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This is a case study of a hospital operating from its clinics. The major issue is that the hospital is recording losses from the recent past. The approach taken in this case study is more or less of auditing, more specifically, a procedural audit of the operations of the hospital. This is a thorough, analytical and critical review of the internal control systems of the organization as a whole. The utmost and prerequisite objective the study is to closely examine the internal control systems of the hospital and establish its strengths and weaknesses. In fiscal management, once the internal control systems are okay, the other things fall in place. This methodology is operations based and it aims at improving the procedures in the hospital as far as the delivery of services is concerned. Improvement of the internal control systems has an overall effect of improving service delivery.

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1 .ANALYSIS OF THE DATA

The data given is specific and it addresses the ground scenario of the hospital. To create a clearer picture of the internal control systems, it is important to analyze the numerical data as follows:

Number of clinics: 3

Average clinic visits: 67%

 
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Patient satisfaction: 82%

Bed occupancy: 70 - 80%

Skill mix change: 2 years ago

Resulting visits per day due to the skill mix: 117 - 97

Patient appointment waiting time: 63 days

Appointment times: Monday- Friday

RN Turn over: 20% annually

Percentage of available patients seen: 90%

Patients requiring MD assessment and intervention: 25 - 30%

Time of establishment: 5 years earlier

Clinic visit bookings: 90%

Average visits per day: 37

Patient satisfaction: 94%

Assessments bookings times: Monday - Friday

Patients who see physicians: 50%

Patients who see CRNP: 50%

2. APPARENT OPERATIONAL AND FINANCIAL ISSUES

A close study of the operations of the hospital reveals many weaknesses that need correction very urgently, before the whole organization tumbles down. They pertain to the internal control systems of the organizations. Below is a list of issues that have come out from the previously mentioned study.

3. SHORT TERM RECOMMENDATIONS

Having that the Hospital is already in a slippery financial position, only some short-term solutions may work for now. Long-term solutions will come to play when the clinics will be in a good financial position to implement them. Some of the workable short-term recommendations would include the following:

4. LONG TERM RECOMMENDATIONS

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These recommendations are very important since they help in ensuring that the going concern of the clinics is not threatened. They may take a little longer to implement since they may involve restructuring the operational systems of the clinics. Again, they may involve some capital expenditure. In this case, some of them may include:

5. COST SAVINGS PROTOCOL

The most workable method of cost control is controlling the relevant incremental costs. This will mean that the relevant costs need control. The following table shows some proposed cost reduction. I suggest you consult your internal cost Accountant for some more realistic scenarios

6. IMPLEMENTATION PLAN

Since these recommendations are short term and long term, it would be wise to implement in phases.

7. IMPORTANT MISSING INFORMATION

There is some unavailable information that would have improved greatly the quality of this study. In case of a second study, the following information would be important: