Case study: identifying, prioritizing and choosing program goals

You are the supervisor of a small cardiac rehabilitation program. The program includes inpatient cardiac teaching and an outpatient exercise rehabilitation program. Because of limited reimbursement by third-party insurance payers for patient education, there has been no direct charge for inpatient education. Outpatient program participants pay $240 per month to attend three 1-hour sessions per week, although the revenue generated from the outpatient program still leaves an overall budget deficit for the program of approximately $6,800 per month. Today, Jane is summoned to the associate administrators office to discuss her budget for the upcoming year. At this meeting, the administrator states that the hospital is experiencing extreme financial difficulties due to declining reimbursements. He states that the program must become self-supporting in the next fiscal year; otherwise, services must be cut. On returning to her office, Jane decided to make a list of several alternatives for problem solving and to analyze each for driving and restraining factors. These alternatives include the following:

Implement a charge for inpatient education. This would eliminate the budget deficit, but the cost would probably have to be borne by the patient. (Implication: Only patients with adequate fiscal resources would elect to receive vital education.) Reduce department staffing. There are currently three staff members in the department, and it would be impossible to maintain the same level or quality of services if staffing were reduced.
Reduce or limit services. The inpatient education program or educational programs associated with the outpatient program could be eliminated. These are both considered to be valuable aspects of the program.
Increase the fee for the outpatient program. This could easily result in a decrease in program participation because many outpatient program participants do not have insurance coverage for their participation.
Step 2 Address the Following

Identify five program goals for the cardiac rehabilitation program.  Discuss how you came up with these goals, using supportive rationale and citation(s).
Prioritize the five program goals, providing supportive rationale behind your decisions.
Based on the priorities that you have established, which alternative would you select?  Provide supportive rationale and citations for your decision.