1
3
Dr. Diane Rullo
CASE of Sigmund
INTAKE DATE: FEBRUARY 2019
DEMOGRAPHIC DATA:
This is a voluntary intake for this 53 year old Jewish male. Sigmund has had several psychiatric hospitalizations in the past. Sigmund has been married for 29 years and has been separated from his wife for the past ten months. He has been living alone for the past five months. His wife and three daughters live two blocks from him. Sigmund has had difficulty in jobs and has not been at any job longer than three years.
CHIEF COMPLAINT:
"I miss my family and do not want to live without them".
HISTORY OF ILLNESS:
Sigmund reports first seeking psychiatric treatment when he was sixteen years old. He was prescribed anti-depressants, but does not remember what kind. Since they helped his mood he remained on anti-depressants for several years. In his late teens he began drinking. His use of alcohol continued into his early thirties. At thirty four years old he attempted suicide after his wife and children left him. He was hospitalized in a psychiatric unit for thirty days. At that time Sigmund was put on lithium, with continued successful results for several years, resulting in reconciliation.
In December 2018 Sigmund returned to his psychiatrist because he was becoming depressed again, feeling sad, fearful and suicidal. He was given Parnate. Soon after, both Sigmund and the psychiatrist did not think this was working very well and the psychiatrist added Ritalin to his medication regiment. During the next three months Sigmund felt on top of the world sometimes lasting for 10 days. He then would have angry outbursts. His wife asked him to leave the home. He then took an overdose of Klonopin. Sigmund was then prescribed ECT (shock treatment). Sigmund returned home after the shock treatment but reported that it was an inhumane experience and felt anger towards his wife believing she forced him to receive ECT to return home.
Sigmund continued on anti-depressants and lithium. Mrs. Sigmund was getting continuously concerned about their financial state because Sigmund would constantly be buying big items that they could not afford. They would have arguments about this all the time. By the end of August he was asked to leave his home again because he used pills as a suicidal gesture. He began drinking again to cope with the separation. This use and behavior continued up to his current presentation for intake.
PSYCHOSOCIAL HISTORY:
Sigmund reports growing up as tumultuous. His mother beat him and would lock him out of the house when she became angry. His mother separated from his father on several occasions and sometimes would throw Sigmund out of the house with the father. His mother made all the decisions and his father played a more passive role. Both parents would often have physical fights and Sigmund would try to break up the fighting from as early as he can remember.
Sigmund is the only child from his parents union. He has an older brother from his mother's previous marriage. Sigmund does not have any contact with his brother. Sigmund was initially considered an underachiever in the early years of school. He had trouble being in fights with other kids because they use to make fun of his wrinkled clothes. Sigmund always wanted to be a doctor. He spent the following five years after college graduation taking courses but never completed his graduate studies.
Sigmund has no legal history. He worked in the family business through high school and college. He became a project coordinator at his next job. He stayed there three years.
MEDICAL HISTORY:
Sigmund states he currently takes Synthroid for a thyroid problem and this helps him keep his weight down.
FAMILY ISSUES AND DYNAMICS:
Sigmund was first married at age twenty one years old. He reports not loving his first wife but liked the stability of her family and asked her to marry him. They spent one year together. He physically abused her from the beginning of their marriage. Mrs. Sigmund the first had an affair that ended the marriage. Mrs. Sigmund reports Sigmund had spoken to her several times about getting involved with other men for sexual pleasure with his knowledge and she states she just followed through with his wishes. They had no children.
Six months after his first divorce Sigmund married again. He reports not loving his second wife but thought it was better to be married. The second Mrs. Sigmund had one child from a previous marriage who Sigmund adopted. They had two other children.
The first ten years of their marriage Sigmund reports physically abusing his wife. He reports hitting the oldest child once. He stopped the physical abuse when Mrs. Sigmund asked for a divorce the first time. Sigmund reports he always wants people around him. He believed his wife was becoming more distant from him over the past several years which he could not take. Their fighting increased, although he would not become physical with her now.
MENTAL STATUS EXAM:
Sigmund presents as a neatly dressed male who appears younger than his stated age. His hair is a bit disheveled. His nails are neatly groomed. Facial expressions are appropriate to thought content. Motor activity is appropriate. Thoughts are logical and organized. There is no evidence of hallucinations. Sigmund admits to a history of suicidal ideation, gestures and attempts. His mood is depressed. During the interview Sigmund talked fast. Sigmund is oriented to time, place and person. His intelligence appears above average.
Attached is Section 1 and Section 2 of the complete work about Cleveland Clinic
Section 3
Write a conclusion for your paper and combine all the sections into a project paper.
Impact of economic and outside influences to the Cleveland Clinic
• National and world economy impact
• Explanation of the sustainability of this organizational care model
• Healthcare reform
• Regulations
• Summarize the info regarding organization.
• Provide a glimpse into the future for the organization based on your learning.
Combine all Sections into a narrative, using APA formatting and citation style. This narrative report is essentially a detailed, comprehensive assessment of your experience. Please combine Sections 1, 2, and 3 in this submission and be sure to complete any improvements that were indicated by your instructor. You will need to cite at least 12 references in the complete report, add 4 for the section 3. Prepare this Assignment according to APA formatting and citation style. Section 3 should contain a conclusion that is to be 1600-2000 words in length and in APA format. Label each section (Section 1, Section 2, and Section 3)
Running head: CLEVELAND CLINIC 1
CLEVELAND CLINIC 9
Cleveland Clinic
Section 1
Healthcare is quickly evolving from the traditional care of the 20th century. Most of the hospitals built in the 20th century were not designed to enhance patient satisfaction and experiences. Little attention was given to the aesthetics of hospital rooms. Consider, for instance, the seemingly frightening medical equipment and the depressing hospital rooms painted in green. However, all this is beginning to change as healthcare moves towards a more holistic and patient-centered care model. Hospitals are complex ecosystems with hundreds of processes. In recent years, more emphasis has been placed on streamlining hospital administrative and operational processes to improve care. This paper will shed light on Cleveland’s goals, mission and vision, the Clinic Health System (CCHS), organizational structure, clinical research and activity, and the hospital's community and global impact. I chose Cleveland clinic because the hospital is spearheading the shift towards a patient-centered approach, and is shaping the future of healthcare by streamlining operational processes through a more efficient process and workflow.
Cleveland Clinic is a non-profit cross-functional facility that integrates clinical care with research and education. Cleveland Clinic (located in Cleveland, Ohio) has earned a spot on the list of the best international medical and research facilities (Cleveland clinic, 2019). The Clinic was named among the top hospitals in the “2019-2020 Best Hospitals” survey. Five Cleveland Specialties featured in the top five, and the clinic’s heart programmed was ranked the best since 1995. Cleveland Clinic is considered one of the most advanced medical centers in the U.S (Cold et al., 2019). It is typically recognized as one of the top three best healthcare organizations in the U.S, along with the Mayo Clinic and John Hopkins hospital. It’s Cardiology and Heart program is the best in the world.
Cleveland Clinic Organizational Structure
At the helm of the clinic’s structure is the board of directors. The clinic has a 28-member fiduciary governing body which is in charge of the hospital’s affairs and operations. They ensure that the hospital is well-operated and that it is working to fulfill its mission. Board members are chosen on the basis of expertise and experience in multiple disciplines valuable to the hospital’s administrative needs. Cleveland Clinic’s CEO Tomislav Mihaljevic is the second person in command. The CEO has the responsibility to ensure that all aspects of the hospital are working efficiently. He implements the board's directives, manages hospital departments, and oversees the daily operations of the hospital. The CEO works hand-in-hand with the board of governors, which is tasked with overseeing the clinical activities and maintaining standards of care at the hospital. The board of governors also appoint, promote, and terminate medical professionals as well as department chairs.
The CEO has an executive team that acts as an advisory team to the CEO, act as a communication link between the CEO and departmental heads and ensure that the board’s directives are executed at the department level. Below the CEO is the CEO council that is made up of the chief strategy officer, Chief of operations, and Chief HR officer. They convene weekly to discuss pertinent issues and make key decisions. The Clinical enterprise management team reports to the CEO council. The team is made up of leaders from all aspects of clinical practice. The team defines and oversees the implementation of the clinical enterprise strategy. All services in the hospital are organized in multidisciplinary teams, defined around disease and organ systems referred to as “clinical institutes.” These institutes include Head and Neck, Urology and kidney, heart and vascular, metabolism, digestive disease, respiratory disease, neurological, cancer, among others. Each institute has defined diseases within their scope, skills needed to care for patients, and a set of measured outcomes for which teams in the institute will be responsible.
Facility Physical Settings
With over 5875 beds system-wide and 1400 beds on Cleveland Clinic main campus, the facility is one of the largest hospitals in the U.S. In addition to the main campus, the clinic 10 regional hospitals, more than ninety Nothern Ohio outpatient posts, Cleveland Clinic in Canada Toronto, Cleveland Clinic Florida and Cleveland Clinic Abu Dhabi. The hospital has 7 surgical suites, research labs, administration offices, educational facilities, and 100 operating rooms.
Evidence-based design (EBD) has shown great potential in contributing to the healing process of patients. Sound can contribute to stress, and colors can affect mood. Cleveland’s clinic medical property management creates and maintains a healing environment for patients by designing medical facilities that provide positive distractions, eliminate environmental stressors, and provide access to nature. Evidence-based design has shown that patient rooms can be manipulated to increase patient satisfaction, improve sleep, and reduce hospital-acquired infections. The more successfully hospital designs tap into the positive and negative emotional states of patients, the higher the satisfaction of patients and by extension, the quality of the hospital.
Patient base
With a local, national, international clientele, Cleveland Clinic In 2018, the facility handled 295,093 Acute Admissions, and observations, 857,801 Emergency Department visits 5,406,591 Outpatient E&M visits and performed 244,636 surgeries and procedures.
Level of Clinical Activity and Research
The hospital is dedicated to the improvement of patient safety and outcomes through the Clinic’s Health System, which is driven by three main objectives, notably patient safety, and patient satisfaction and clinical services. The health system has the infrastructure in place to facilitate the achievement of the three objectives mentioned above. The infrastructure works as the analysis and measurement pillar of the health system’s performance plan. The hospital has a Quality Institute that is in-charge of managing CCHS improvement objectives and initiatives. Patient safety is one of the most important elements in the hospital's approach to quality improvement. The safety initiative outlines the fundamental expectations for the hospital facilities. The QI coordinates patient safety at the system level to achieve integration across all departments, organizations (Nadzam et al., 2005). Cleveland Clinic has made significant strides in the creation of standardized processes for analyzing and reporting medical errors system-wide to prevent re-occurrence of such events.
Cleveland Clinic is the quintessence of patient-centered care. With overwhelming expectations and an evolving healthcare environment, Cleveland clinic has made the transition to a patient-centered and value-based care that recognizes patients as bona fide members of the healthcare team, a true partner in their health journey (Barry & Edgman-Levitan, 2012). The Clinic provides access points along the continuum of care, which not only reduces wait times but also reduces cost and empowers patients. The hospital has implemented several innovative strategies to ensure optimal time management. These include using a patient tracking general positioning system (GPS), open scheduling of appointments, direct communication between physicians and patients, and expanded hours (Wadsworth et al., 2009). Further, multidisciplinary and multiagency collaboration has strengthened Cleveland’s clinic ability to provide quick, effective, and coordinated care to its patients.
Research and education is the cornerstone of Cleveland’s clinic mission and the core of each medical professional’s training. Medical professionals should be able to assess, synthesize, and apply medical data from literature to patient treatment and care, and to share this information with professionals and patients both orally and in writing. Cleveland clinic mentors its internal medicine residents in their research. The hospital has a 120+ faculty of globally revered clinical researchers and educators who serve as research mentors. In the past five years, medicine residents have published more than 80 journal articles, over two dozen book chapters and over 150 abstracts in scholarly journals such as JGME, Clinical Endocrinology, Journal of Immunology, American Journal of Cardiology, Cleveland Clinic Journal of Medicine and American Journal of Clinical Oncology just to mention a few.
Mission, Vision, goals
Cleveland Clinic’s mission is to provide better care for the sick, investigate their health issues, and further the education and skills of the professionals who serve them. The hospital’s vision is to be the best place for care and the best place to work in healthcare. The clinic pursues a three-pronged strategy for improving its performance. These are reducing the cost of healthcare, improving patient outcomes, and experiences and creating awareness in the community. Creating and implementing new models of value-based care is one of the main goals of Cleveland Clinic. The hospital has also outlined its ambitious goal of serving an even wider clientele. The CEO, Mihaljevic, wants the hospital to see more than 4 million patients by 2024. To accommodate such a large number of patients, the hospital will need to grow both physically and digitally. Although the hospital posted a good safety report in 2018, Mihaljevic believes the hospital can do better.
Community and Global Impact
Cleveland Clinic’s benefits extend beyond the patients it serves. As an anchor organization, the clinic promotes the social and economic well-being of its neighborhood. The clinic impacts the community positively by providing top-quality healthcare services, supporting the community’s healthcare initiatives, funding research on advanced cures, and educating the next generation of medical professionals. According to Cleveland Clinic’s 2017 community, the hospital spent $906.5 million in community-based initiatives. $90 million went to financial assistance, $70.6 million to research, $406.9 million was used to mitigate Medicaid shortfall, $22.0 million used on subsidized health services, $36.1 million allocated for outreach programs and $280.9 million to education. Cleveland clinic supports more than 120,000 jobs representing over $8 billion in total earnings.
Cleveland Clinic is a global community with healthcare professionals from different nationalities. The clinic organizes international symposiums where healthcare specialists from different disciplines engage in an open discussion of research, challenges, and future directions of pertinent issues affecting the healthcare profession. The clinic is at the forefront of medical innovation, global collaboration, and business optimization. The hospital collaborates with healthcare institutions all over the world looking to optimize practices that enhance the delivery of care and improves patient outcomes.
References
Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making—the pinnacle of patient-centered care. New England Journal of Medicine, 366(9), 780-781.
cleveland clinic - Google Search. (2019). Retrieved 13 August 2019, from https://www.google.com/search?source=hp&ei=_q1SXay8GOScjLsP-P6N2A8&q=cleveland+clinic&oq=cleveland+clinic&gs_l=psy-ab.3..35i39l2j0i67j0l5j0i67j0.1303.3670..4347...0.0..0.343.4919.2-11j6......0....1..gws-wiz.......0i131j0i131i67j0i3j0i20i263.fVxonOH8Pe8&ved=0ahUKEwiss7y77f_jAhVkDmMBHXh_A_sQ4dUDCAU&uact=5
Cold, F., Health, E., Disease, H., Disease, L., Management, P., & Conditions, S. et al. (2019). U.S. News Releases 2019-2020 Top Hospitals List. Retrieved 13 August 2019, from https://www.webmd.com/health-insurance/news/20190730/us-news-releases-2019-2020-top-hospitals-list#1
Nadzam, D. M., Atkins, P. M., Waggoner, D. M., & Shonk, R. (2005). Cleveland clinic health system: A comprehensive framework for a health system patient safety initiative. Quality Management in Healthcare, 14(2), 80-90.
Wadsworth, T., Graves, B., Glass, S., Harrison, A. M., Donovan, C., & Proctor, A. (2009). Using business intelligence to improve performance: Cleveland Clinic tracks KPIs daily to measure progress toward achieving the organization's strategic objectives. This effort has helped reduce labor costs and other expenses--and improve the quality of care. Healthcare Financial Management, 63(10), 68-73.
1
3
Dr. Diane Rullo
CASE of Sigmund
INTAKE DATE: FEBRUARY 2019
DEMOGRAPHIC DATA:
This is a voluntary intake for this 53 year old Jewish male. Sigmund has had several psychiatric hospitalizations in the past. Sigmund has been married for 29 years and has been separated from his wife for the past ten months. He has been living alone for the past five months. His wife and three daughters live two blocks from him. Sigmund has had difficulty in jobs and has not been at any job longer than three years.
CHIEF COMPLAINT:
"I miss my family and do not want to live without them".
HISTORY OF ILLNESS:
Sigmund reports first seeking psychiatric treatment when he was sixteen years old. He was prescribed anti-depressants, but does not remember what kind. Since they helped his mood he remained on anti-depressants for several years. In his late teens he began drinking. His use of alcohol continued into his early thirties. At thirty four years old he attempted suicide after his wife and children left him. He was hospitalized in a psychiatric unit for thirty days. At that time Sigmund was put on lithium, with continued successful results for several years, resulting in reconciliation.
In December 2018 Sigmund returned to his psychiatrist because he was becoming depressed again, feeling sad, fearful and suicidal. He was given Parnate. Soon after, both Sigmund and the psychiatrist did not think this was working very well and the psychiatrist added Ritalin to his medication regiment. During the next three months Sigmund felt on top of the world sometimes lasting for 10 days. He then would have angry outbursts. His wife asked him to leave the home. He then took an overdose of Klonopin. Sigmund was then prescribed ECT (shock treatment). Sigmund returned home after the shock treatment but reported that it was an inhumane experience and felt anger towards his wife believing she forced him to receive ECT to return home.
Sigmund continued on anti-depressants and lithium. Mrs. Sigmund was getting continuously concerned about their financial state because Sigmund would constantly be buying big items that they could not afford. They would have arguments about this all the time. By the end of August he was asked to leave his home again because he used pills as a suicidal gesture. He began drinking again to cope with the separation. This use and behavior continued up to his current presentation for intake.
PSYCHOSOCIAL HISTORY:
Sigmund reports growing up as tumultuous. His mother beat him and would lock him out of the house when she became angry. His mother separated from his father on several occasions and sometimes would throw Sigmund out of the house with the father. His mother made all the decisions and his father played a more passive role. Both parents would often have physical fights and Sigmund would try to break up the fighting from as early as he can remember.
Sigmund is the only child from his parents union. He has an older brother from his mother's previous marriage. Sigmund does not have any contact with his brother. Sigmund was initially considered an underachiever in the early years of school. He had trouble being in fights with other kids because they use to make fun of his wrinkled clothes. Sigmund always wanted to be a doctor. He spent the following five years after college graduation taking courses but never completed his graduate studies.
Sigmund has no legal history. He worked in the family business through high school and college. He became a project coordinator at his next job. He stayed there three years.
MEDICAL HISTORY:
Sigmund states he currently takes Synthroid for a thyroid problem and this helps him keep his weight down.
FAMILY ISSUES AND DYNAMICS:
Sigmund was first married at age twenty one years old. He reports not loving his first wife but liked the stability of her family and asked her to marry him. They spent one year together. He physically abused her from the beginning of their marriage. Mrs. Sigmund the first had an affair that ended the marriage. Mrs. Sigmund reports Sigmund had spoken to her several times about getting involved with other men for sexual pleasure with his knowledge and she states she just followed through with his wishes. They had no children.
Six months after his first divorce Sigmund married again. He reports not loving his second wife but thought it was better to be married. The second Mrs. Sigmund had one child from a previous marriage who Sigmund adopted. They had two other children.
The first ten years of their marriage Sigmund reports physically abusing his wife. He reports hitting the oldest child once. He stopped the physical abuse when Mrs. Sigmund asked for a divorce the first time. Sigmund reports he always wants people around him. He believed his wife was becoming more distant from him over the past several years which he could not take. Their fighting increased, although he would not become physical with her now.
MENTAL STATUS EXAM:
Sigmund presents as a neatly dressed male who appears younger than his stated age. His hair is a bit disheveled. His nails are neatly groomed. Facial expressions are appropriate to thought content. Motor activity is appropriate. Thoughts are logical and organized. There is no evidence of hallucinations. Sigmund admits to a history of suicidal ideation, gestures and attempts. His mood is depressed. During the interview Sigmund talked fast. Sigmund is oriented to time, place and person. His intelligence appears above average.

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