Health Care Delivery System

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Health Care Delivery System
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Objectives

• Explain the role of the primary health care
  provider and identify the individuals who fulfill
  this role
• Describe the roles of various allied health
  workers
• Discuss the ways in which alternative health care
  resources meet health care needs

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Objectives

• Describe different mechanisms of health care
  financing
• Explain how regulatory agencies, payers,
  providers, and consumers demonstrate power in the
  health care system
• Describe economic influences on health care
  delivery

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Introduction

• First-line patient care management is the
  coordination of resources and clinical processes
  at the point of service delivery. 
• First-line patient care management uses the
  nursing process to plan, implement, and evaluate
  the outcomes of care for populations of patients
  as opposed to individual groups of patients.

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Strategic Planning

• Strategic planning is a process designed to
  achieve goals in dynamic, competitive
  environments through the allocation of resources.

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Unit Strategic Planning

• Unit or departmental strategic planning begins
  with examination of the external environment,
  both independent of and through the lens of the
  larger organizational system of which the
  unit/department is a member.
• The group developing the unit strategic plan must
  examine the impact that the external environment
  will have on the particular unit.

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Unit Strategic Planning

• The group must also examine the internal
  environment that supports the work unit to
  determine the state of the human resources,
  clinical systems, support services, information
  infrastructure, and finances available to deliver
  care.
• Unit strategic plans should be consistent with
  and support the mission, vision, strategic plan,
  and annual operating plan of the organization of
  which they are a part.

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Philosophy Based on Values That Drive Unit
Practice

• A philosophy is a statement of beliefs based on
  core valuesinner forces that give us purpose. 
• A units mission and vision is most authentic if
  it is developed based on the philosophy or core
  beliefs of the work team.
• A units core beliefs or values should be
  incorporated into the units mission and vision
  statements.

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Mission Statement

• Mission is a call to live out something that
  matters or is meaningful.
• An organizations mission reflects the purpose
  and direction of the health care agency or a
  department within it.
• A mission statement has three elements
• A mission statement is no longer than a couple of
  sentences.
• It states the units purpose using action words.
• It should be simple and from the heart.

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Vision Statement

• A unit vision statement describes how the mission
  of the unit within an organization will be
  actualized.
• A vision statement includes four elements
• A vision statement is written down.
• It is written in present tense, using action
  words, as if it were already accomplished.
• It covers a variety of activities and spans broad
  time frames.
• It addresses the needs of providers, patients,
  and environment in a balanced manner that anchors
  it to reality.

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Goals and Objectives

• The work unit develops broad strategies that span
  the next three to five years, and then develops
  annual goals and objectives to meet each of these
  strategies.
• Goals are written as specific aims or targets
  that the unit wishes to attain within the time
  span of one year.
• Objectives are the measurable steps to be taken
  to reach each goal.

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Structure of Professional Practice

• In an organization where professional nursing
  practice is valued, development and
  implementation of strategic initiatives is most
  effectively carried out through a structure of
  shared governance and shared decision making
  between management and clinicians.

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Shared Governance

• Shared governance is an organizational framework
  based on the idea of decentralized leadership
  that fosters autonomous decision making and
  professional nursing practice.
• It implies the allocation of control, power, or
  authority (governance) among mutually (shared)
  interested vested parties.

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Shared Governance

• In most health care settings, vested parties in
  nursing fall into two distinct categories
• Nurses practicing direct patient care, such as
  staff nurses
• Nurses managing or administering the provision of
  that care, such as managers

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Shared Governance

• Clinical Practice Council the purpose is to
  establish the practice standards for the work
  group.
• Quality Council the purpose is to credential
  staff and to oversee the unit quality management
  initiatives.
• Education Council the purpose is to assess the
  learning needs of the unit staff and develop and
  implement programs to meet these needs.
• Research Council At the unit level, this council
  advances research application with the intent of
  incorporating research-based findings into the
  clinical standards of unit practice.

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Shared Governance

• Management Council this council ensures that the
  standards of practice and governance agreed upon
  by unit staff are upheld and that there are
  adequate resources to deliver patient care.
• Coordinating Council the purpose is to
  facilitate and integrate the activities of the
  other councils. This council usually facilitates
  the annual review of the unit mission and vision,
  and develops the annual operational plan.

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Competency/Professional Staff Development

• Competency is defined as possession of the
  required skill, knowledge, qualification, or
  capacity.
• Competency of professional staff can be ensured
  through credentialing processes developed around
  a clinical or career ladder staff promotion
  framework.
• Clinical ladders acknowledge that staff members
  have varying skill sets based on their education
  and experience.

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Benner's Novice to Expert

• There are five progressive stages of Benners
  model of nursing practice
• Novice task-oriented and focused
• Advanced beginner demonstrates marginally
  acceptable independent performance
• Competent has been in the same role for two to
  three years demonstrates conscious, deliberative
  planning

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Benner's Novice to Expert

• Proficient perceives situations as wholes as
  opposed to a series of tasks
• Expert intuitively know what is going on with
  patients

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The Process of Professional Practice Situational
Leadership

• Situational leadership maintains that there is no
  one best leadership style, but rather that
  effective leadership lies in matching the
  appropriate leadership style to the individuals
  or groups level of task-relevant readiness. 
• Readiness refers to how able and motivated an
  individual is to perform a particular task.

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The Process of Professional Practice Situational
Leadership

• A leader should help followers grow in their
  readiness to perform new tasks by adjusting
  leadership behavior through four styles along the
  leadership curve
• Telling
• Selling
• Participating
• Delegating

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Accountability-based Care Delivery

• Accountability-based care delivery systems focus
  on roles, their relationship to the work to be
  done, and the outcomes they are intended to
  achieve.
• Competence is evidenced not by what a person
  brings to the work, but instead by the results of
  the application of the persons skills to the
  work.

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Primary Nursing

• In a primary nursing model, one nurse is
  accountable for the care a patient receives
  during a given episode of care.
• She functions through associate nurses during the
  hours of the day when she is not present in the
  workplace.
• The hallmark of primary nursing is that one nurse
  maintains 24-hour accountability for a specific
  patients care.

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Patient-focused Care

• Patient-focused care is a model of differentiated
  nursing practice that emphasizes quality, cost,
  and value.
• The first-line patient care manager takes on an
  expanded role, assuming accountability to manage
  nurses and staff from other departments. The
  focus has expanded to include overseeing the
  coordination of all care activities required by
  patients and their support systems.

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Case Management Primary Goals

• The primary goal of case management is to deliver
  high-quality patient care in the most
  cost-effective way by managing human and material
  resources.

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Case Management

• Secondary goals are to
• Manage the delivery of care within a given time
  frame
• Decrease length of stay for inpatient care
• Ensure appropriate use of services and resources
• Improve continuity of care
• Standardize the care delivered for a given
  diagnosis
• Improve patient outcomes from a given episode of
  care

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Measurable Quality Outcomes

• Regular evaluation of a units performance to
  ensure that the outcomes of care delivery are
  meeting the objectives of professional practice
  as outlined in the units annual operational plan
  is an important component of first-line patient
  care management.
• The development of process improvement measures
  in todays health care organizations is driven by
  the standards of quality required by the Joint
  Commission on Accreditation of Healthcare
  Organizations (JCAHO) and the National Council
  for Quality Assurance (NCQA).

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Unit-based Performance Improvement

• To develop a comprehensive unit-based quality
  improvement program, the first-line patient care
  manager should track outcomes from four domains
• Access
• Service
• Cost
• Clinical quality

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Population-based Quality Improvement

• In todays health care environment, organizations
  are able to track their aggregate performance in
  caring for select populations of patients against
  evidence-based standards of care.
• Quality compass
• Functional status
• Clinical outcomes
• Cost and utilization
• Patient satisfaction