A1. Considering all the facts, the most feasible option is to develop oncology services and building space for it within Trinity Community Hospital. The facts are as follows:
Currently, Trinity Community Hospital (TCH) does not offer any formal oncology, orthopedic, or cardiology programs. There are no cancer specialists at TCH; however, there are a few cardiologists and orthopedic surgeons that maintain privileges at the hospital. Little work is done at TCH for orthopedic services, as the specialty groups are located to a competing facility. There are also several orthopedic groups interested in opening practices near the hospital. Several cardiology services around the hospital offer more sophisticated services than at TCH, drawing most of the cardiology patients away from the hospital. There is no oncology services mentioned.
In terms of competition, there are two hospitals within close proximity. One has strong orthopedic and cardiology programs, but a poorly organized oncology program. The second hospital also has a strong orthopedic program and existing cardiology program. This hospital also has a poorly organized oncology program.
Building space for oncology service will allow patients to easily coordinate with services already within the hospital and make use of the newly improved and more developed resources within Trinity Community Hospital.
The Community Health Needs Assessment identified that the orthopedic cases are expected to rise by over 46%, inpatient joint and spine procedures by 30%, and outpatient joint and spine procedures by 350% in the next five years. However, there are existing nearby facilities that already cater to this market, some well-renowned. The Needs Assessment also identified, in terms of cardiology services, coronary artery disease is expected to grow over 21%, diagnostic cath procedures by at least 22%, and angioplasties by at least 25% in the next 5 years. Again, there is already existing services at competing hospitals, with at least one hospital having a strong cardiology program. Oncology services is expected to rise by 15% within the next five years, an increase of 50% and 30% of men and women, respectively, developing cancer in their lifetimes, and at least a 34% increase in new cancer patients in five years. Both of the competing hospitals’ oncology programs are considered poorly developed, which allows TCH to rise above and become the community’s leading oncology program by developing a well-run program with state-of-the-art equipment. Although there is interest from local physicians to develop the orthopedic and cardiology service lines, there is a greater need for oncology services due to lack of the service in the community. The needs of the community should take precedence.

A2. Current national healthcare trends in oncology are focusing efforts towards meeting demands while strengthening resources such as education, screening, and community outreach (Shulman, n.d). The idea is that early detection of the disease can be promoted through strengthening resources and in turn treatment and survivorship increases. Trinity Community Hospital’s goal for oncology services is congruent with current international demands. The goal for TCH in developing oncology services is to develop regional cancer center noted for clinical and service excellence. To achieve this goal, TCH came up with 3 strategies; offer distinctive clinical programs and services, emphasize cancer prevention and control, and enhance service access; which are in line with international trends. Dillon and Prokesch (2013) highlighted in the Harvard Business Review, that personalized medicine and technological advances, as well as evidenced-based medicine are megatrend happening in global healthcare: TCH’s goal of developing state of the art oncology services with evidenced based treatment, clinically proven tools, screening, referrals, and personalized care is well on its way to meeting this trend. Dillon and Prokesh (2013) also highlighted that prevention is an emerging trend. In developing oncology service at TCH, prevention and early detection is part of the service. Efforts will focus on reaching out to the community through education and screening for early detection and prevention. Trinity Community Hospital can also use the opportunity of developing oncology services to other countries. Developing oncology services with state-of-the-art technology and excellent coordination of aftercare and other services will draw those that need oncology services from other countries. People are always looking to be treated in well-known, well-respected industries and TCH can develop the service line to become a well-know, highly-respected hospital using state-of-the-art evidenced-based technology and treatment.

A3. Many of Trinity Community Hospital’s features can be complimentary to the development of oncology services. TCH is well known for having competent, dedicated nursing staff who are committed to outstanding patient care and could be used as an added benefit to developing a renowned oncology service line. Caring and competent staff are key to patient satisfaction, word of mouth advertising, and success for the hospital. TCH has full Joint Commission accreditation that includes a broad range of medical and surgical services. The hospital offers newly renovated patient rooms that make the patient feel like they are at home. TCH offers an award winning dietary department with renowned chefs that are able to prepare meals specific to the dietary needs of patients seeking/undergoing oncology treatment. The hospital also boasts high patient satisfaction rates, and 100% board certified medical staff from numerous specialties. The hospital has 150 beds consisting of 136 medical/surgical beds and 14 intensive care unit beds. The hospital also has 20 operating rooms and an emergency department with basic support services, laboratory, radiology, pharmacy, physical and respiratory therapy, an equipped radiology department, nuclear medicine, and ultrasound services. The existing features and services offered at TCH is can be developed to become complementary with the goals identified for the new oncology service line.

A4. In analyzing the financial feasibility of instituting a new oncology line, we must review the need for the service. There is a demand for oncology services in the area. TCH does not have oncology services, and the oncology services in other surrounding hospitals are poorly run. The need for oncology services is expected to grow. There is a lack of oncology resources in the area.
Five year projections for gross charges in oncology discharge are projected at $70,000 per discharge at 382 discharges, totaling $26,740,000. The five year projection for gross charges for radiation oncology treatment is $450 with 9,100 cases, totaling $4,095,000. The estimate for chemo treatment is $600 with 7,000 cases, totaling $4,200,000. The total five year projection for oncology services gross charges is $35,035,000 while the capital investment is estimated at $8,000,000 for renovating the vacant space to include an oncology center with simulator, linear accelerator, and infusion suite. However, the recommendation is to build space for the oncology service line within TCH, which will carry an additional capital investment of $500,000. The five year gross charges for oncology services significantly exceeds the initial capital investment, including the added capital investment, further giving evidence to the feasibility of developing oncology services for Trinity Community Hospital.
A5. Targeting and marketing qualified and competent physicians to secure referrals services takes finesse and skill. One strategy is to use the existing resources at Trinity Community Hospital. John Printer, Cathy Promo, and Robert Holland, and Dr. Randy Sharp are board members at TCH and all have affiliations with the community. John Printer owns a successful communications business and a native of the community. His family has ties with the community. He is an excellent resource to promote the new oncology service line. TCH can look into Mr. Printer as becoming the spokes person for the oncology service line, as he is well respected in the community. Cathy Promo is a director of marketing for a local utility and her skills can be used to target potential consumers for the new service line through extensive advertising and marketing of the newly remodeled facility, equipment, and better developed and organized resources.

References:
Dillon, K. & Prokesch, S. (2013). Megatrends in global health care. Retrieved August 25, 2013 from http://hbr.org/web/extras/insight-center/health-care/globaltrends/1- slide

Shulman, L.N. (n.d.). Trends in oncology care. Challenges and obstacles. Retrieved August 23, 2013 from Http://www.iom.edu/~/media/Files/Activity%20Files/Disease/NCPF/TrendsinOnco logyCareChallengesandObstaclesShulman.pdf