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 2 www.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
HMOs, PPOs
Changes in reimbursement methods
Change to prospective payment system (DRGs)
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 pros and cons?
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?
Nurses 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

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