NR 506 Drivers of High Performance Healthcare Systems
NR 506 Drivers of High Performance Healthcare Systems
Access and Quality in Healthcare
One driver for high performance healthcare systems is actual access to healthcare. On average, the residents of the southern part of the United States have less access to healthcare (Nguyen & Sommers, 2016). One study in my home state of Arkansas revealed over forty four percent of the population does not have medical insurance (Nguyen & Sommers, 2016). These residents will be less likely to visit a medical professional when they have an issue, or they might not be compliant with the prescribed treatment due to lack of finances. I have seen this issue appear time and time again in my professional practice. We have patients admitted with an infected limb because they did not see a physician when they first noticed symptoms. Because they waited too long, the condition worsened, and severe infection developed. They might endure multiple surgeries and still end with a limb amputation. A clear majority of these patients are also diabetic and do not monitor their blood sugar or take the prescribed medication; these practices also contribute to their complications. These patients remain in the hospital for weeks and are drowning in medical bills they cannot afford when they are discharged. If affordable healthcare were accessible to these patients, they might be better able to maintain their illnesses at home and prevent the complications that ultimately cost them even more money. The healthcare system is ultimately a business geared to show profit. As healthcare professionals, we must be mindful of our patient’s financial situation when we prescribe treatments. We have to be flexible in our options for patients to help them be the most successful when maintaining their health.
Another driver of the healthcare system is quality. I have heard this term addressed many times by both our supervisor and administration. Quality and patient safety are two concepts that are intertwined (Akram et al., 2017). The reason for quality is to promote patient’s well being while in our care in the hospital (Akram et al., 2017). Quality scores have become an even more prominent concept since patients now have increased access to this information and can choose where to seek medical attention based on these scores (Akram et al., 2017). On my own unit, we have a trauma quality team assessing us. The results that they find will be made known to the individual at home, to insurance companies, and to government agencies that control medical funding. The results of these scores are also reflected in the hospital’s repayment for services. If the reimbursement amount decreases because of our inferior performance, our jobs could be in jeopardy. Therefore, understanding this driver is of utmost importance for nurses. The manner in which we provide care and the quality of care we provide affect more than our one patient. Our performance may determine what equipment and services we have access to and could ultimately impinge on our jobs as well.
Akram, G., Tayyebeh, R., Farahnaz, A., Zahra, S., & Iman, D. (2017). Quality of healthcare services and its relationship with patient safety culture and nurse-physician professional communication. Health Promotion Perspectives, Vol 7, Iss 3, Pp 168-174 (2017), (3), 168. doi:10.15171/hpp.2017.30
Nguyen, K. H., & Sommers, B. D. (2016). Access and Quality of Care by Insurance Type for Low-Income Adults Before the Affordable Care Act. American Journal Of Public Health, 106(8), 1409. doi:10.2105/AJPH.2016.303156
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Select two drivers (for example quality, cost, and access) of high performance healthcare systems and apply it to your current work situation. The application could demonstrate the presence of the driver in a positive manner or it could acknowledge the presence of a concern.
In my opinion two drivers such as quality and cost are the most importance in high performance healthcare systems.
However, it is hard for the two drivers to go hand in hand. One would think that in order to get high quality healthcare, it would cost more. In my current work situation there is always a staffing shortage in the ICU, probably because other departments RN cannot float to ICU since it is a specialty unit. It costs hospital to staff RNs in order to provide quality care and maintain the patients to nurse ratios. Not having adequate staff due to cost containment can jeopardize efficient quality healthcare. “Nurse staffing has a significant impact on both quality of care and cost due to nurses’ vital role as front‐line care providers, and insufficient staffing and unreasonable home healthcare costs can thus reduce health benefits through missed opportunities to improve patients’ health status” (Park, 2017).
People tend to associate things that are not costly with poor quality. Which comes to mind, the objective of the “Patient Protection and Affordable Care Act (ACA)” was to attain virtually worldwide health insurance coverage in the United States. ACA helped a lot of people get insurance for an affordable price. “On the supply side, concerns have been raised about whether there are sufficient numbers of primary care physicians to treat all of these newly insured patients” (Courtemanche et al., 2018). Now that everyone could be insured, the question is how will the quality of care be affected? What types of physicians will care for these patients. Time with patients will be compromised due to lack of time to see patients. I believe there must be a medium for quality of healthcare and cost.
Courtemanche C., Marton J., Ukert B., Yelowitz A., & Zapata D. (2018). Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health. Southern Economic Journal. 84(3), p660-691. 32p. DOI: 10.1002/soej.12245.
Park, C. S. (2017). Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis. Journal of Advanced Nursing. 73(8): 1838-1847. 10p.
“Value-based purchasing strategies, primarily (1) pay-for-performance (P4P); (2) accountable care organizations (ACOs), and (3) bundled payments, are geared towards achieving value by reducing costs while improving quality based on a predetermined set of performance standards including quality and cost measures” (Walter et. al., 2015). The government motivates hospitals by paying out incentives when quality care is met through patient satisfaction surveys or statistics. At our hospitals we have core measures sets, which are things to focus on such as CHF, sepsis, stroke, and etc. made by the The Joint Commission to provide quality care. Lowering the cost of health insurance makes it affordable for everyone, at the same time bringing more businesses to providers, and having incentives to motivate these providers to give great quality care.
Walter A.W., et. al. (2015). The Affordable Care Act and Value-Based Purchasing: What’s at Stake for Children with Medical Complexity? The Catalyst Center. p1-13.
There are many potential drivers in the healthcare system but two that are very important are cost and accessibility. The cost of healthcare can be a controversial issue for many individuals, which is why it is so important. The changing cost in healthcare can be for many reasons including pharmaceutical changes, technology innovations, healthcare reforms and even government expenditures (McGrail & Ahuja, 2017). This affects both the patient and the hospital on a daily basis. Our hospital has just opened its own pharmacy for the use of not only employees, but also the patients and the community. The goal for the pharmacy was to cut down the cost of prescribed medications for the patient and their families. The pharmacy has been open for about a year now and the feedback has been great. Patients are getting their prescriptions at half the cost of anywhere else, if not more. It does make me wonder however, why other places are charging such large amounts. I do feel that the pharmacy in the hospital is a positive driver in our hospital’s situation.
The second driver is access to healthcare. In our town, which is quite small and only has the rural hospital, there are two healthcare facilities or physicians’ offices. Both offices are open regular hours, 8am-5pm and provide no urgent or afterhours care. Due to this, in the evening and on weekends, the emergency room is very busy but not with trauma, with things likes ear infections, influenza and headaches. In our area, access to care outside of normal business hours is non-existent. This is a huge negative for the community, patients and even staff members. This can also tie back into the cost as well. Instead of the patient paying for a simple Doctor’s visit, the patient must pay an emergency room bill, which can sometimes be triple the amount. This may be a positive driver in terms of money for the hospital but definitely negative for the patient and patient care all together.
McGrail, K. Ahuja, M. (2017). What is bending the cost curve? An exploration of possible drivers and unintended consequences. Healthcare Policy, 13(2), 20-30.