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Health Care Delivery System


Describe the roles of various allied health workers. Discuss the ways in which ... The hallmark of primary nursing is that one nurse maintains 24-hour ... – PowerPoint PPT presentation

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Title: Health Care Delivery System

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

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

  • 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.

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

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.

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
  • 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.

Philosophy Based on Values That Drive Unit
  • 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

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
  • It states the units purpose using action words.
  • It should be simple and from the heart.

Vision Statement
  • A unit vision statement describes how the mission
    of the unit within an organization will be
  • 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.

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
  • 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.

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.

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.

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

Shared Governance
  • Clinical Practice Council the purpose is to
    establish the practice standards for the work
  • Quality Council the purpose is to credential
    staff and to oversee the unit quality management
  • 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.

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.

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

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

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

The Process of Professional Practice Situational
  • 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.

The Process of Professional Practice Situational
  • 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

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
  • 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

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
  • The hallmark of primary nursing is that one nurse
    maintains 24-hour accountability for a specific
    patients care.

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.

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

Case Management
  • Secondary goals are to
  • Manage the delivery of care within a given time
  • 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
  • Improve patient outcomes from a given episode of

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).

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

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