Health Care Delivery System:

Societal Trends and Economics

Unit III

Change & Health Care Delivery Rapid and Constant Nurses must embrace change Nurses must contribute to problem solving

Why Did Health Care Delivery Need to Change?

Rising health care cost Increasing elderly population Expanding technology Emphasis on acute care rather than prevention Insurance reimbursement that rewarded

increased spending

Health Care Delivery Changes:Cause and Effect

Cause: Consumer demands Technological advances Governmental scrutiny

Impact on Nursing: Challenge theoretical viewpoint, practice models,

and patient services

Approaches Introduced to Control Costs

Managed-care strategies HMO’s, PPO’s

Changes in reimbursement methods Change to prospective payment system (DRG’s)

Hospital restructuring Mergers

Corporatization Integrated Health Care Delivery Systems

Do We Need National Health Care?

Improved access to care Competitive free-market

Questions to Ponder How does futile care contribute to

increased costs? How can preventive health care and

wellness education lower costs of later acute care?

Should health care adopt corporate business practices? Telemedicine For-profit organizations

Health Care Trends Graying of America Technological advances Globilization Delivery System changes Social evolution

Globilization and Nursing Spread of a common culture around the world Universal sharing of attitudes, products, industry,

and stocks

Role of Nursing: Learn about health care beliefs and practices of

other cultures International Nursing Forums to share nursing

practice

Social Changes and Nursing Consumer control

Desire to make own choices Conventional vs. Alternative therapies

Question health information Research independently Demand more preventive care

Judge value of health care Service orientation

Aging Majority population Multiple health care needs

New technology Telemedicine

Current Trends affecting the Vision of Nursing

Dominant role in health care delivery systems

Geriatrics a prominent specialty Leadership role in determining/implementing

policy Provide holistic care (integration of multiple

facets) Technology enhanced quality care

Current Trends (continued) Quality care based upon outcome criteria Emphasis on case-management Increased nursing involvement in making

policy and governmental decisions affecting health care

Education more user-friendly Expanding cultural knowledge and practice

Health Maintenance Organizations Staff Model Group Model Network Model Independent Practice Association

Preferred Provider Organization (PPO)

Another type of Health Plan Use of physicians who have agreed to

provide services at a lower price to the insurer

Ethics and Nanotechnology Need new delivery systems which

incorporate demands of advanced technology

Need lower-tech, higher-touch therapeutic interventions to offset technology

Need to combine alternative care approaches with conventional medical treatments

Types of Health Care Organizations

Acute Care Hospitals Psychiatric Hospitals Community Mental Health Centers Long-term Care Facilities Day Care Centers and Homes for Elderly Ambulatory Care Home Health Care

Organizational Structures Centralized Decentralized

Organizational Charts Maps that determine who reports to whom Shape dependent upon size and

governance style Reflect formal communication patterns

Organizational Approaches to Getting Work Done

Committee structure Participative management Shared governance Self-governance Unions

Nursing Care Delivery Patterns Functional Team Primary Patient-focused Case-managed

What are the pro’s and con’s?

Delegation Who can delegate? What can be delegated? When should delegation be used? How can you determine if delegation is

effective?

Nursing Assignments JCAHO

Require that staffing be based on organized system

Patient Classification or Acuity System ANA

Identified principles of staffing Patient care-related Staff-related Institution/organization-related

Nursing Shortages and Staffing What constitutes a staffing crisis? What can be done when there is a staffing

crisis? What are your responsibilities when staffing

is short?

Nurse’s Role in Decreasing Health Care Costs

Challenge: provide excellent care with fewer dollars Knowledge about equipment/service costs

Resource utilization Promote preventive health care

Consumer education

Computers and Health Care Telemedicine

Use of computer technology and telecommunications to provide contact between the provider and the consumer.

Primary goal: provide access to rural and underserved communities.

Computers in Healthcare Information Superhighway

“term used to describe the explosion of electronic information retrieval and communication taking place through computers and modems.”

What is important to remember when using electronic data?

Role of Nursing in Telehealth/Telemedicine

Active involvement Practice issues when care transcends state

lines Triage from emergency care facilities Home care services Hospice care Video assessments and vitals through

telemonitoring

Realities of Health Care Financing Expenditures are continuing to increase Managed care has not reduced the growth

of Medicare beneficiaries and overall spending

Reasons for continued increases Inflation Increased demand for services Expensive technological advances

How is Health Care Financed? Self-payment Third-party payment Health care assistance

Health Care Financing and the Role of the Nursing

Nurses are involved in the decision-making process

Patient/consumer advocacy Need to understand budget process

Questions to Ponder Why must nurses be involved in fiscal

management? What does the budget have to do with

nursing practice?

Terms to Know Budget

Operating budget Capital budget Personnel budget

Budgets and Cost Control Unit cost Standard costs Target or budget costs Cost variance report

Reasons for Cost Problems Poor quality Theft Carelessness

“Costing Out” Nursing Services Used to understand the cost of treating a

patient relative to the revenue received from treating that patient.

Quality and Patient Care Why must quality be controlled? What is the best way to control quality?

(prospective vs. retrospective) Who is responsible for quality? How is quality measured? What is the bottom line?

Quality JCAHO

Mission: “enhance the quality of health care provided to the public”

Quality Assurance Method of monitoring and improving consumer-oriented

services Unique to each institution Unit based and requires individual involvement

Definition: What does quality mean to you?, to consumers?

Evaluation perspectives: Structure Process outcome

Computerization Mainframe PC PDA

We must balance the use of this technology with increased personal contact (touch) to maintain the human element of nursing.

Nursing Informatics 1994 ANA Recognition A specialty that “integrates nursing science,

computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing practice, administration, education, research, and the expansion of nursing knowledge” (ANA, 1994)

Theories Associated with Nursing Informatics

Nomenclature, Classification and Taxonomy

General Systems Theory Change Theory

Buzzwords for the Future Preventive medicine Preventive care