Evolution in Healthcare Practice and Patient Care
Write an informal presentation (500-700 words) to educate nurses about how the practice of nursing is expected to grow and change. Include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics.
Share your presentation with nurse colleagues on your unit or department and ask them to offer their impressions of the anticipated changes to health care delivery and the new role of nurses in hospital settings, communities, clinics, and medical homes.
In 800-1,000 words summarize the feedback shared by three nurse colleagues and discuss whether their impressions are consistent with what you have researched about health reform.
Evolution in Healthcare Practice and Patient Care
The healthcare delivery system in the US significantly contributes to the welfare of the society and has continued to change based on technology and new care models. A key projection is that nursing jobs and roles will continue to increase while less will be in the acute care hospital. This will be related to the quality of primary care and more focus on preventative measures (Vogenberg & Santilli, 2018). The rise in the number of nursing roles will be aimed at sufficing the steady increase in medical facilities and in particular those providing primary care. Besides these changes, other concepts and realms that will contribute to transformation in this sector include continuum of care, Accountable Care Organizations (ACOs), Nurse-Managed Health Clinics (NMHCs), and medical homes.
Healthcare Growth and Change
Changes in the US healthcare delivery system are aimed at enhancing the future of care and establishing a smart and sustainable healthy community. Leaders are developing profound management approaches that will foster collaboration among different stakeholders within and out of the healthcare ecosystem. The present trends, as noted in the Deloitte (2018) report, shifts towards a financial model that is founded on value but not volume. The fundamental goal in these new models is to ensure people are healthy and few are within the hospital. These efforts are further aimed at altering the fee-for-service approach which targets more patients for revenue. Instead, the new model considers people as members and focus on promoting loyalty, building a strong reputation, and improve the nation’s health. Other major changes that will inform 2019 healthcare dynamism will include health plans and health systems collaboration, shift from illness to wellness, adopt new and improved technologies, increase virtual care options, and focus more on community health.
Continuum of Care
In line with the focus on illness and community health, the continuum of care concept which entails a system guiding and tracking patients through various health services is another transformation that will promote the safety and quality of patient care from birth till death. According to HIMSS, services in care continuity include acute hospital care, extended care, ambulatory care, outreach, housing, wellness, and home care (Woo, Lee, & San Tam, 2017). Notably, the patient is provided with continuous care even when switching between care institutions and caregivers.
Accountable Care Organizations
Collaboration to deliver quality care is another core evolution. The Accountable Care Organizations approach entails a team of medical providers such as doctors and nurses who work with various hospitals to ensure the quality of care (Barry & Edgman-Levitan, 2012). The objective of ACOs is to provide coordinated and quality care which in turn keeps one away from expensive treatments and tests that are not needed. In addition, patient safety is achieved since teamwork avoids mistakes. Essentially, ACOs are more beneficial to people with chronic illnesses including cardiovascular illnesses and diabetes.
Nurse-Managed Health Clinics
The ability to meet the healthcare needs of the increasing American population faces a major setback since primary care providers are insufficient to meet the escalating demand. As a result, Nurse Managed Health Clinics or Centers are considered an effective model that will expand the access to quality primary care. NMHCs are community-based healthcare units providing primary services and are under the management of an advanced nursing practitioner. Notably, these units emphasize on disease prevention, health promotion, and awareness. Despite the rise in NMHCs, they still face two main setbacks which impede their effectiveness. These include the laxity in credentialing advanced nursing practitioners to execute all their knowledge and services and opposition from physicians who also provides a hostile working environment (Institute of Medicine, 2017). These challenges will, therefore, have to be addressed to realize the effectiveness of NMHCs.
Consistent with the patient-centered care approach are medical homes which aim at providing primary and quality care to patients. Medical homes focus on team-based, comprehensive, coordinated, accessible, and enhanced safety and quality. The model has gained popularity, and when effectively organized and executed, significant changes are noticed and healthcare goals achieved (Reuben & Tinetti, 2012). The philosophy underpinning medical homes encourages healthcare providers to meet patients and provide care that is in line with the individual factors including the condition, race, background, and cultural beliefs. In addition, dignity, compassion, and respect are factored in the care which promotes the collaboration between the healthcare provider and the patient.
Response from Nursing Colleagues
Drawing from different responses by nurses, it is apparent that the majority are conversant with the changes in the health sector and agree that they are the foundation of enhanced quality and safety of care. A key aspect that all nurses concurred is that technology is the foundation of transformations in the healthcare sector from the management to diagnoses and surgery. One nurse specifically pointed out the Electronic Medical Recording (EMR) and the use of robotics to perform surgeries. These advancements have significantly reduced the morbidity and mortality associated with health challenges and in particular the chronic illnesses. The management and leadership of healthcare are changing, and the adoption of transformation and team-based approaches is a critical element that the nurses noted to have changed the health care sector. According to Barry and Edgman-Levitan (2012), the quality of leadership in a healthcare organization is an essential aspect in ensuring effectiveness and safety of the healthcare services where more focus is on enhancing the welfare of the community rather than making a profit.
The adoption of person-centered care approaches in medical homes and ACOs is the foundation of promoting the safety and quality of care. One nurse advocated for more ACOs to meet the escalating demand of primary care and the increasing patient population. However, she stated that it is imperative for the Congress in collaboration with other stakeholders to develop policies that remove barriers to advanced nursing practitioners to execute their services in full. While citing the physician collaboration authority issues where the nurse must seek consent from the physician, this nurse noted that the effectiveness of ACOs would continue to face setbacks since there is no supportive environment for nursing practitioners to comprehensively execute their roles and responsibilities according to their Scope of Practice and education. Indeed, there is a need to empower advanced nursing practitioners to fully practice their independence according to the credentialing, education, and experience (Institute of Medicine, 2017).
All the three nurses concurred on the model shifts in the current healthcare practice where more focus is on value rather than volume. One nurse in his response stated, “There are no signs of the healthcare industry slowing down thus it is important for the country to emphasize on technology, innovation, and profound management.” Notably, the nurse was referring to the increase in the global need for quality healthcare that will improve the growing and aging populations, reduce the significance of chronic illnesses, and develop advanced technologies that will cut the expenditure and costly systems (Stokowski, 2010). In response to these endeavors, another nurse noted that stakeholders in the healthcare sector are still struggling to manage the financial, clinical, and operational challenges where new healthcare delivery models and digital technologies will effectively address these issues and build a foundation for quality, accessible and affordable healthcare that is also sustainable. All nurses affirmed that it is time for the healthcare delivery system to shift focus from patient-oriented services to considering the sick as members.
In another response, the nurses agreed to the importance of continuum care but added that it cannot be achieved without technology. This allows the patient information to be accessed across different medical units and among healthcare providers. This introduces the importance of collaborative and team-based healthcare practice. According to Naylor, Aiken, Kurtzman, Olds, and Hirschman (2011), the importance of continuum of care is reflected among chronically ill patients. The merits of this approach is that it results to the enhancing the patient and medical provider’s satisfaction, reduces healthcare costs, and promotes the quality and safety of care. To contribute to the discussion, one nurse noted that the family doctor is the coordinating and primary caregiver who receives and mediates additional treatment while maintaining care over time. However, it is imperative to have advanced information systems characterized by computer technologies to also for collection, storage, and transfer of data between medical facilities and healthcare provider. Another factor that was featured in the response is the importance of medical homes in primary care delivery. All nurses demonstrated an understanding of this care approach and its features including patient-centered, comprehensive, coordinated, accessible, and committed to safety and quality.
Based on the nurses’ responses, it is evident that they are aware of the evolution in the healthcare sector and the importance of different healthcare models including medical homes, NMHCs, ACOs, and continuity in care. Other details gathered from their responses is that more emphasis should be placed on improving community awareness regarding these transformations. This will prompt their participation and establish the specific needs to factor in future changes. Another important revelation is that nurses should be engaged in life-long learning. This is in response to changing healthcare systems and delivery models which include technology. Life-long learning will ensure that these nurses are conversant with the transformations in healthcare and will reduce risks such as resistance to change. Another emphasis by the nurses was on nurses being equipped with diverse skills and competencies. These include interpersonal, communication, and leadership (Reuben & Tinetti, 2018). This will play a core role in the implementation of ACOs, continuum of care, and NMHCs. Besides, the foundation of delivering quality and safe care is a profound collaboration between the healthcare provider and the patient (Vogenberg & Santilli, 2018). In line with philosophies such as person-centered care and financial models, these skills and competencies are important in promoting interaction among different stakeholders.
In summary, the healthcare delivery system is not only changing, but also improving to ensure quality and safety practice. Through the adoption of models and philosophies including patient care and financial, the fundamental shift in healthcare practice has been from volume to value-based. The key objective of these changes is to keep the community healthy and from hospitals. Current and future changes will be characterized by collaboration between health plans and systems, shift from illness to wellness, adoption of technologically advanced systems, increasing virtual care options, and focusing on population health. Drawing from the nurses’ responses, it is evident that these changes are popular and are supported by medical providers. However, it is imperative to enhance community awareness while for the nurses, life long learning is essential in promoting their competencies.
Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making—the pinnacle of patient-centered care. New England Journal of Medicine, 366(9), 780-781.
Deloitte (2018). 2019 US and Global Health Care Industry Outlook. Shaping the Future of Health Trends. Retrieved January 29, 2019 from https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/us-and-global-health-care-industry-trends-outlook.html#
Institute of Medicine (2017). The Future of Nursing. Leading Change, Advancing Health. Report Recommendations. Retrieved January 29, 2019, from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf
Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The importance of transitional care in achieving health reform. Health Affairs, 30(4), 746-754.
Reuben, D. B., & Tinetti, M. E. (2012). Goal-oriented patient care—an alternative health outcomes paradigm. New England Journal of Medicine, 366(9), 777-779.
Stokowski, L. (2010). Healthcare reform and nurses: challenges and opportunities. Retrieved from https://www.medscape.com/viewarticle/721049
Vogenberg, F. R., & Santilli, J. (2018). Healthcare Trends for 2018. American health & drug benefits, 11(1), 48.