The Impact of Age-Related Visual Impairment on Society

Visual problem is one of the critical health issues affecting the US health sector. More adults living in the US are facing the stark reality of eye problems than ever before. In the year 2014, the National Eye Institute and Prevent Blindness America sponsored research which shed light into the burden of eye problems in the United States (Ferris, 2004). The Eye disease Prevalence Research Group conducted the study. The figures obtained from the investigation reveal a considerable challenge posed by eye diseases alongside some discrepancies. Glaucoma, macular degeneration, cataract, and diabetic retinopathy are the major eye problems which were singled out as most prevalent among the age-related eye complications among those aged 40 years and above (Prevent Blindness America, n.d.). The problems affecting the normal functioning of the eye tend to increase with age. Consequently, there is a higher likelihood of an older individual developing an eye problem than it is for a younger person.

As of 2014, more than 3.4 million Americans aged 40 years and above has visual disabilities. The number of cases as well as the severity of visual loss and other eye diseases increases substantially with age ("Causes and Prevalence of Visual Impairment Among Adults in the United States," 2004). Macular degeneration is the leading cause of age-related blindness in whites. The condition accounts for more than half of the cases. However, among the blacks, cataract is the largest contributor to cases of blindness accounting for over 60 percent of the cases. Diabetic retinopathy affects a twelfth of individuals aged 40 years and above. The rise in cases in diabetes even among the young people is pausing a serious threat to their future vision and health. Additionally, research shows that the aged population in America affected by visual problems is expected to double in the next three decades ("Prevalence of Diabetic Retinopathy among Adults in the United States," 2004).

Introduction

The annual cost incurred in the treatment of age-related diseases is vast. The yearly Medicare budget for cataract stands at over 3.4 billion dollars. However, only 60% of the budget goes to cataract treatment. A group of Medicare patients was followed up for more than ten decades, and the results of the study derived from the submitted claims showed that approximately half of the patients developed macular degeneration, glaucoma or cataract (Lee, 2003). Many would be beneficiaries of Medicare do not benefit leading to deterioration of their visual problems beyond manageable levels. Cataracts which have not been corrected surgically are the leading cause of blindness among the African- American population (Sommer et al., 1991). A disease such as glaucoma progresses slowly hence it is challenging to detect. Unless regular tests are conducted, the patients realize they have a problem only after the disease has progressed to advanced stages.

The impacts of eyesight problems can have far-reaching consequences on society. The high cost associated with the treatment as well as the risks eyesight problems may be burdensome to the community, for example, visual impairment has been blamed for a majority of falls occurring among the older adults. Visual problems seriously degrade the quality of life of an individual. Severe depression is often witnessed among the patients suffering from macular degeneration. This problem needs prompt solutions to improve the experience of the older people and alleviate the burden eyesight issues pose to the society at large With early detection, most of the age-related vision problems such as glaucoma and diabetic retinopathy are preventable. If these conditions are detected early enough, they can lead to prompt treatment to restore and preserve vision. Currently, studies are being conducted to determine ways of reducing macular degeneration. Even though early detection has been lauded as one of the means of lowering visual disabilities, many people are still not receiving prompt treatment. This makes alleviation and restoration of vision quite challenging. The older adults are faced with tough hurdles when trying to access supportive care services for low vision. These services have the potential of improving the eyesight of older adults and making them lead independent lives.

Current Proposal

The current proposal aims to solve the problem of visual problems affecting Americans aged 40 years and above by establishing a fully operational Protecteur Eye Clinic in Michigan State at the Brighton Health Centre. Brighton is a Metro Detroit suburb situated in the South East part of the Livingstone County in the U.S state of Michigan. According to the 2012-2016 ACS Demographic and Housing survey, Brighton city’s population was estimated at 7,550. The median income for the households in the city according to the 2012-2016 survey estimates was $59,972. According to the 2012-2016 survey, approximately 10.0% of the families lived below the poverty line. This necessitates the development of a low-cost medical scheme to cater for this poor populace. Brighton hospital falls under the University of Michigan. Michigan medicine provides collaborative medical care which is centered on the patients in several hospitals, health centers and outpatient clinics within Michigan.

There are several cases of eye problems in Michigan. These range from, myopia, hyperopia, age-related degeneration, blindness, cataract, diabetic retinopathy, glaucoma. Cataract is the single most prevalent eye problem in Michigan. According to the 2012 study, cataract accounted for 831, 710 cases of visual problems for those aged 40 and above, in the state. The patients who were affected by age-related macular degeneration totaled to 73, 102 (Prevent Blindness America, n.d.). These figures show a dire need for ophthalmology services in the state to bring down the prevalence of eye problems among the older generation.

This proposal outlines features of Protecteur Eye Clinic starting with a discussion of the health services being offered to distinguished clientele, and that is Americans aged 40 years and above. A market analysis is then determined from the view of the competition and the target population. These two factors justify the establishment of the clinic. The next is organizational design and governance structure, which provides details on how the organization will be managed, whether the organization will have a tall or flat organizational structure, the rationale behind the selected structure, functional departments, the duties and responsibilities of the clinical staff among other factors. The next section is leadership, motivation, and communication which explains how the leadership qualities influence motivation. The proposal also includes the strategic plan. The strategic plan entails how often the strategic planning is done, how frequently the program will be updated, those involved in the strategic planning process, SWOT analysis, the key goals and how the goals will be implemented. The marketing strategy entails how the clinic will market its products more effectively, how the 4ps of marketing will be implemented and whether niche marketing will be adopted and the proforma financial statements. The financials include the start-up costs and revenues and the projected operating budget for years 1 and finally the timeline.

Mission Statement

The Protecteur Eye Clinic works in within the context of the overall mission of the U and M Brighton of offering high-quality diagnosis, medical care, preventive medicine and maintenance of health. Ensuring follow-up treatment and offering of outpatient services. The Mission of the Protecteur Eye Clinic is: “To ethically and compassionately provide prompt, affordable and high-quality ophthalmology services through our highly trained and loving personnel with an aim of effectively and efficiently reducing age-related eye diseases in people aged 40 years and above through medical treatment, corrective surgery and preventive medicine” The clinic will focus on provision of healthcare services with a specific emphasis on eye care in the elderly patients aged 40 years and above. Protecteur Eye Clinic aims to alleviate the eye problems which brings much suffering to older adults such as depression and frequent falls and enable the old people to regain their youthful vision. All the service providers are well-trained ophthalmologists who love their job and caring for the sick especially the older adults. Acknowledging the critical role these older adults play in the society, our staff is committed to offering service with compassion and dignity regardless the social status, race or gender.

Vision Statement

The long-term visions of Protecteur Eye Clinic are to:

1. Effectively reduce the eye problems in people aged 40 years by 60% in Brighton City within the next five years

2. To eliminate the problem cataracts in people aged 40 years and above through corrective surgery in Brighton city within the next five years.

3. To begin five more clinics which specialize in the prevention and treatment of closed and open-angle glaucoma within Brighton city in the next five years.

4. To completely turn around the eye treatment business and become the leading provider of special eye treatment in the entire Michigan State in the next five to ten years.

Core Values

1. Compassion

2. Professionalism

3. Social Responsibility

4. Respect

5. Attention

6. Accountability

Type of HS/HSO Services Provided

Protecteur Eye Clinic is intended to be established in the service line of the University of Michigan Healthcare System (UMHS) to offer ophthalmic services to seniors aged 40 years and above. UMHS is an instate healthcare system whose headquarter is at Anne Arbor, Michigan. There are several programs under the UMHS. These include Patient Care, Research and Education ("Michigan Medicine | University of Michigan," n.d.). The research section comprises of a faculty group practice with several research laboratories, UM hospitals, and health centers. The health section is included of Michigan medicine offers a broad range of specialized centers for diseases such as cancer, cardiovascular care, women’s health, trauma, depression, Epilepsy, pediatrics among others. UMHS also offers 179 intensive care units making it the HS with the highest bed capacity in the country. UMHS is readily supplied with well-trained healthcare professionals from the University of Michigan Medical school. This makes interaction with and access to health specialists much easier.

Market Analysis Summary

Even though ophthalmology services are being provided by the UMHS, Protecteur Eye Clinic is specially meant to serve the old people who often fall victims to age-related eye problems within the Brighton City and its environs. Research shows that older adults fall at least once a year due to visual issues (Harwood, 2005). Additionally, studies show that 30% of people aged 65 years and above fall each year. These falls lead to the victims becoming depressed since the impacts of such falls are always adverse. The falls often don’t result in fractures, but 5% of fall complications lead to death. (Biderman, 2002). In light of these problems, Protecteur Eye Clinic is expected to offer ophthalmic services strictly to the older patients aged forty years and above through corrective surgeries to replace the damaged lens, phacoemulsification and preventive medicine to deal with ocular diseases such as diabetic retinopathy.

Healthcare is a critical service in any part of the world and Michigan is not an exception. Health institutions are increasingly striving to satisfy the needs of patients by offering patient-centered services. This is because high service quality has the is essential to creating or improving customer loyalty (Gummerus, Liljander, Pura, and Van Riel, 2004). Protecteur Eye Clinic is facing stiff competition from rival clinics in other healthcare systems which offer specialized eye treatment and care. One of the major competitors of Protecteur Eye Clinic is Grosinger, Spigelman & Grey Eye clinic which specializes in the following services: Lasik, lenSx, contact surgery, cataract surgery, clear lens extraction, advanced surface ablation (ELASA), Allegretto wave, Descemet Membrane Endothelial Keratoplasty (DMEK). This hospital is located at Bloomfield Hills, Michigan. It targets those living in Birmingham, Detroit but due to the proximity between the two hospitals, the catchment area may extend to Brighton.

Michigan has several health systems which rival University of Michigan Healthcare System (UMHS). They can either be public or private organizations parent organizations (just like UMHS) which wholly owns, is the only shareholder or holds exclusive power to appoint the Board of Directors in either: one or multiple Michigan Hospitals (Type 1-A- members) which are individually licensed or two or more acute care institutions with different geographical locations being run by the parent organization under a single license. There is a total of thirteen in-state healthcare systems UMHS included. In addition to the in-state healthcare systems, there are seven other healthcare systems which have headquarters outside Michigan (Michigan Health & Hospital Association, n.d.).

Organization Design & Governance Structure

UMHS is divided into three functional areas; patient care, research, and education. The patient care division (where Brighton Health Centre falls under) comprises of an elaborate administrative structure headed by a president who is deputized by the dean for University of Michigan, Medical School (UMMS). Vertically under the dean, UMMS is executive vice-dean for the clinical affairs (UMMS) assisted by the chief of staff for clinical issues. The hospital system is further subdivided into three categories: children and women hospitals, university hospital and cardiovascular center, and University of Michigan Medical Group. Protecteur Eye Clinic is meant to fall under the Michigan Medical Group (MMG) which is headed by the chief operating officer and Chief nursing officer. The organizational chart for Protecteur Eye Clinic is as shown in figure 1 below.

Figure 1: University of Michigan Health System Organizational System

The President will be the chief administrator who will oversee the entire operations of the clinic. The Chief optician will be directly answerable to the president. His duties will be to ensure that all the departments within the clinic including the Cataract Division, Endothelial Keratoplasty Division, and the Clerical Division. The specialists and surgeons are directly answerable to the Chief optician and will be in charge of directing and participating in eye surgeries and treatments. The clerical staff will be in the cost of receiving and sending of correspondence and production and reproduction of critical clinical documents.

Leadership, Motivation, and Communication

The style of leadership that will be exemplified in Protecteur is democratic or participatory where decisions made involve the input of all the managers in various divisions to reduce opposition to the consequences of such decisions. Democratic style of leadership acts to motivate employees because it makes them feel part of the whole system and their views respected and appreciated by the top management. For example, if a senior manager visits a clerical staff and inquires what could be done to ensure that their work is not interfered with, the administrative staff are most likely to feel encouraged, cared for and appreciated for the work they are doing. The ultimate aim of the participatory or democratic style of leadership is to increase a sense of agency within the organization, improve the self-esteem of staff and finally enable the team achieves the self-actualization needs as defined by Abraham Maslow (Maslow, 1943).

The use of participatory leadership is justified by the study which was conducted by (Bish, Kenny, & Nay, 2013). The authors suggest that participatory leadership encourages self-evaluation among health professional and promote participatory problem-solving. As this statement indicates, participatory leadership can have far-reaching consequences both to an individual healthcare specialist and the entire health care facility. Some of the positive repercussions include increased employee motivation and career development.

Effective and efficient communication is critical in ensuring that the operations of the eye clinic proceed as smoothly as planned. Poor communication structures have the potential to lead to poor service delivery hence may affect the entire organization. Protecteur Eye Clinic will have a simple a flat organization structure as shown figure 1 above. This will ensure that the internal flow of information is both quick and effective by eliminating the unnecessary bureaucracies associated with a tall organizational structure. External communication will be initiated through the use of brochures, newspaper periodicals, and annual reports. These mechanisms are believed to yield optimum results regarding delivering the required information in the right form and at the right time.

Strategic Plan

The strategic plan for Protecteur Eye clinic will be broad-based and include various stakeholders and approaches in its implementation. The Long-term Strategic Plans will be drawn once after every five years. However, short-term strategies for the Clinic will be updated regularly on a quarterly basis. Updating short-term strategies are essential as they will keep the Clinic on the right track towards achieving the long-term goals. One of the key the short-term goals will ensure that the business breaks even within six months of operation. To remain in business, the company needs to be on the profitability path thus breaking even and entering profitability is of great cognizance to Protecteur Eye Clinic. The Clinic will ensure that the short-term goals are specifically targeted to the health issues in question, have outcomes that are quantifiable, are realistic enough to be achieved, are relevant to the long-term strategic objectives and are set to be completed within a specific time frame. The person(s) who will be involved in the planning process will include the Board of Directors the Clinic. They will be charged with developing the long-term strategic goals for implementation by the management of the Clinic including the President and line managers such as those in charge of the various divisions within the facility. Achievement of these goals is achievable with the proper formulation and clear directions for implementation.

SWOT Analysis

SWOT analysis is a critical strategic management tool that is used to identify an organization's core strengths, weaknesses, opportunities, and threats. Analysis of these components is vital in ensuring that the business will be ready to deal with any challenges it might face as well as take advantage of the opportunities that might come in future. A brief analysis of these dimensions is as described below:

Strengths

Brighton Health facility which will house the clinic has a high brand reputation. This will ensure that the clinic gets more customers who wholeheartedly believe in the quality of our services. Since the customers of Protecteur Eye Clinic will be seniors, accessibility to the health facility is critical. The clinic will be in Brighton Health center which is easily accessible to potential customers. The location is also excellent regarding the high traffic experienced in the city as well as a full catchment area provided by the high number of people residing in the town.

Weaknesses

Due to the specialized nature of the services offered, patients will have to wait longer to be served which may discourage some to look for alternative clinics.

The clinic plans to make the staff as lean as possible to avoid the high cost of maintaining paying the health professionals. This may increase the workload for the newly recruited health professionals and result in poor service quality and lead to high staff turnover. A good number of patients we shall be dealing with may not like the idea of visiting the hospital. It may be challenging to make them believe that regular eye checkup is essential in preventing dangerous eye conditions such as glaucoma through prompt detection and treatment.

Opportunities

There are ample parking spaces within Brighton Health Centre. Most old people are not able to walk over long distances hence depend on cars for transport. The ample parking space presents an opportunity of attracting them indirectly to the clinic. Protecteur Eye clinic has the potential of serving customers from far-flung areas such as Detroit. This access to a broader market is a great opportunity which can be exploited to earn superior revenues. The right brand image of the hospital ensures that the hospital attracts the top talent pool. The hospital is also readily supplied with health practitioners from the University of Michigan, Medical School.

Threats

Expansion of the clinic to include several subsidiaries may pose challenges regarding effective communication. Stiff competition from other eye clinics and unhealthy internal competition among the staff may affect cohesion within the organization and change the overall financial performance of the clinic. Dealing with older patients may be difficult and lead to reduced morale and consequently dissatisfaction among the caregivers. There is increasing threats posed by rising levels of insecurity such as gun attacks. Finally, dissatisfaction among customers is a likelihood which may pose serious challenges towards the achievement of long and short-term financial goals of the clinic.

Marketing Strategies

The marketing objectives and goals will be formulated in line with the vision of the clinic such as becoming the leading eye clinic in Michigan within the next five to ten years (Richmond, 1997). Due to its perception to break even within the next six months, Protecteur Eye clinic will engage inexpensive advertising and promotional strategies since Brighton Health center is a well-established brand. The initial plans will only aim at increasing awareness of the availability of special eye treatment for the aging population within the precincts of Brighton city. After the clinic has gained financial stability, more aggressive marketing will be done in the city to increase awareness and attract more customers.

Awareness will be increased through customer friendly newspaper publications, brochures, radio adverts, and short television commercials. Other means which will be employed include personal selling and free eye clinics. The newspaper publications will be written in simple English and large print to facilitate more comfortable reading and understanding. Strategic marketing will be done primarily in health facilities which do not offer specialized eye care to old patients.

Protecteur Eye clinic will ensure desired results are achieved by utilizing the four ‘Ps' of marketing such as product, place, price, and promotion in the following ways.

Product

The products offered will include Lasik surgery, contact surgery, cataract surgery, Special eye examination and professional advice on preventive measures for eye diseases for patients aged 40 years and above.

Place;

Protecteur eye clinic will be located within the precincts of Brighton Health Center, Brighton City in the US State of Michigan.

Official working hours will be from 8:00 am to 6:00 am, but employees will work in shifts to ensure a 24-hour service to all clients. The facility will be readily accessible through personal cars or bus transport due to the presence of a well-spread road network in its neighborhood.

Price

The price paid by the customers will depend on the type of patients, the progress of the condition and the nature of assistance required. However the standard charges for Lasik surgery will be between $2,150 and $ 4,300, cataract surgery will cost between $3,600 and $6,000, contact lens examination will cost between $15 and 160, contact lens fitting service will cost between $140 and $400. The patients will buy the contact lenses for $50-$70 depending on the desired quality.

Promotion

The primary promotional mechanisms which will be used by the Clinic include customer-friendly new paper prints and radio advertisements. Other devices such as personal selling and brochures will be employed in strategic locations such as close to health centers which do not offer specialized eye treatment. Niche Marketing will also be utilized. The niche marketing materials will entail attractively designed brochures and fliers given to school going children to take home to their parents and grandparents.

Financials

Startup costs

The startup costs refer to the expenses that Protecteur Eye Clinic will incur for it to begin operating. Proper estimation of these costs is critical since underestimation or failure to include certain important costs may endanger the establishment of the clinic. To this effect, it is important to provide near accurate forecast of the expenditure before the project commences to avoid delaying implementation of the project. The critical cost components include the cost of Ophthalmology supplies and equipment including Nikon Lens 24 D Ophthalmic equipment, Titanium Microsurgery Ophthalmic Equipment Medical Surgical Instrument, Optical LED Visual Chart LightBox Optometry Eye Test Chart Ophthalmic Equipment etcetera is approximately $ 200,000 ("Ophthalmic Equipment | eBay," n.d.), Office supplies will cost approximately $19 per month and $228 per annum ("How to Get Office Supplies on the Cheap," 2011), Rent is projected at $ 1,043 per month ("Average Rent in Brighton City & Rent Prices by Neighborhood - RENTCafé," n.d.).This translates to $12,516 annually. Staff remuneration is approximately $208,595 ("Ophthalmologist Salary | PayScale," n.d.). With a target number of 10 staff, the annual salary will be approximately $ 2,008,595.

Projected Operating Budget for Year 1

The projected operating budget for the first year of operation is as tabulated below.

Revenue

The amount in ($)

Lasik Surgery

258,000

Cataract Surgery

432,000

Lens Examination

18,000

contact lens fitting

57,600

Sale of contact lenses

7,200

Total Revenue

772,800

Expenses

Office Supplies

12,516

Advertisement

10,000

Equipment Purchases

200,000

Staff salaries

208,595

Total Expenses

431,111

Gross Profit

341,689

Interest on Loans

-

Income tax @21%

71,755

After Tax Income

269,934

Timelines

In a bid to ensure that all things are in place before the clinic is opened to customers, a twelve-month schedule will be used (beginning from November 2018) as explained below

November 2018- February 2019 (months before the commencement of core operations): The timeline begins effectively after the hiring of the first staff-the President of Protecteur Eye Clinic. His task is to ensure that all the required ophthalmologic equipment and construction standards are obeyed.

March 2019- June 2019 (months before the commencement of core operations):

The task will be to form relationships with research institutions, scientific laboratories, medical schools, and the local communities to provide a substantive base for launching the clinics. Student ophthalmologists can offer labor cheaply which can be beneficial to the overall financial performance of the Clinic during the formative periods.

July 2019- October 2019 (months before the commencement of core operations):

Advertisement for variously available vacancies within the clinic will be done. All the critical equipment should be installed during this period. Staff interview and orientation will be conducted on October 27th, 2019 and continue until the facility is opened officially.

References

Average Rent in Brighton City & Rent Prices by Neighborhood - RENTCafé. (n.d.). Retrieved from https://www.rentcafe.com/average-rent-market-trends/us/mi/brighton-city/

Causes and Prevalence of Visual Impairment Among Adults in the United States. (2004). Archives of Ophthalmology, 122(4), 477. doi:10.1001/archopht.122.4.477

Ferris, F. L. (2004). Blindness and Visual Impairment. Archives of Ophthalmology, 122(4), 451. doi:10.1001/archopht.122.4.451

How to Get Office Supplies on the Cheap. (2011, August 18). Retrieved from https://www.newtekone.com/2011/08/18/how-to-get-office-supplies-on-the-cheap/

Lee, P. P. (2003). Longitudinal Prevalence of Major Eye Diseases. Archives of Ophthalmology, 121(9), 1303. doi:10.1001/archopht.121.9.1303

Ophthalmic Equipment | eBay. (n.d.). Retrieved from https://www.ebay.com/bhp/ophthalmic-equipment

Ophthalmologist Salary | PayScale. (n.d.). Retrieved from https://www.payscale.com/research/US/Job=Ophthalmologist/Salary

Prevent Blindness America. (n.d.). Vision Problems in the U.S. - Prevalence of Age-Related Eye Disease in America. Retrieved from http://www.visionproblemsus.org/index.html

Richmond, B. (1997). The Strategic Forum: aligning objectives, strategy, and process. System Dynamics Review, 13(2), 131-148. doi:10.1002/(sici)1099-1727(199722)13:2<131::aid-sdr121>3.3.co;2-a

Sommer, A., Tielsch, J. M., Katz, J., Quigley, H. A., Gottsch, J. D., Javitt, J. C., … Ezrine, S. (1991). Racial Differences in the Cause-Specific Prevalence of Blindness in East Baltimore. New England Journal of Medicine, 325(20), 1412-1417. doi:10.1056/nejm199111143252004

The Prevalence of Diabetic Retinopathy Among Adults in the United States. (2004). Archives of Ophthalmology, 122(4), 552. doi:10.1001/archopht.122.4.552

U.S. Census Bureau QuickFacts: Brighton city, Michigan. (2017, July 1). Retrieved from https://www.census.gov/quickfacts/brightoncitymichigan