Health Care Delivery System

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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
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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
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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
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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
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Do We Need National Health Care?
 Improved access to care
 Competitive free-market
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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
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Health Care Trends
 Graying of America
 Technological advances
 Globilization
 Delivery System changes
 Social evolution
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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
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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
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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
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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
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Health Maintenance Organizations
 Staff Model
 Group Model
 Network Model
 Independent Practice Association
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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
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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
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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
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Organizational Structures
 Centralized
 Decentralized
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Organizational Charts
 Maps that determine who reports to whom
 Shape dependent upon size and
governance style
 Reflect formal communication patterns
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Organizational Approaches to Getting
Work Done
 Committee structure
 Participative management
 Shared governance
 Self-governance
 Unions
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Nursing Care Delivery Patterns
 Functional
 Team
 Primary
 Patient-focused
 Case-managed
What are the pro’s and con’s?
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Delegation
 Who can delegate?
 What can be delegated?
 When should delegation be used?
 How can you determine if delegation is
effective?
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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
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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?
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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
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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.
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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?
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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
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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
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How is Health Care Financed?
 Self-payment
 Third-party payment
 Health care assistance
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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
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Questions to Ponder
 Why must nurses be involved in fiscal
management?
 What does the budget have to do with
nursing practice?
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Terms to Know
 Budget
 Operating budget
 Capital budget
 Personnel budget
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Budgets and Cost Control
 Unit cost
 Standard costs
 Target or budget costs
 Cost variance report
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Reasons for Cost Problems
 Poor quality
 Theft
 Carelessness
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“Costing Out” Nursing Services
 Used to understand the cost of treating a
patient relative to the revenue received
from treating that patient.
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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?
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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
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Computerization
 Mainframe
 PC
 PDA
We must balance the use of this technology
with increased personal contact (touch) to
maintain the human element of nursing.
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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)
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Theories Associated with Nursing
Informatics
 Nomenclature, Classification and
Taxonomy
 General Systems Theory
 Change Theory
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Buzzwords for the Future
 Preventive medicine
 Preventive care
9/15/2014 41 www.drjayeshpatidar.blogspot.com
THANK YOU
9/15/2014 42 www.drjayeshpatidar.blogspot.com

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