330 likes | 338 Views
CHAPTER 10 MANAGING CLIENT CARE. The Economic Climate in the Health-Care System. Resources are scarce Resources have alternative uses Individuals want different things and have different preferences. Cost Containment Programs. Economic stabilization program Voluntary effort
E N D
The Economic Climate in theHealth-Care System Resources are scarce Resources have alternative uses Individuals want different things and have different preferences
Cost Containment Programs • Economic stabilization program • Voluntary effort • Certificate of need • Medicare prospective payment system • Diagnostic related groups • Managed care
Forces Driving Health Care • Cultural diversity • Aging population • New services and technologies
Nursing Shortage • High acuity of clients in hospitals • Increased demand for nurses • Aging nursing workforce • Job dissatisfaction • Reduction in nursing faculty
Changes in Work Design • Nursing care delivery systems have the structure that allows nurses to plan and provide nursing care to groups of clients • The current acute nursing shortage continues to fuel the frenzy of work redesign in acute- care hospitals across the nation
Organizing Principles of a Delivery System • Decision-making • Care allocation • Communication • Management
Traditional Models of Care • Total care • Functional • Team • Modular • Primary nursing
Contemporary Models of Care • Case management • Client-focused care • Product line management • Differentiated practice
Case Managers • Negotiate services/treatments • Communicate • Coordinate • Clinical expert • Holistic caring approach • Coach
Goals of Case Managers • Achieve outcomes based on standards of care • Collaborative coordination • Efficient use of resources • Timely discharge • Enhance quality of life
Differentiated Practice • Structuring of nursing roles and functions • Education • Experience • Competence
Differentiated Practice Models • Associate degree nurse • BSN or primary nurse • MSN nurse • Advanced practice roles
Quality Management • Professional organizations • Federal/state governments • Licensure • Private accreditation
Characteristics of Quality Management • Links to the strategic plan • Quality councils • Training programs • Selection of improvement opportunities
Characteristics of Quality Management • Formation of process improvement teams • Staff support • Motivating personnel policies
Quality Focused Professional Organizations • Joint Commission on Accreditation of Healthcare Organizations (JACHO) • American Nurses Association (ANA) • Institute of Medicine (IOM)
IOM Essential Competencies • Provide patient-centered care • Work in interdisciplinary teams • Employ evidence-based practice • Apply quality improvement • Use informatics
IOM – Medical Errors • 44,000 – 98,000 die each year • $17 - $29 billion total cost • JACHO International Center for Patient Safety • Yearly patient safety goals • Unapproved abbreviations
Nursing Errors • Medication • Knowledge • Procedure
Continuous Quality Improvement (CQI) • Identify indicators • Collect ongoing data on indicators • Analyze and evaluate data • Implement change
CQI Elements • Localized improvement efforts • Organizational learning • Process reengineering • Evidence-based medicine and management
Quality Improvement Structure • Facilities • Equipment • Staff • Finances Process Outcome
Organizational and Unit CQI • Strategic planning • Framework for decisions • Basis for detailed planning • Explain business to others • Assist in benchmarking • Stimulate change
Monitoring and Evaluating Quality of Care • Guidelines • Protocols • Algorithms • Standards of care • Critical pathways
Structured Care Methodologies • Link the process of care and the outcome • Allow for measuring quality care
Structured Care Methodologies • Increase the predictability of services needed • Clarify the responsibilities of interdisciplinary team
Structured Care Methodologies • Facilitate communication among team members • Decrease documentation time • Provide a systemic approach to measurement
Root Cause Analysis • Process of learning from consequences • Determine influences • Establish linked chains of influence • Determine necessary and sufficient influences • Try and drill down to root causes
Risk Management • Part of CQI • Service occurrence • Serious incident • Sentinel events
Conclusion Regardless of the care model used or the indicators selected, focus attention on the following in patient care delivery:
Conclusion • Think critically • Plan and report outcomes • Make introductory rounds • Plan partnership with the client • Communicate the plan • Evaluate progress