Care Redesign: A Higher Quality, Lower-Cost Model for Acute Care
a) Which four (4) components does the article point out are needed for the U.S. healthcare system to succeed?
- Clinical integration
- Implementation of technology
- Clinical performance improvement
- Operational efficiencies to manage financial constraints.
- The one recommendation from the ten cited in the Institute of Medicine Report to improve quality and reduce the cost that is described in the article?
The recommendation that is described in the article is optimizing operations by continually improving healthcare operations to reduce waste, streamline care delivery, and focus on activities that improve patient care (Rudisill, Callis, Hardin, Dienemann, & Samuelson, 2014, p. 388). This optimizes professional services in the nursing sector and enables the available staff to deliver quality care to patients despite financial constraints.
- A recent factor to be identified of reducing cost is?
The factor is use of accountable teams and balanced caregiver costs. Through pilot programs in three hospitals, innovative changes in nursing have been attributed to a system of accountability and delegation of roles. Health facilities can reduce costs since the available staff works effectively to deliver care to patients. Reducing costs should not affect the quality of services provided but should patient satisfaction and wellbeing.
- Name four (4) factors that influence patient outcomes described in the article.
The factors that influence patient outcomes described in the article include:
- number of hours per patient-day or number of staff,
- quality of work environment,
- educational level of nurses, and
- a mix of skills among nursing staff.
- Name the four (4) different nursing care delivery models and give a short description of each.
- Patient allocation or total patient care through assigning a group of patients to a nurse without Unlicensed Assistive Personnel (UAPs). The nurse is in charge of the patients’ care during their stay in the health facility. Communication had to be made to registered nurses or licensed practical nurses (LPNs) concerning the patient, and the model is also referred to as relationship-based care.
- Expanding primary care to coordinating care. The registered nurse assumes care as the primary nurse after discharge for readmissions.
- Computer simulation mode. Here the skills of registered nurses (RN), LPN and UAP are utilized to deliver quality care by incorporating lean principles to enhance the roles of each person.
- Shared accountability model- utilized RN-led teams with LPNs and UAPs to promote functioning at full potential. The skill-mix potential of the team is matched to meet the patient’s needs.
- What is the meaning of the term “lean” as described in the article?
Lean is a concept that is adapted from the manufacturing industry used to streamline processes, reduce costs, and improve care delivery (Rudisill, Callis, Hardin, Dienemann, & Samuelson, 2014, p. 389). The concept is used in nursing in that nurse’s skills either add value or eliminate waste (under-utilization). The overall outcome is that the nursing care process adds value. The lean concept is implemented in care redesign and evaluated to ensure the desired changes are achieved.
- Summarize the method utilized in the study to offer higher quality and lower cost method for acute care in just a few sentences.
The method used involved a pilot study done in one medical-surgical unit at each of the three hospital sites in Alabama, Tennessee, and Mississippi (Rudisill, Callis, Hardin, Dienemann, & Samuelson, 2014, p. 390). The administration was involved, and their support and knowledge of lean principles and the purpose of redesigning nursing care were important.
In the first step, the scope of practice was reviewed, and the policies, competencies, and job descriptions for RNs, LPNs, and UAPs revised to ensure the highest level of practice. The job descriptions were also re-evaluated. Secondly, education was developed and provided to LPNs and UAPs to achieve competence in all functions and improve patient safety.
Finally, patient needs were assessed using acuity tools, and nurses’ skills were matched through a personal digital device, which was modified to reduce input while maintaining validity in multiple settings. New processes were adopted in bedside shift reports for all the caregiver of the team. Reviews were done at a minimum of every 4 hours with new acuity assessment, daily patient goals, and expected LOS review, as well as any identified patient safety issues.
Rudisill, P. T., Callis, C., Hardin, S. R., Dienemann, J., & Samuelson, M. (2014). Care Redesign. JONA: The Journal of Nursing Administration, 44(7/8), 388-394.