decide where to have a baby, surgery or even select a provider. Patients know they have options and can choose where to seek care. If patient receive good quality care they are more likely to return for their own medical needs and recommend that facility to their friends and family. Long term this can have a substantial impact on the hospitals’ bottom-line.
B6a. Impact on Quality
- Cause of Scores
There can be numerous probable reasons for the HCAHPS scores being low. The below table illustrates the three lowest scoring questions for BHL. The results are measured against the results of the HCAHPS results nationally, completed surveys and likely causes for the results.
|Low scoring HCAHPS questions||Potential Causes|
|Patients who reported that staff “Always” explained about medicines before giving it to them||· Nurse shortage, leaves nurses with less time with each patient
· Inadequate skills in communication
· English not being their first language
|Patients who reported that the area around their room was “Always” quiet at night||· Staff being loud or the patient room to location near the nursing station
· Overhead intercom system utilized at night
· Alarms, monitor alerts
|Patients who “Strongly Agree” they understood their care when they left the hospital||· Inadequate skills in communication
· English not being their first language
· Lack of training in discharge planning
D1. Organizational Change
The table below summarizes the organizational goals, organizational changes that are necessary to accomplish the goal, and the manner in which it will improve the hospital’s HCAHPS scores.
|Organization Goal||Organizational Change||Improvement in HCAHPS Scores|
|Improve patient satisfaction and safely related to medication education||Training provided to nursing staff on educating patients on their medication prior to administration.||Increase in patient safety and patient outcome. Patients communicate a better comprehension of their medications and will therefore improve HCAHPS score on the survey questions related to patients always explained medications.|
|Decrease noise at night||Arrange for education to staff on the significance of being quiet in the hallways, at the nurse’ station, and around patient room doors during the night. Implement a policy regarding a cutoff time for overhead announcements and pages.||There will be a significate decrease in reports of sleep disruptions and noise level complaints at night on the HCAHPS survey.|
|Increased discharge communication
|Develop a new program to have a discharge team for all discharge planning and teaching.
|Better HCAHPS scores on questions related to “strongly agree they understood their care plan when they left the hospital”.|
D2. Structure, Process, and Outcomes
|Improve on the process of explaining medication before giving it to the patients||Ø Assess the healthcare provider’s knowledge on the process of administering medications to patients and identification of gaps.
Ø Work with the administration and nurse educator to establish education and training grounds for nurses about medication administration.
Ø Provide additional education to nurses on the process of medication administration and its relevance to patients.
Ø Evaluate understanding of nurses on medication administration process.
|Score higher on the question “Patients who reported that staff “Always” explained about medicines before giving it to them|
|Reduction of noise at night||Ø Research evidence-based practices (EBP) to lessen the noise at night while taking care of patients.
Ø Organize for education on the importance of quiet environments at night to patients.
Ø Work with the administration and IT department to establish cut off time (From 9 p.m. to 4 a.m.) for overhead announcements and paging at night.
Ø Implement the new strategy and monitor for adherence to the set policy.
|Increase HCAHPS scores on the question “Patients who reported that the area around their room was “Always” quiet at night|
|Improve patient’s comprehension of their care||Ø Search literature for EBP to improve communication and administration of discharge information to patients.
Ø Work with the nursing administration to select a team responsible for patient education before leaving the hospital.
Ø Educate the selected team on pertinent discharge information to be included for every patient.
Ø Work with the administration to establish a department responsible for discharge planning and education for all patients.
Increase HCAHPS scores on the question “Patients who “Strongly Agree” they understood their care when they left the hospital
D3. Improving Organizational Quality
EBP in healthcare today has increased as organizations strive to provide top-quality care to patients. These practices utilize evidence from research, internal evidence from clinical practice, and patient preferences and values to inform new change. According to Melnyk, Gallagher-Ford and Fineout-Overholt, the use of EBP improves patient outcomes including aspects of patient safety and standardization of care across healthcare organizations (2016). In the implementation of the new change, I plan to research articles on EBP to reduce noise at night and best practices for ensuring discharge information is adequately provided to patients. For instance, there is strong evidence supporting the use of education and training for nurses to improve on the aspect of medication administration (Bourbonnais & Caswell, 2015). Evidence-based practices will also guide the provision of education and training for staff regarding the effective delivery of discharge information to patients.
Incorporation of shared governance will be the other approach to ensuring quality in the organization. Shared governance is an approach that includes communication, teamwork and accountability while functioning together to resolve issues that influence nursing practice and patient care. In the new plan, I will engage different healthcare groups including nurses, doctors, and managers to make critical decisions towards the improvement of HCAHPS scores in the selected areas. Secondly, communication of change and implementation plans will be done to every stakeholder while considering their views. Through shared governance, it will be easy for the healthcare teams to accept the proposed solutions and work collaboratively to achieve the set goals.
D4. Shared Accountability
Accountability in healthcare involves taking responsibility for one’s actions, ensuring competency in performing tasks, and putting the patient’s interests first. Shared accountability among different healthcare teams is crucial for strengthening performance and advancing the position of an organization. During the implementation of the new changes, shared accountability will prevail among the patients, medical providers, payers, and personnel.
Patients will be among the key stakeholders involved in the implementation of new changes in the organization. A discussion will be necessary to ensure patients understand the importance of returning the patient experience surveys. Secondly, the discussion will stress the relevance of providing accurate results to ensure that changes made are geared towards improving quality. Another method will involve the use of routine rounding by the managers to collect patients’ views on the implemented change and taking necessary action.
Changes in the identified low HCAHPS score areas will involve both the nurses and the doctors. The first approach to promote shared accountability will involve encouraging all personnel to participate in meetings and education programs. The chief medical officer and the nurse managers will work to ensure every member is an active player in the new change process. Disciplinary action for those that do not meet the set limits and the use of incentives for those that perform well will promote shared accountability. Lastly, the provision of feedback will ensure staff understands their roles and efforts towards improving quality in the organization.
Engagement of the payers will be done through collaborative practice with the Revenue department. The Revenue department will communicate regularly with the payers to ensure they provide timely feedback on the HCAHPS surveys and how they inform the financial status of the organization. Accountability will also be demonstrated through timely reimbursement and provision of guidance towards achieving higher scores in areas that will underperform.
The personnel will be encouraged to participate in meetings to ensure they understand their roles in the implementation of the new changes. Secondly, I will ensure the timely provision of feedback through the managers so that all members get to know the position of the organization regarding patient satisfaction. Another method will involve recognition of the roles of individuals through incentives to ensure that other teams work hard towards improving quality. Lastly, education and training practices for other departments will ensure the members are well-equipped to improve quality and patient safety in the organization.
D5. Technology Trends
Today’s technology has fundamentally changed the way healthcare services are received and improved the quality of care provided to patients. The first aspect that involves technology is documentation using the electronic health record system. The system will be used to gauge the understanding of healthcare providers especially aspects of medication administration and any challenges experienced. The second aspect will involve timely communication of results to stakeholders via the hospital website including reaching out to the payers and other external stakeholders.
D6. Improve Care Delivery System
Quality care represents the extent to which services provided to patients meet the expected outcomes. The plan of improving HCAHPS scores on the three areas demonstrates quality because it ensures healthcare provider accountability. For example, nurses and doctors will be able to understand the relevance of explaining medication before administration to patients. Explaining medication will minimize medical errors and promote understanding of patient care. Secondly, the plan will involve the education of staff in areas that require improvement. Continuing education for staff is recognized as a measure to improve quality service delivery.
The plan is to improve HCAHPS scores in three identified areas which will translate to more reimbursements. The financial status of the organization will improve upon meeting the set standards and more capital will be available to implement processes in the organization. Additionally, educating staff on aspects of medication administration will ensure the reduction of errors that cause unnecessary spending to patients and providers.
The plan improves access to healthcare services by ensuring that healthcare providers understand their roles. Nurses will be able to provide relevant information to patients before medication administration which is a fundamental right to the patient. Secondly, the plan will involve routine rounding which will ensure patients and families present their complaints to managers.
The implementation plan involves patients as key stakeholders responsible for making decisions about their care. Regular communication between patients and healthcare providers will ensure they get to air their grievances while understanding aspects that need intervention. Secondly, the plan allows for regular provision of feedback by the patients allowing them to be part of the team transforming healthcare.
D7. Improve Financial Stability
The process for improving the business or financial aspect of the organization is through the improvement of the HCAHPS scores. Higher HCAHPS scores mean more reimbursements from the Medicare and Medicaid services leading to financial stability. Secondly, higher HCAHPS scores will put the hospital in a competitive position which will ensure the generation of more revenue from customers. Additionally, improving aspects such as medication administration and effective provision of discharge information will reduce hospital readmissions and reduce the cost of healthcare.
E1. Stakeholder Roles and Responsibilities
|Stakeholder||Stakeholder Roles and Responsibilities|
|Hospital Administration||Ø Coordinate the implementation of EBP to improve processes within the institution.
Ø Allocate necessary resources for the implementation of new changes to improve HCAHPS scores.
Ø Work collaboratively with the nurses and physicians to set policies governing noise reduction at night.
Ø Monitor the implementation of new change.
Ø Work with the payers and external stakeholders to ascertain improvement of HCAHPS scores.
|Nursing Department||Ø Act as the patient’s educator and advocate during the process of implementing change.
Ø Work collaboratively with other healthcare teams to set policies on noise reduction at night.
Ø Ensure the set policies are implemented and quiet times are observed from 9 p.m. to 4 a.m. daily.
Ø Actively engage in explaining medication before administration to patients.
Ø Attend education and training programs to improve on the area’s leading to low HCAHPS scores in the facility.
Ø Evaluates the effectiveness of the new process to the organization and how it promotes patient-centered care.
|Physicians and Medical Services||Ø Participate in education programs geared towards improving quality in the organization.
Ø Collaborate with the nursing team and the administration to set policies on noise reduction.
Ø Actively engage in explaining medication administration to patients and providing discharge information when required.
Ø Communicate appropriately to patients and families during the change process.
Ø Evaluate the effectiveness of the new Process.
|Patients and Families||Ø Be the recipients of care.
Ø Be involved in their care.
Ø Communicate to the healthcare team during the implementation of new change.
E2. Stakeholder Accountability
|Stakeholder||Stakeholder Accountability||Stakeholder Involvement|
|Hospital Administration||Ø Demonstrate effective communication and sharing with other stakeholders.
Ø Provide regular feedback on the implementation process including areas that require improvement.
Ø Provide set deadlines for meeting objectives for each involved department.
|Ø Involvement in monthly meetings to assess the progress of the new changes.
Ø Planning for rewards and recognition upon realization of set goals.
|Nursing Department||Ø Expected to share with other stakeholders during meetings.
Ø Disciplinary action against non-compliant staff with set policies and procedures.
|Ø Participate in education meetings and regular evaluations.
Ø Provide regular feedback on the new changes including areas of improvement.
Ø Rewards and recognition upon improvement of HCAHPS scores.
|Physicians and Medical Services||Ø Share with other stakeholders during meetings.
Ø Provide reports on their activities during the implementation phase.
Ø Disciplinary action upon going against set policies and procedures.
|Ø Participate in meetings during the implementation phase.
Ø Feedback provision on the new changes.
Ø Involvement in rewards and recognition upon improvement of outcomes.
|Patients and Families||Ø Demonstrate communication and sharing to healthcare providers.||Ø Engage in education activities upon discharge.
Ø Provide feedback on the new changes through filling the patient satisfaction surveys.
The first approach towards the improvement of HCAHPS scores will involve the education of staff on the importance of explaining medications before administration. Necessary training for the team on areas to stress during medication giving and documentation of data in the EHR system is necessary. The second aspect will involve training of staff on ways to disable the overhead paging and announcement systems during the quiet hours. Regarding the provision of discharge information, the implementation team will be trained on how to effectively communicate to patients and areas to stress during discharge.
E4. Plan Implementation
|Patients who reported that staff “Always” explained about medicines before giving it to them||Patients who reported that the area around their room was “Always” quiet at night||Patients who “Strongly Agree” they understood their care when they left the hospital|
|Goal||Get better explaining medications before administration to the patient.||Reduce the noise at night.||Improve communication of discharge information to patients.|
|Months 0 – 3||Ø Assess the healthcare provider’s knowledge on the process of administering medications to patients and identification of gaps.
Ø Review the current HCAHPS scores for medication administration.
Ø Establish timeline for implementation of new change.
|Ø Literature search on EBP to reduce noise at night.
Ø Review the current HCAHPS scores for medication administration.
Ø Decide on the new change to reduce noise at night.
|Ø Literature search and review on effective ways to ensure delivery of discharge information to patients.
Ø Review the HCHAPS scores on patient’s understanding of care upon leaving the hospital.
Ø Establishment of a timeline for activities leading to the implementation of the new change.
|Months 4 – 6||Ø Communicate the plan to the healthcare providers.
Ø Assemble education material including identification of rooms for education.
|Ø Meeting between essential stakeholders to establish policies on quiet hours at night.
Ø Establish alternatives for overhead paging and announcements at night.
Ø Communicate the plan to staff across all hospital departments.
|Ø Meeting between administration and other stakeholders to identify a discharge planning and education team.
Ø Organize for training of the team on their roles and responsibilities.
Ø Communicate the plan to the employees.
|Months 7 – 9||Ø Train staff on the significance of explaining medication before administration.
Ø Nurse Managers perform routine rounding to ascertain workability of the new change.
|Ø Implement the new policy on quiet hours between 9 p.m. and 4 a.m.
Ø Collection of regular morning reports on the applicability of the new policy.
|Ø Educate the selected team on their roles and responsibilities regarding coordination of discharges in the facility.
Ø Monitor processes leading to communication of discharge information.
Ø Rounding to determine effectiveness of the new change and reinforce education practices.
|Months 10 – 12||Ø Obtain feedback from staff and patients on the new change.
Ø Review HCAHPS scores and communicate the results.
|Ø Evaluate the effectiveness of the new change.
Ø Review HCAHPS scores to see improvement and communicate effectively to staff.
|Ø Auditing of the team to ensure understanding of roles.
Ø Obtain feedback from patients and families on the effectiveness of the new change.
Ø Review HCAHPS scores to ascertain improvement, make necessary changes and communicate back to the team.
|Periodic Review||Month 9 – Check with staff to ensure understanding of the new change and to identify any barriers.||Month 10 – Check with staff to determine barriers to the new change and make necessary adjustments.||Month 8 – Check on the selected team to ensure they understand their roles and identify barriers to the adjustment.|
- Evaluate the Strategic Plan’s Success
The initial approach will involve the evaluation of education and training offered to staff during the implementation phase. Evaluations during the review points for all the three changes will be done to ascertain the understanding of staff and patients on their new roles. Secondly, attendance sheets for the regular training of staff will be used to assess their involvement in the new change process. A score of 95% to 100% attendance will demonstrate the success of education and training. Lastly, the HCAHPS scores will be compared with those from the previous year to ascertain the effectiveness of the change.
F1. Involvement of Stakeholders
|Stakeholder||Involvement in Evaluation|
|Hospital Administration||Ø Collect data from other stakeholders to ascertain workability of the new changes.
Ø Provide feedback on the improvement of HCAHPS scores and necessary changes to achieve positive outcomes.
Ø Review of education and training for staff.
|Nursing Department||Ø Monthly meetings to assess the progress of the new change and provide feedback on areas of difficulty.
Ø Review routine documentation on medication administration.
Ø Review the HCAHPS scores and improve appropriately.
Ø Review attendance during education meetings and take necessary actions.
|Physicians and Medical Services||Ø Review attendance during education meetings.
Ø Regular provision of feedback to the chief medical officer including barriers experienced.
Ø Review of the HCAHPS scores.
|Patients and Families||Ø Provide feedback to the managers during rounding.
Ø Participate in the HCAHPS surveys.
F2. Communication of Result
The results will be conveyed to hospital personnel and to the public using different methods. Internal communication will be done using the departmental heads who will inform their staff. Secondly, the hospital newspaper, noticeboards, and internal memos will serve to communicate results to staff and patients. Face-to-face communication of results will be used during rounding. Results to the public will be posted on the hospital website, local newspapers, and using social media platforms like Facebook and LinkedIn.
Baptist Health Lexington. (2020). About Baptist Health Lexington. Retrieved from https://www.baptisthealth.com/lexington/about-baptist-health-lexington/
Bourbonnais, F. F., & Caswell, W. (2015). Teaching successful medication administration today: More than just knowing your ‘rights’. Nurse Education in Practice, 14(4), 391-395. DOI: 10.1016/j.nepr.2015.03.003
Kentucky Public Health. (2017). Cabinet for health and family services: Kentucky state health improvement plan 2017- 2022. Retrieved from https://chfs.ky.gov/agencies/dph/Documents/StateHealthImprovementPlan20172022.pdf
City – Data. (2020). Lexington-Fayette, Kentucky. Retrieved from https://www.city-data.com/city/Lexington-Fayette-Kentucky.html
Medicare.gov. (n.d.). Hospital compare: Survey of patients’ experiences. Retrieved from https://www.medicare.gov/care-compare/details/hospital/180103?id=3df4e82e-88a8-4f5e-84a7-15e462a07de1&city=Lexington&state=KY&zipcode=40503&measure=hospital-patient-surveys
Melnyk, B. M., Gallagher-Ford, L., Fineout-Overholt, E., & Sigma Theta Tau International,. (2017). Implementing the evidence-based practice (EBP) competencies in healthcare: A practical guide to improving quality, safety, and outcomes.
World Population Review. (2020). Kentucky population 2020. Retrieved December 26, 2020, from https://worldpopulationreview.com/states/kentucky-population
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