NR 506 Week 5 Discussion

Sample Answer for NR 506 Week 5 Discussion Included After Question

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.

Week 5: Drivers of High Performance Healthcare Systems

A Sample Answer For the Assignment: NR 506 Week 5 Discussion

Title: NR 506 Week 5 Discussion

 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.

References

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.

Reference

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.

I agree with your comment about staffing being a major factor that affects cost and quality. I know in my hospital we too have a shortage of nurses. The hospital has resorted to hiring a large amount of travel nurses. There have been some units that most days they do not have any core staff members. This issue is costing the hospital in quality of care and cost. The cost of travel nurses is significantly more than staff nurses. This budget increase is going to make the hospital cut cost somewhere else. NR 506 Week 5 Discussion

This cut usually affects the equipment we have available to us or other quality issues. Also, by not having core staff who understands the doctors and the patient population specific to the unit, the quality of the care for patients could also not be the best it could be. This ultimately will reflect in patient satisfaction scores which could also affect insurance and government reimbursements. Having the correct staffing can truly affect every aspect of the hospital system.

Thanks for your reply. Our hospital hired a lot of travel nurses for the holidays to cover for the staff nursing shortage and consequently, we had two sentinel events, the death of two patients. By not up fronting out money for staff nurses, the hospital compromised care and safety of our patients. One of the travel nurses bolus the patient with Levophed that lead to irreversible cardiac arrest. I agree with you that cutting cost compromises the quality of our patient care, and now with have constant visits from government agencies like The Joint Commission and Medicare/Medicaid. 

It is important to have clear data that indicates that staffing is a major issue in error.  One needs to look at error from a system’s perspective using Just Culture rather than individual blame.  I can’t even imagine how awful this error must have been for the travel nurse and the family and unit.  What investigation was done to look into the causes of the error and was one of the findings related to staffing?  

The CNO gave us a handful about having to talk to the family of the deceased patient and I cannot even imagine the family’s shock and emotions. Yes there was an internal investigation that was done. We use what is called an Alaris pump, and all the high alert medications are programed into the pump such as Levophed, and there is a high alert alarm when someone overrides the intended maximum dose. Long story short, the travel nurse gave the patient the whole bag of Levophed at a much faster rate then she should have.

I do feel like the travel RN gets less orientation days than the regular staff nurse and may be she was not ready or proficient in using the Alaris pump, at the same time if she was not ready she should have advocated for herself and asked for more orientation days. The outcome of this was the hospital will give travel RN more orientation days, and hopefully they will be more equip and make less errors. Nevertheless, this horrible incident that no one wanted to happen has taught all of us nurses to slow down, double check high alert medications with another nurse, and give quality care to all patients. 

I hope the travel nurse got support as well.  Have you or anyone heard of the case that happened in Seattle in which a nurse was fired after a baby died due to a error and she committed suicide?  We are all human and can expect to make an error, which is why systems are put into place to catch errors.  Did the nurse override the intended maximum dose and ignore the alarm?

http://www.nbcnews.com/id/43529641/ns/health-health_care/t/nurses-suicide-highlights-twin-tragedies-medical-errors#.Wr53T9PwbjA (Links to an external site.)

Reading your response I agree with you, utilizing the Just culture algorhythm is an appropriate approach to deal with something like this.  I have used this tool before and it really helps to decide which route is best take when dealing with the situation.  It can help separate repeat offenders or continued at risk behaviors from innocent wrong doing most likely due to the systems and processes in place needing to be evaluated.  

I can say with certainty that the travelers who work in my organization do not get very much orientation to the unit they’re working in.  When someone is coming to help cover staffing for only 6-13 weeks not very much time can be utilized for orientation.  It does make me consider the fact that maybe the 2 to maybe 3 shifts that an traveler gets may not be sufficient, very hard to know what is best.  Although, this could definitely happen to anyone, traveler or not, especially in times of being rushed and understaffed.  I have seen unfortunate outcomes happen to the best and most experienced nurses I have worked with. It’s very humbling and reminds me of how important it is to be vigilant to provide high quality of care to my patients. 

It sounds like you and I could relate well to each other in regards to our work life.  As a critical care nurse I know all too well the nursing shortage we face in working in a closed unit.  Our organization has cross trained about three of our float pool nurses in order to help staffing in CCU when able.  Working in a unit that has such high turnover can be very difficult.  Quality of care suffers when staffing is not adequate.  We have 4 travelers our unit currently which is the most we have ever had.  I have to wonder if utilizing travel staff can also have negative effects on quality in our unit.  

I found your comments on having enough qualified PCP’s available for the number of people now having health insurance very interesting.  I have the same concerns.  When times are tough and people are being spread too thin I feel like as long as someone has the right degree behind their name they are hired for the job even if they aren’t the most qualified.  These are the instances I believe you are talking about when quality of care may be at risk. 

    I completely agree with your discussion concerning the importance of quality and cost in a healthcare system.  I also chose those two factors for the topic of my discussion.  One of the United States developmental goals is to ensure healthy lives and promote well-being through quality healthcare (Kruk, Kelly, & Syed, 2017). Studies show that examining variations in quality healthcare allows healthcare professionals methods to diagnose drivers of performance (Kruk, Kelly, & Syed, 2017).

Thursday, I spent all day in the emergency room with my grandfather that was experiencing blood pressures as high as 240/120.  According to Debt.org, the average cost of an emergency room visit is over two thousand dollars and the average wait time is over two hours for admission (Debt.org, 2017).  With that statistic at thought, a person would expect good quality.  However, that was not the case.  As a nurse and family member, I was very disappointed in the quality of care and as a consumer, I would not visit that facility again.  I was able to diagnose drivers of performance that impacted my healthcare experience.

Debt.org. (2017).  Emergency room vs. urgent care centers.  Retrieved from https://www (Links to an external site.).

            debt.org.

Kruk, M., Kelly, E., Syed, B. (2017).  Measuring quality of health-care services: What

            is known and where are the gaps?  Bulletin of the World Health Organization (95),

            6, 389-390.