Health Care Delivery for the 21th Century

1. Health Care Delivery for the 21thCentury Advanced Skills for Health Care Providers, Second Edition Barbara Acello Thomson Delmar Learning, 2007

2. Objectives • Spell and define terms. • Define workplace redesign and describe changes in the nursing department that have occurred because of restructuring. • Define the role, responsibilities, and scope of practice of the Patient Care Technician, and explain why standards of care are important

3. Objectives, continued List the five rights of delegation and give examples of situations in which delegating a procedure to a PCT is not appropriate.

4. Objectives Continued • Diffentiate an intradisciplinary team from an interdisclipinary team and list some general responsibilities of teams • List at least ten desirable qualities of the PCT • Identify professional boundaries in relationships with patients and families

5. SPELLING TERMS • WORKPLACE REDESIGN • RESTRUCTURING • RE-ENGINEERING • MULTISKILLING • CROSS-TRAINING • PROCESS IMPROVEMENT • QUALITY IMPROVEMENT (QI) • QUALITY ASSURANCE (QA) • CONTINUOUS QUALITY IMPROVEMENT • BENCHMARK • BENCHMARKING

6. SPELLING TERMS CONTINUED • CRITICAL THINKING • QUALITY INDICATOR • ADVERSE EVENTS • CLOSE CALLS • INTENTIONALLY UNSAFE ACTS • SENTINEL EVENTS • ROOT CAUSE ANALYSIS (RCA) • TRANSPARENCY • INSTITUTE FOR HEALTHCARE IMPROVEMENT (IHI) • PATIENT FOCUSED CARE • UNLICENSED ASSISTIVE PERSONNEL (UAPs)

7. SPELLING TERMS CONTINUED • NURSE PRACTICE ACT • STANDARDS OF CARE • NEGLIGENCE • MALPRACTICE • DELEGATION • DELEGATED • ASSIGN • INTRADISCIPLINARY TEAMS • INTERDISCIPLINARY TEAMS • INTRADEPARTMENTAL TEAMS • INTERDEPARTMENTAL TEAMS • PARAPROFESSIONALS • TACT

8. Health Care Delivery from 1980 to the Present • Health care is provided in many settings • The type of care given is determined by the type of services the agency delivers • Health care workplace organization remained largely the same for many years. • Before the mid-1980’s, health care facilities were set-up so that many departments provided services to patients

9. CHANGES IN REIMBURSEMENT • Changes in reimbursement for health care services began with the federal government in the late 1970s. • This was done to save Medicare money • In the mid-1980s, changes began to have a profound effect on the health care industry. • These changes caused modifications in the operation of physicians’ offices, clinics, laboratories, hospitals, long term care facilities.

10. WORKPLACE REORGANIZATION • Most health care facilities studied their operations to see how they could become more efficient. • This was necessary because reimbursement for services was less than it had been previously • Organizations had to figure out how to provide the same services at a lower cost. • Some hospitals closed because they could not operate on lower revenues

11. WORKPLACE REORGANIZATION • Many agencies learned that they could save money if they combined the services that departments and workers deliver. • Small departments merged, becoming part of larger departments • The workers were taught to perform new patient care procedures. • Now fewer workers provide a broader spectrum of care. • Collectively, these changes are called workplace redesign.

12. EFFECTS OF WORKPLACE REDESIGN • In most health care agencies, the nursing department’s responsibilities have been expanded • Staff is given additional training in procedures that nursing was not responsible for previously • Training of this type is called multiskilling or cross-training

13. EFFECTS OF WORKPLACE REDESIGN • The multiskilled worker has completed a basic nursing assistant or other educational program to learn to provide personal care and basic comfort measures to patients • The assistant attends classes to learn additional technical skills. • Most agencies have changed the assistant’s title to reflect the changes in responsibility.

14. QUALITY ASSURANCE • All health Care Facilities have an interval program for process improvement. This is commonly called quality improvement or quality assurance or continuous quality improvement. • The purpose of quality assurance is to identify problems and potential and find solution for improvement.

15. BENCHMARKING • Benchmarking is an important part of the quality improvement process. • Benchmarking is an activity in which an organization establishes best practices by comparing what it is doing with what other similar organizations are doing • By benchmarking with other organizations, the facility can improve its processes and achieve excellence

16. QUALITY INDICATORS • Quality indicators are decision-making and research tools that are used for tracking changes, recognizing potential quality problems and identifying areas that warrant further study and research

17. Serious Events • Adverse events- incidents, accidents, events and injuries associated with patient care and services. • Close calls- Situations that could have resulted in an adverse event but did not. • Intentionally unsafe acts- results from criminal acts, purposefully unsafe actions • Sentinel events- Serious injury that result in patient death or serious physical or psychological death

18. ROOT CAUSE ANALYSIS • Root cause analysis or RCA is a process for identifying the cause or contributing factors associated with untoward events • Every facility has guidelines for conducting a root cause analyses investigation • Transparency- is the part of the investigative process that involves keeping people informed

19. PATIENT- FOCUSED CARE • The purpose of patient focused care is to bring services to patients, instead of bringing patients to services. • Fewer workers are needed to provide services to each patient under this model of care.

20. Role and responsibilities of the Patient Care Technician • The role of the PCT vary from one agency to the next. • Understanding what you can and cannot do is very important • Your employer will give you a job description, listing your responsibilities. A sample job description is given in figure 1-3

21. Nurse Practice Acts • Nursing practice is regulated by a board of nursing or other governing body in each state. • The nurse practice act describes the nurses scope of practice in your state. • Never perform procedures that you have not been taught to provide, or that are illegal for patient care technicians in your state.