Changes in the health care environment can have
a significant effect on staff and patients (Dunham –Taylor, 2015). In order to improve the
customer’s experience, health care organizations are placing a great deal of
effort to improve customer service times and access to care (Kangasniem,
Vaismoradi, Jasper & Turinen, 2013). Current health care system are now
being reimbursed for how the customer perceives the care they have received
during hospitalizations (Dunham
–Taylor, 2015). In order to improve the customer’s experience,
health care organizations are placing a great deal of effort to improve
customer service times and access to care (Dunham
–Taylor, 2015).A dilemma arises when improvements to the patient’s perception of care;
decrease the quality of the care received by the patient. One reason for this
predicament is insufficient research in the healthcare settings in the area of
customer service done by healthcare professionals (Kangasniem, Vaismoradi,
Jasper & Turinen, 2013). Many of the improvement initiatives are taken from
other industries and may not be prudent or effective for the health care environment
(Kangasniem, Vaismoradi, Jasper & Turinen, 2013).
One example is in order to have the emergency
room wait time; patients are taken from the waiting area and placed in
observation room, to be seen by the doctor. The patient is often in this room
without being seen by a doctor for several hours due to a shortage of emergency
physicians. The patient perceives they are receiving more expedient, when in
reality they are not. The doctor gives minimal orders in an effort to get the
patient placed in a hospital bed as quickly as possible, to meet health care
delivery times. The Patients are more often than not given minimal treatment to
stabilize their medical condition. The nurses in the emergency room are given
lower patient ratios due to the fact that they are suppose to stabilize the patient
prior to arrival to the hospital floor. In
essence, due to the lack of doctor’s orders and nursing staff failure to
intercede, the patient arrives admitted to a hospital bed with a nurse that has
a higher patient ratio, in an unstable condition. It is common practice for a floor
nurses to receive multiple emergency room patients at the same time and still
have several other admitted patients under their care. This phenomenon could be
detrimental to the health and safety of the patient. To add to the situation
many hospitals in an effort to prevent a bottle neck, in their emergency rooms
are using bed placement systems orchestrated by employees with minimal medical
background, that do not recognize the need to place patients in rooms that
would best suit their medical needs. Examples include isolation, fall risk,
safety issues, and patient preference.
A
direct example of this in current practice is, an eight-one year old female
with a history of dementia was readmitted to the hospital with chest pain and
coughing, after being home three weeks due to new diagnosis of pulmonary emboli.
The family requested to stay with the patient stating that she becomes confused
at night and combative. The family also acknowledged the patient had multiple falls
last admission when they did not stay. The emergency room doctor told the family
it was fine they stayed with the patient during hospitalization. The patient arrives
to the floor with pulmonary emboli, with a blood pressure of 250/110; no
antihypertensive or anticoagulation medication given prior and is placed in a
double occupancy room. The nurse receives at the same time, a twenty-one year
old male with pancreatitis that is screaming in pain. The patient stating what
was given in the emergency room for pain was not effective. The nurse calls the
attending doctor to receive orders and it take thirty minutes for a call back.
While
waiting the nurse calls bed assignment and is told that it is not medically
necessary for the patient to have a private room. The nurse then realizes the
patient rapid influenza test was positive in the emergency room and the patient
is in with another client. The nurse again has to call bed assignment to move
the patient. The family is irate. The nurse is left with few resources, such as
calling on other staff, because the bed assignment schedulers send all the new
admission to the floor at the same time. The nurse cares for the most urgent
situations first but, the customer experience for the patient in pain and the
wait for a private room and the potential exposure of another patient to
influenza, causes the patient’s hospital experiences
to be negative and their trust in the providers care to be in jeopardy. Also
the delayed care received by all patrons could have resulted in unnecessary
medical complication during this admission. This entire situation is a result
of the healthcare effort to improve the patient’s perception of care that
results in decreasing the quality of care.
As leaders of nursing it is of the greatest
important to safe guard the quality of care while maintaining a robust economical
standing (Kangasniem, Vaismoradi, Jasper & Turinen, 2013). Currently in the United States patients are
receiving the quality of care of patients in a third world country, at a cost
that is the highest in the world (Dunham
–Taylor, 2015). In order for health the industry to increase the quality of care,
it must move from a volume based system to a value based system (Dunham –Taylor, 2015). Medical payment incentives are shifting to
reimburse for the value of care (Dunham
–Taylor, 2015). The worth of the care is
determined by the customer
(Dunham –Taylor, 2015). In the
information age people value time and want expedient, expert, personalized care (Dunham –Taylor, 2015). For the health care industry to survive
financially, this goal must be met (Dunham
–Taylor, 2015). In today’s world nurses must learn to adapt to a fast pace and
chaotic environment (Dunham
–Taylor, 2015). Nurses must view the new chaotic atmosphere; they find themselves
in, as a dynamic changing environment that they have the ability to influence
and be reminded that perfect order breed’s habit that can lead to the death of an
organization (Dunham
–Taylor, 2015).
The scenario above well it may seem almost unsolvable at first
glance, is really the result of the staffs failure to communicate, use new
technology appropriately and to work together as a team (Dunham –Taylor, 2015). In the new chaotic age
of information to maintain patient safety and expectations, nothing is more
important than a seamless transition of care (Dunham –Taylor, 2015). Organizations must
invest time in educating staff of new technology, such as bed board, to prevent
patients being placed in unsafe beds (Dunham
–Taylor, 2015). Hospitals must question sacred cows such as keeping floor orders
and emergency orders separate, to promote teamwork and timely flawless care (Dunham –Taylor, 2015). Nursing staff must be
given ongoing meaningful education to cope with and manage the new norm of
every changing technology, influx of new information, and complexity of patient’s
medical decisions
(Dunham –Taylor, 2015). Every
decision of action within an organization has a direct impact on patient
outcomes, leadership must control the end product the patient receives by
establishing and communicating that the most sacred assets to the organization
is the customer (Dunham
–Taylor, 2015).To communicate this value within a organization all process should
reflect providing a meaningful experience for the patient.
What actions can a health care organization take to
increase reimbursement? Productivity?
In order for
organizations to remain financially competitive and viable it must continually
improve on the productivity of staff (Harte, Mallet, Mahieu, Norville, &
Vanderwest, 2011). One of the greatest areas that affects productivity is
employee absences (Harte, etal., 2011). It is in the interest of the employer
to have healthy staff. In the United States the average cost for every staff
member is thirteen thousand dollars yearly for medical care (Harte, etal.,
2011). For every one dollar spent on health care, the organization looses three
dollars of output, within the organization (Harte, etal., 2011). For a business
to improve their bottom line caring for their employees physical and mental
health is necessary to financially remain competitive (Harte, etal., 2011).
Furthermore research demonstrated that when
leadership provides work balance, health incentives and demonstrated truly
caring leadership styles, those organizations are more economically secure (Dunham
–Taylor, 2015).
We are currently at the dawn of a new age
of health care (Dunham –Taylor, 2015). Health reimbursement is moving from an
era of quantity to an area of value based care (Dunham –Taylor, 2015).In order for healthcare
organizations to provide care that is of value they must determine what is
meaningful to the patient (Dunham
–Taylor, 2015). Value is defined by each individual person differently. Health care of this new decade will require
that staff provide individualized, yet standardized safe care (Dunham –Taylor, 2015). In order
to accomplish this very lofty goal it will require greater communication with
the patient (Dunham –Taylor, 2015). To find out what is meaningful to patient
will require that managers make it a priority to regularly speak with patient
and communicate their needs to their staff (Dunham –Taylor, 2015). Managers
must demonstrate in words and actions that caring for the patient as an
individual is a value of organization, that cannot be compromised (Dunham
–Taylor, 2015). Research has proven that managers that treat their employees
with value will pass that on to the patients and this one action improves
productivity within their organization (Dunham –Taylor, 2015). To provide
standardized safe care with require continued research by nursing as a
profession to provide evidence – based care (Dunham –Taylor, 2015). The combination of
individualized, standardized, safe and technological advanced care is what will
bring the highest reimbursement for the health care industry.
3). From your perspective, what is the most
important core value in a health care
organization? Do core values impact financial
viability?
The foundation of health care has
a Christian beginning (Selanders & Crane, 2012). The
most
predominate value of the Christian religion in love (Selanders & Crane,
2012).
To
deny the foundation of health care would be to turn our back on the power that
created
and
continues to fuel the industry
(Selanders & Crane, 2012). Most of the healthcare
provided
in the past was from religious organizations and was charity (Selanders &
Crane, 2012). These religious organization began caring for the sick as a means
to love and care for the children of God (Dunham –Taylor, 2015).The Bible tells
Christians that love is a action “ let us not love in word or talk but in deed
and truth” ( 1 John, 3:18 ). No matter how complex and fast paced the world becomes;
the answer to the salvation of man is love (Dunham –Taylor, 2015). The world
has given many definitions of love, but the only description that will solve
all the problems of the world including the health care crisis, can be found in
the person of Jesus Christ (Dunham –Taylor, 2015). Our forefathers were able to
care for the sick in the past and we must have faith that God will help us do
the same in the future. “I live by faith in the son of God, who loved me and
gave himself for me” (Galatians 2:20). The kind of love that is necessary to
transform organizations is purpose, service and sacrifice (Dunham –Taylor,
2015). The only person on this earth that has that has ever portrayed perfect
leadership and love is Jesus Christ. As an industry we have grown and thrived
from Christian principles, to continue we must remember are greatest purpose is
are fellow man. Research confirms organizations that follow their purpose and
values are more stable economically (Dunham –Taylor, 2015). Organizations with
the primary value of love have encompasses the highest standard and principles
and find failure is impossible. Studies also indicate that mangers with high
principles made more revenue for their organizations (Dunham –Taylor, 2015).
4)
How can a nurse
leader increase staff decision making at the point of service?
We are currently at the cusp of a new age
(Dunham –Taylor, 2015). This is the first time in history were information and
technology are arriving so rapidly that it is impossible to keep abreast in an
increasing complex varying world (Richard, 2013). Antiquated patriarchal
business models, where the boss is all knowing, are no longer effective or safe
in the health care industry (Janne, 2015). With the expansion of the
available knowledge and increased technology in the health care it is necessary
to move to a more horizon business model (Richard, 2013). Horizontal
business models, allow for increased sharing of information within an
organization, as the vertical chain of command is removed (Richard, 2013). To
have this type of organization managers must take on the role of a coach (Richard,
2013). The practice of leadership as all knowing and responsible for fixing all
the problems within an organization is not only false but, unsafe (Dunham –Taylor, 2015). Coaching is the ability for the manager to
develop and use each individual employee’s gifts for the betterment of the
company (Richard, 2013). In this new age
of information managers that fail to become coaches will be obsolete (Collins,
2009).
Leadership has discovered to increase the
productivity of their business and provide meaningful value to their customer;
staff must be able to make decisions at the point of service (Dunham –Taylor, 2015). In
today’s world, companies that can provide personalized care are highly valued
by the customer and more profitable (Richard, 2013). Mangers
must empower their staff thru education, mentoring and trust, to make decisions
for the patients, at the point of care in order to remain relevant in today
market (Dunham –Taylor, 2015). Leaders must be able to create and inspire
others to follow their vision for the organization (Dunham –Taylor, 2015). Furthermore for staff to
make decisions that are right for the company management must create a
foundation of values that reflect the purpose of the organization (Dunham –Taylor, 2015). Leadership must hold everyone in the
organization accountable to uphold these values and inspire staff to follow
their vision and purpose for the company (Dunham
–Taylor, 2015). The staff must learn to
make decisions that reflect the needs of each individual client, while taking
into consideration the rest of the organization (Dunham –Taylor, 2015). When these decisions are made mistake are
inevitable mangers must take the role of coach and view these foibles as
learning opportunities for staff to improve service in the future (Dunham –Taylor, 2015). With the
ever increasing complexity of health care it is not only important that health
care organizations provide personalized care but, standardize safe care (Dunham –Taylor, 2015). Healthcare managers must insist that all
practice are evidenced –based and provide employees with the resources to
perform services using best practice (Dunham –Taylor, 2015).This also gives leadership the responsibility to
mentor and provide means for professionals to continue research in health care
practices to provide the safest most effective care for their patients (Dunham –Taylor, 2015).
Does patient rounding have a
financial impact for healthcare organizations? Who should participate in rounding?
The use of technology has greatly enhanced
the care of patients (Glemboki & Fritzpatrick, 2013). Technology has also
had the unsuspected consequence of moving the nursing staff further from the
patient bedside (Glemboki & Fritzpatrick, 2013). This has resulted in two areas
where the benefit of the new technology is causing serious cost to the care of
the patient. The first area is patient do not feel that they are being treated
as individuals (Glemboki & Fritzpatrick, 2013). When the patient arrives to
the hospital, they are met by staff behind computer screens and placed in a
multitude of machines but, they are never seen as an individual person (Glemboki
& Fritzpatrick, 2013). This sterile environment may treat the illness but,
does nothing to treat the soul of the client (Glemboki & Fritzpatrick,
2013). Furthermore the technology has caused many nurses to become so focused
on the process; they have lost the meaning of why they have entered the
profession, which was to care and treat patients both physically and
spiritually (Glemboki & Fritzpatrick, 2013). Oftentimes nurses change
positions or leave the profession because they are seeking the reason they
became nurses to begin with, to care and heal people through relationships (Betbeze,
2012). Then nurse falsely believes that it is their position they’re in, when
in fact it is their failure to integrate technology appropriately into their
practice (Betbeze, 2012).
Research has demonstrated that one of the
highest expenditures of nursing managers is the orientation,
retention and hiring of employees (Betbeze, 2012). Another
unforeseen side effect is patients that feel cared for personally are less
likely to sue the organization (Betbeze, 2012). Furthermore as reimbursement is
moving form volume based care to value based care it is necessary for the
organization to determine what patient’s value within their health care
experience (Dunham –Taylor, 2015). Economically it is of benefit for the nurse
manager to remove barriers of care between the patient and outside forces
(Dunham –Taylor, 2015).
Investigation has demonstrated closing
the gap between technology and the patient care result when every member of the
patient care teams participates in rounding with the patients to include:
management, CEOs, doctors, nurses, ancillary staff and nurses aids (Dunham
–Taylor, 2015). Research has proven that
organizations that nurse mangers incorporate regularly rounding done by them
and their staffs are able to identify problems and address them immediately
(Dunham –Taylor, 2015). The end result is that patients are more satisfied with
their care and the organization receives greater reimbursement (Dunham –Taylor,
2015). Another phenomenon that has been demonstrated through research is staff
that engages in regular patient rounding feel their jobs have greater meaning
and purpose (Dunham –Taylor, 2015).
Furthermore regular rounding decreases the use of call lights by
patients and alarm fatigue is decreased and productivity increases (Glemboki
& Fritzpatrick, 2013). Organizations that return to patient centered care
are financially more stable and this can be accomplished through rounding
(Betbeze, 2012).
Provide
an example of when poor leadership affects the bottom line. Describe the
ineffective leadership and place dollar amounts on the losses incurred.
In the multifaceted
health care industry, leadership is more important that it has ever been in
history. Management that fails to set high standards of quality and safety not
only affect the financial stability of their organization but also of the
United States government (Robinson,
2011). Over half of the national debt in the United States is a result of
health care cost incurred by it citizens, that are paid by government
entitlements (Robinson, 2011). Furthermore leaders that fail to ethically and
financially safeguard the system in which they are responsible through
accountability of all members of their organization can cause death or
interpretable damage to the clients they serve (Diffenderfer, Duham-Taylor, Snyder,
& Malcolm, 2015). Annually 52,127 Medicare patients develop a no
comical blood stream infection that cost 1.2 billion dollars and 8,114 deaths
(Diffenderfer, etal., 2015). For every ten surgical patient one dies from
complications that could have been avoided (Diffenderfer, etal., 2015).
Preventable patient safety issues cost Medicare 7.3 billion dollars (Diffenderfer,
etal., 2015). In addition hospitals that maintained the highest levels of care
saved the federal government 1.8 billion dollars yearly (Diffenderfer, etal.,
2015). A price cannot be placed on the lives of these patients.
Ineffective leaders not only effect
organizations but, communities, states, governments, nations and ultimately the
world. Leaders that fail to have moral and ethical foundations can cause damage
to all under their sphere of influence (Dunham
–Taylor, 2015). Furthermore all that is
done has a ripple effect that ultimately reaches the rest of humanity (Dunham –Taylor, 2015). Leaders that fail to
hold themselves and others accountable for their actions based on moral
principles can cause damage that is significant and has far reaching effects (Diffenderfer,
etal., 2015). Leaders must inspire others to leave the world a better place
(Diffenderfer, etal., 2015). Failure to take the future generations into considerations
and leave a legacy for the next generation is toiling in vain (Diffenderfer,
etal., 2015). Failure by management to create safe, culturally diverse, family friendly
organizations ultimately cost everyone in society in the end (Diffenderfer,
etal., 2015).
Consider
this statement: “Make decisions on behalf of patients; the dollars will
follow.” As a nurse leader, what does this statement mean to you as you
approach your daily responsibilities to provide safe and quality care?
The reasons why most nurses enter the
profession is because they are passionate about people and want to help patients
(Glemboki & Fritzpatrick, 2013). Research demonstrates that organizations
that place patient at the center of their care are safer, have happier staff,
better outcomes and have higher revenue (Glemboki & Fritzpatrick, 2013).
With the influx of technology it is easy to get bogged down in the tasks at
hand (Diffenderfer, etal., 2015) Failure by the profession to acknowledge that
the vocation was created for the patient
would remove the heart out of our work and decrease the value of nursing care
in the health care industry (Glemboki & Fritzpatrick, 2013).
Nurses that establish relationship with
their patients not only provide a health care experience that is of value to
their patients, they are able to address any problems that could complicate the
patient stay (Glemboki & Fritzpatrick, 2013). Technology has only enhanced
our profession if used correctly. To be successful nursing staff must use
technology to augment patient care not replace the care they provide (Glemboki
& Fritzpatrick, 2013). Nursing leaders must demonstrate this core value of
the profession in action; of the daily tasks they perform (Dunham –Taylor, 2015). Nursing is a calling
were you are called to step into people lives and help provide healing along
the journey.
5)
As
the nurse leader of your unit/organization, provide examples of which elements
are important for you to provide to achieve an appropriate budget. How will you
utilize your influence as a nurse leader to present your budget to
administration to achieve the best possible outcomes for your unit?
The budget of
a nursing unit must allot for patient care needs, core scheduled staff, nurse
patient ratios, ancillary staff, admission, discharge, transfer activity within
a unit, education hours, sick, vacation time, new staff orientation, and
overtime (Malloch & Dunham
-Taylor, 2015). For a nurse manager to obtain the funding that is necessary
to provide safe and effective service to patients, justification of all
expenditures must be presented to administration (Malloch & Dunham -Taylor,
2015). Nursing leaders must budget, monitor productivity, measure quality and
staffing plans, in order to stay within budget and justify need for future
expenditures (Malloch & Dunham -Taylor, 2015). There are many information
systems that are available to allow nurse managers to track meaningful data
that helps reduce cost and improve quality (Malloch & Dunham -Taylor, 2015).
Nurse leaders
must continually validate the need for requested budgets (Malloch & Dunham
-Taylor, 2015). To have the current documentation of data regarding
expenditures, quality and patient care, as well as evidence based research to
support your budget , will go a long way in influencing leadership, to provide
the nurse manager with the budget to successfully run their unit (Malloch &
Dunham -Taylor, 2015). Furthermore the nursing manager should try to align the
goal for their unit to match the organization and the financial managers
(Dunham –Taylor, 2015).
References
