health care-delivery-system

Health Care Delivery System:

Societal Trends and Economics

Dr. Jayesh Patidar

www.drjayeshpatidar.blogspot.com

Change & Health Care Delivery

Rapid and Constant

Nurses must embrace change

Nurses must contribute to problem solving

9/15/2014 2www.drjayeshpatidar.blogspot.com

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


THANK YOU


health care-delivery-system

Education

preventive health care

health care beliefs

health care deliveryrapid

national health care

health care delivery

health care delivery

excellent care

futile care