HCA 499 Module 1 Choosing and Defining a Capstone Problem Example

Finding a Problem Worth Solving: Defining a Heart Failure Readmission Capstone

Student Name

Health Care Administration Program, Aspen University

HCA 499: Senior Capstone

Instructor Name

Month Day, Year

Finding a Problem Worth Solving: Defining a Heart Failure Readmission Capstone

A capstone project stands or falls on its problem. A problem that is too broad cannot be finished, one that is too small does not matter, and one the student cannot influence leads nowhere. This paper describes how Dana, a composite health care administration student who works as a patient access supervisor at a 180-bed community hospital, chose and defined her capstone problem.

Criteria for a Good Problem

Dana used four criteria. The problem should be important to patients and the organization. It should be feasible within about six months with available time and support. It should be measurable with data she could obtain. And it should be within her influence, or that of a sponsor willing to support the work. A problem that meets all four gives the project a realistic chance of producing results.

Four Candidates

Dana listed four problems she had seen at work and scored each from 1 to 5 on the criteria.

Breaking the Tie

Registration waits and heart failure readmissions tied. Dana chose readmissions because the stakes for patients were higher and the hospital's leaders had named it a priority, which meant a sponsor was likely. Registration waits would have been easier but less consequential. She noted registration as a possible future project.

Why Readmissions Matter

Returning to the hospital soon after discharge is common and often preventable. Close to one traditional Medicare patient in five went back into the hospital within a month, and among medical patients who returned, half had seen no outpatient physician in the meantime (Jencks et al., 2009). That gap suggests that many patients leave the hospital without timely follow-up.

The Policy Context

Readmissions also carry financial consequences. Under the federal readmissions program, Medicare trims payments to hospitals whose returns for certain conditions, heart failure among them, run above expected levels. National returns for the targeted conditions dropped by several percentage points in the years after the program began (Zuckerman et al., 2016). Dana's hospital had received a penalty the previous year.

Heart Failure Specifically

Among older adults, few diagnoses fill hospital beds, and refill them, as often as heart failure. Across 225 hospitals and some 30,000 older heart failure patients, just over a fifth came back within a month, and patients discharged from hospitals with higher rates of early physician follow-up had lower readmission rates (Hernandez et al., 2010). That finding suggested an administrative lever Dana could influence: follow-up scheduling.

Early Data

Dana asked the quality department for a year of data. Of 312 heart failure patients discharged, 72 returned within a month, a rate of 23.1% that sits above the national figure. Roughly two patients in three went home without a booked follow-up visit. These numbers confirmed that the problem was real and measurable.

The Problem Statement

Dana wrote: Among adults discharged from the hospital's medical units with a principal diagnosis of heart failure, 23.1% were readmitted within 30 days during the past year, higher than national rates and associated with a federal payment penalty. Few patients leave with scheduled follow-up. This project will identify contributing factors in the discharge and post-discharge process and design, test and evaluate an intervention to reduce readmissions.

Scope

In scope: adult heart failure patients sent home from either medical unit; processes from discharge planning through 30 days after discharge. Out of scope: patients discharged to skilled nursing facilities, clinical treatment decisions made by physicians and other diagnoses. Clear scope keeps the project manageable and focused on processes within administrative influence.

Stakeholders

Stakeholders include patients and families, hospitalists, cardiologists, nurses and case managers on the medical units, the outpatient cardiology clinic's schedulers, pharmacists, the quality department, finance and hospital leadership. Dana met with the director of case management, who agreed to sponsor the project, and with a cardiologist who agreed to advise.

Feasibility Check

Dana confirmed she could obtain monthly readmission data, observe discharges on both units and interview staff and patients. Her supervisor approved four hours a week for the project. The sponsor agreed to champion changes with unit leaders. The capstone instructor approved the topic as appropriately scoped for a six-month project.

Ethical Considerations

Because the project would use patient data and interview patients, Dana confirmed with the hospital's quality office that it qualified as quality improvement rather than research and followed privacy rules, using deidentified data for analysis and obtaining permission before interviews.

Narrowing the Question

Dana's first idea was simply reducing readmissions, which covered every diagnosis and every unit. Her instructor pushed her to narrow it. Focusing on heart failure, the two medical units and patients discharged home made the project small enough to finish and large enough to matter. Narrowing also made the data request simpler and the stakeholder group smaller, both of which made success more likely within six months.

Linking to Coursework

The capstone draws on earlier courses. Health information systems coursework helped Dana plan the data request; quality and operations courses gave her process mapping and root cause tools; finance coursework helped her understand the penalty; and ethics coursework shaped how she would handle patient data and interviews. Naming these links showed the capstone as an integration of the program rather than a separate assignment.

Why a Sponsor Matters

An administrative capstone needs someone with authority to approve changes. Without a sponsor, a student can analyze a problem but cannot test a solution. Dana's sponsor, the director of case management, could open doors to nursing, the clinic and informatics. Securing that commitment early was as important as choosing the topic, and Dana put the agreement in a short email the sponsor confirmed.

Conclusion

Choosing a capstone problem required balancing importance, feasibility, measurability and influence. Heart failure readmissions scored highly, carried national evidence of preventable returns and a financial penalty, and offered an administrative lever in follow-up scheduling. A clear problem statement, defined scope, engaged stakeholders and early data gave Dana a solid foundation for the rest of the capstone.

References

Hernandez, A. F., Greiner, M. A., Fonarow, G. C., Hammill, B. G., Heidenreich, P. A., Yancy, C. W., Peterson, E. D., & Curtis, L. H. (2010). Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA, 303(17), 1716-1722. https://doi.org/10.1001/jama.2010.533

Jencks, S. F., Williams, M. V., & Coleman, E. A. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine, 360(14), 1418-1428. https://doi.org/10.1056/NEJMsa0803563

Zuckerman, R. B., Sheingold, S. H., Orav, E. J., Ruhter, J., & Epstein, A. M. (2016). Readmissions, observation, and the Hospital Readmissions Reduction Program. New England Journal of Medicine, 374(16), 1543-1551. https://doi.org/10.1056/NEJMsa1513024