Affordable Care Act

Reduce out of pocket costs, passed in 2010

50% discount on total cost of brand name drugs while in the

donut whole gap

Change process

Three basic reasons to introduce a change: solve a problem,

improve efficiency, and to reduce unnecessary workload for
some group

Assessment, planning, implementation, evaluation,

stabilization of change

Change theories and theorists

Lewin
o General model for most situations and organizations
o Force-field model
o Unfreeze, move, refreeze

Lippitt
o Good for changing a process, general change
o Seven phases of a change
o Diagnose, assess motivation and capacity for change,
assess change agents motivation for change and
resources, select progressive change objectives, choose
appropriate role of change agent, maintain the change,
terminate the helping relationship

Havelock
o Six step model: build a relationship, diagnose a problem,
acquire resources, choose solution, gain acceptance,
stabilize and self-renew

o Educational/ cultural change

Rogers
o Diffusions of innovations theory: awareness, interest,
evaluation, trial, adoption
o Used in organizational change, individual, and group
change

Communication roles

Sender: sends a verbal message or nonverbal message to

another receiver , and receives feedback

May be public, intrapersonal, and interpersonal (person to

person)

Confidentiality

Act of limiting disclosure of private information

Conflict resolution

Accommodate: smooth or cooperate, on side gives in to the

other side

Competing: two or three sides force to compete for goal

Compromise: each side gives up something

Negotiate: high level discussion that seeks agreement

Collaborate: both sides work together to develop optimal

development

Open, honest communication, private relaxed setting

Agree on ground rules

Consensus building

All group members can live with and fully support the decision
regardless of whether they totally agree

All group members can participate and realize the contributions

each member makes to the decision

Requires more time

Consumerism

Promote the interest of consumers

Demand for accountability

Disaster preparedness

Disaster: incident where human suffering and needs cannot be

managed or alleviated by the vitcims without assistance

Non-disaster, pre disaster, impact stage (it has occurred),

emergency stage (long need for assistance and care),
reconstruction and recovery

CDC recommends: detect, control, maintain, recover, plan, and

exercise

Public health preparedness, medical preparedness

Evidence-based practice

Process approach to collecting, reviewing, interpreting, critiquing,

and evaluating research and other literature to apply to direct
patient care

Observed and researched evidence

Feedback mechanisms

High quality information systems that prove feedback on a

frequent basis

To have value: nurses must see that there needs to be a change

Frequent, timely, given at precise time intervals to sustain new

behaviors

Usable, consistent, correct, and of sufficient diversity

Hawthorne experiments

Change in employee behavior occurs as a result of being

observed

Shift to human motivation theories in organizational environment

Health care as a business

Cost of providing care in traditional way is prohibitive

Flat fee for service

Mission statement is the purpose for business

Vision helps establish long range goals for business or unit

o Direct cost
Manager unit, nurse salary, patient care supplies
o Indirect: facility, heat, maintenance
o Fixed
Regardless of number of patients
Mortgages
Salaries
o Variable
Supplies, laundry

Health care disparities

Differences in health risks and health outcome measures that

reflect the poorer health status that is found disproportionately in
certain population groups

Unequal burdens

Health care disparities: difference in coverage, health care

system access and quality of care for different racial ethnic and
socioeconomic population groups that persist across settings

Many social causes

Poverty

Health care insurers

One of most significant factors in US to obtaining services

Gain profit from basic health coverage

Idea of copayment and deductibles

Health care payment

Copayment: fixed health care fee paid by the patient to the HCP

Deductible: predetermined out of pocket fee paid by a patient for

health care services prior to reimbursement

Health determinants

Models help to assess and address the priority health needs of

the at risk population groups

Holistic, multiple cause of health disparities

Assess the physical, social, environments and the polices and

interventions

Healthy People 2020

High performance organizations

Value people as human assets

Respect diversity, and empower individuals to use their talents to

advance personal and organizational performance

Build synergy from talents, employer: max performance

Technology and people together in context

Thrive on learning, sharing, continuously grow and develop

Achievement orientated, dynamic of the workplace

Informatics nursing

Integration of nursing, its info, and information management

with information processing and communication technology

Support health of people worldwide

Analyze, formalize, and model nursing information processing

and nurse knowledge for all nursing practice

Innovation

Pivotal management tool, team event

Ongoing research, application of EBP, self care initiatives and

innovation

Leadership characteristics

Interaction in which leader influences others towards goal

achievement

Leader and follower in interaction: reciprocal interaction,

inspiring engaging, social setting professional setting

Enlivening, inspiring, engaging

Guiding vision, passion, integrity

Intelligence, self confidence, determination, integrity, social,

caring, respectable, flexible, trustworthy

Magnet status

Goal is to promote quality in milieu that supports professional

nursing practice

Identify excellence in delivery of nursing to service patients

High quality care, clinical autonomy and responsibility,

participatory decision making, strong leaders, involvement of
community, two way communication, professional development,
effective use of staff resources, high level of satisfaction

Improve outcomes and enhance culture, improve safety and

retention, enhance competitive advantage

Management

Coordinating actions and allocating resources to achieve

organizational needs

Marshmallow Challenge

Business school students often score the lowest

Kindergarten the highest: will continuously change their product

Architects / engineers

Dynamic of the team, collaboration

Medicare donut hole

rules for membership and eligibility and a gap in coverage for

members

100% of drugs may be paid for out of the patients pocket

exists in Medicare D

Mission, vision, and philosophy

philosophy: value statement of the principle values and belief

that direct the organizations behavior

mission: formal expression of purpose or the reason for the

existence of the organization: values, behaviors, actions

Political activism

nurses are the largest health care group

politically active: have a definitive voice in their work

environments for welfare of the patients

Political influence

clearly articulate several dimensions of nursing to any audience

or stakeholder

advocacy of nursing

collaborate with other health care professionals to improve care

at the local or state

Power

ability to create, get, and use resources to achieve ones goal

derives from characteristics of individual

Profit and margin

profit: the revenue (income) minus the cost (the expense)

need to make profit to stay in business

non-for profit: 4-5% of the total budget as profit or margin

o margin is linked to the mission
o need margin to replace equipment, establish new services,
building cost, etc.

Quality

mechanism that establishes local or regional consensus about

what constitutes the best practices based on scientific research
findings, strong feasible processes to accomplish such practices,
deliberate program of outreach to the community on disease
prevention and health promotion, and a rigorous system to
review actual performance and clinical outcomes

Reasons for change

making something different then what it was, outcome may be

the same but the process to get the outcome may be different

nursing shortage, increase complexity of healthcare

effect of EBP, diversity of culture and languages, rising costs of

healthcare, increased cost of patient safety issues

Resilience

social and psychological capacity of individuals and groups to

adapt, succeed, and preserver over time in the face of recurring
threats to psychosocial and physiologic integrity

Resistance to change

trust, predictability, ability to cope with change

flexibility for the change, evaluation of immediate solutions,

individual stake, consequences of change

Rising health care expenditures

rising annual premium, deductible, co-insurance, copayments

and out of pocket costs

due to aging population, more drug usage, technological

advances, rising hospital costs, practitioner availability and
behavior, cost shift, and administrative costs

Risks for making errors

increase cost, decrease profit

need to be accredited by Joint Commission

transparency in healthcare

Sources of power

Personal:: derives from characteristic of individual (offering

service society needs), how one perceives power, extent to
which individual can influence others

Organizational: come from the hierarchy of the organization,

function powerfully within an organizational culture

Expert: derived from knowledge and skills that nurse possess,

knowing more about a subject than someone else

Legitimate: from position the nurse holds in a group

Referent: how much others respect and like individual, group, or

organization

Reward: ability to reward others to influence them to change

behavior

Coercive: people have ability to punish, take disciplinary action

against one another

Connection: connected to others having power

Information power: nurses influence others with info they provide

Strategic planning process

sum total or outcome of processes by which organization

engages in environmental analysis, goal formulation, and
strategy development for purpose of organizational development

need same vision for organization and planning helps ensure

resource availability

need an environmental assessment: looks at the situation,

external assessment, and internal assessment

SWOT: strength, weakness, opportunities, threat

Community and stakeholder assessment: whose involved in the

process

Need time and marketing plan

Theories X, Y, and Z

Theory X: minimal responsibility, need security and direction,

negative, motivation comes from reward and punishment, need
coercion to get the job done

Theory Y: enjoy their work, able to contribute creatively,

humanistic, positive, have self control and discipline under the
right conditions

Theory Z: collective decision making in the long term

employment

Tuckman and Jensens team process

Evolve through a team forming process

Forming stage (first phase group is created)

Storming: more comfortable team setting

Norming: effective communication and collaboration

Performing: group maturity and stable relationships

Adjourning: termination and consolidation

Types of power

Achieving personal gain and self glorification

Achieving gain for others or the common good

Workplace culture

Assumption, belief, and values shared by members of an

organization

Adaptability, involvement, consistency, and mission

Workplace satisfaction

World languages prevalence