How Business Practices, Regulatory Requirements, and Reimbursement Impact Patient-Centered Care Within A Healthcare Organization
PART 1: Analyze How Business Practices, Regulatory Requirements, and Reimbursement Impact Patient-Centered Care Within A Healthcare Organization.
Healthcare has been a very intricate business. Increased competitions, advancement in technology, shortage in health caregivers, and changes in reimbursement forms have caused the provision of care complex, full of errors and dysfunction. This has been caused by an increase in regulatory requirements, systems functioning in the outdated arrangement, and complex payment processes (Calhoun et al., 2008). Within such complex arrangements, there is lack of focus on the patient which is a significant aspect to consumers of the services offered, which lead to unmet needs.
Patient-centered considered improved care process and healthcare outcomes. A hospital system that is directed by patient and families needs tends to become more relevant. Patient-centered care aggressively connects with all stakeholders and is directed toward low total expenditures. There is consideration of waste reduction through few process delays, maximization of patient education efforts and decreased referrals and diagnostic tests. Patient-centered care approach has well improved the aspect of employee satisfaction and retention. Efficient care systems are capable of reducing employee burnout, improved staff relations and enhanced patient-caretaker communication (Nembhard & Edmondson, 2006).
While healthcare system continues focusing on reimbursement and technology to ensure that there is sustained operations, the patient-centered organization must focus on the provision of care for the patients. In addition, with focus on healthcare quality, service and service delivery process has been compromised. To deal with such changes and refocus on care for individual patients, patient-centered care has set initiatives to institute and balance the aspect of the business, quality, technology, financial models, and supportive reimbursement with service excellence and care delivery. In achieving such goals, service superiority constituents must be moved at the vanguard of developing a culture to place patient first (Reeves, Macmillan & Van Soeren, 2010).
Part B.
| Domain | Element | Low High | Do not know | ||||
| Leadership / Operations
|
Clear statement of commitment to PFCC and PF partnerships | 1 | 2 | 3 | 4 | 5 | |
| Explicit expectation, accountability, measurement of PFCC | 1 | 2 | 3 | 4 | 5 | ||
| PF inclusion in policy, procedure, program, guideline development, Governing Board activities | 1 | 2 | 3 | 4 | 5 | ||
| Mission, Vision, Values | PFCC included in mission, vision, and/or core values | 1 | 2 | 3 | 4 | 5 | |
| PF-friendly Patient Bill of Rights and Responsibilities | 1 | 2 | 3 | 4 | 5 | ||
| Advisors | PF serve on hospital committees | 1 | 2 | 3 | 4 | 5 | |
| PF participate in quality and safety rounds | 1 | 2 | 3 | 4 | 5 | ||
| Patient and family advisory councils | 1 | 2 | 3 | 4 | 5 | ||
| Quality Improvement | PF voice informs strategic/operational aims/goals | 1 | 2 | 3 | 4 | 5 | |
| PF active participants on task forces, QI teams | 1 | 2 | 3 | 4 | 5 | ||
| PF interviewed as part of walk-rounds | 1 | 2 | 3 | 4 | 5 | ||
| PF participate in quality, safety, and risk meetings | 1 | 2 | 3 | 4 | 5 | ||
| PF part of team attending IHI, NPSF, and other meetings | 1 | 2 | 3 | 4 | 5 | ||
| Personnel | Expectation for collaboration with PF in job descriptions and PAS | 1 | 2 | 3 | 4 | 5 | |
| PF participate on interview teams, search committees | 1 | 2 | 3 | 4 | 5 | ||
| PF welcome new staff at new employee orientation | 1 | 2 | 3 | 4 | 5 | ||
| Staff/physicians prepared for and supported in PFCC practice | 1 | 2 | 3 | 4 | 5 | ||
| Environment and Design | PF participate fully in all clinical design projects | 1 | 2 | 3 | 4 | 5 | |
| Environment supports patient and family presence and participation as well as interdisciplinary collaboration | 1 | 2 | 3 | 4 | 5 | ||
| Domain | Element | Low High | Do not know | ||||
| Information / Education | Web portals provide specific resources for PF | 1 | 2 | 3 | 4 | 5 | |
| Clinician email access from PF is encouraged and safe | 1 | 2 | 3 | 4 | 5 | ||
| PF serve as educators/faculty for clinicians and other staff | 1 | 2 | 3 | 4 | 5 | ||
| PF access to/encouraged to use resource rooms | 1 | 2 | 3 | 4 | 5 | ||
| Diversity and Disparities | Careful collection and measurement by race, ethnicity, language | 1 | 2 | 3 | 4 | 5 | |
| PF provided timely access to interpreter services | 1 | 2 | 3 | 4 | 5 | ||
| Navigator programs for minority and underserved patients | 1 | 2 | 3 | 4 | 5 | ||
| Educational materials at appropriate literacy levels | 1 | 2 | 3 | 4 | 5 | ||
| Charting and Documentation | PF have full and easy access to paper/electronic record | 1 | 2 | 3 | 4 | 5 | |
| Patient and family are able to chart | 1 | 2 | 3 | 4 | 5 | ||
| Care Support | Families members of care team, not visitors, with 24/7 access | 1 | 2 | 3 | 4 | 5 | |
| Families can stay, join in rounds and change of shift report | 1 | 2 | 3 | 4 | 5 | ||
| PF find support, disclosure, apology with error and harm | 1 | 2 | 3 | 4 | 5 | ||
| Family presence allowed/supported during rescue events | 1 | 2 | 3 | 4 | 5 | ||
| PF are able to activate rapid response systems | 1 | 2 | 3 | 4 | 5 | ||
| Patients receive updated medication history at each visit | 1 | 2 | 3 | 4 | 5 | ||
| Care | PF engage with clinicians in collaborative goal setting | 1 | 2 | 3 | 4 | 5 | |
| PF listened to, respected, treated as partners in care | 1 | 2 | 3 | 4 | 5 | ||
| Actively involve families in care planning and transitions | 1 | 2 | 3 | 4 | 5 | ||
| Pain is respectively managed in partnership with patient and family | 1 | 2 | 3 | 4 | 5 | ||
Peterson Center on Healthcare
This healthcare facility is operated as a not-for-profit making organization which is motivated toward delivering high quality, affordable healthcare which is a certainty for Americans. Peterson Center works toward the transformation of the US healthcare to a high-performing system through innovative solutions that improve an aspect of quality, low costs, and speed up the implementation process of nationwide size. The hospital was established by Peter G. Peterson Foundation. The center partner with other stakeholders in the healthcare system and connect in research, collaboration, and grant-making (Calhoun et al., 2008).
Strength and Weaknesses of the Organization
Weaknesses
An expensive healthcare system delivering poor outcomes has been threatening the organization health delivery and weakened the operations. In fact, the US healthcare system is considered as the most expensive in the entire world. Despite this, the American healthcare outcomes are worse than any other. Patients have endured avoidable, unproductive and harmful treatments which have lowered the quality of lives (Kaplan et al., 2010).
Strength
The strength of the organization is that it has a mission of transforming the US healthcare to high performing systems. This is enhanced through excellent proved solutions directed toward improved care quality, low cost, and acceleration of national scale adoption.
Part C: One Area of Improvement
The organization needs to pursue performance improvement initiatives to ensure that there are improved patient experiences, improved clinical outcomes and reduced organization costs. To achieve patient-centered care, the organization needs to develop and design systems, programs, and processes. Such changes are well implemented through major organization shift in culture. These would require strong commitment toward organization leadership process, mission, and vision, willingness to develop and improve ways to address the goals of advancing patient experience. The organization must invest in improving patient experience and taking strategic and operational initiatives (Reeves, Macmillan & Van Soeren, 2010).
A clear method of achieving this strategy has to do with the implementation of patient-centered care values. In addition, the organization must be focused on value, interpersonal relationships, consumer choices, patient experiences, and ensure there is relevant communication. As well, there is the need to have more patients involved in the decision-making process, produce outstanding outcomes and increase satisfaction levels. Patient must be involved in their care and engage in care delivery processes (Kaplan et al., 2010).
Healthcare tends to be a complex process. To develop a patient-centered care, there is the need to come up with an adaptive system where relationships and interactions of the diverse component would be concurrently impacted and shape the system. With this being the case, it is crucial for an organization to create strategies toward integration of healthcare objectives. Patient experience needs to be improved and must be connected with new services, new processes, environmental designs, and special amenities. A consistent process to improve patient-centered care must ensure that there is reliable care, personalized and steadfast care for the patients, which account for nursing care process (McCallin, 2003).
Healthcare data methodical will be required to ensure that there is sustainable performance improvement project. This would entail the foundation of informing and making decisions. Healthcare organization tends to have mountain of claims, clinical, operational, financial and patient experience. The analytical system will as well require scaling over time to allow the diverse level of healthcare analytics ((Nembhard & Edmondson, 2006).
Part D: A Multidisciplinary Team
A multidisciplinary team would involve a range of healthcare professionals where they would be required to work as a team and deliver wide-ranging patient care. The ideal multidisciplinary team for delivery of patient-centered care would include general practitioners, community health nurses, practice nurses and health educators (Nembhard & Edmondson, 2006). General practitioners would have a role in treating all common medical conditions and referring the patients to hospitals as well as other medical services in case of special and urgent treatments. They would focus much on patient health with a combination of psychological, social and physical features of care.
On the other hand, practicing nurses would work with a plan to offer nursing care, health education, and treatment to patients of all ages. Practice nurses would work as a professional team consisting of staffs such as therapists, doctors and health visitors (Kaplan et al., 2010). Public health nurses would work to deliver clinical services like well-baby care, immunizations, school health visits and senior home visits. As well, they would work in a team with an aim of monitoring community health risk factors and trends. They would assist communities in setting local health priorities, implementing and designing health education programs directed toward lowering health risks (Calhoun et al., 2008).
A crucial concept for delivery of healthcare services accounts for ways of treating all individuals patient as unique. The main goal of patient-centered care is the provision of individualized care and restoring prominence on personal relationships to improve the quality of care. A team that is culturally diverse would ensure that there is continuous development of goals to increase health care quality as well as reduction of inequality by contemplating people of all color and the less-privileged populations (Nembhard & Edmondson, 2006).
Crucial evolutionary strength that would transform the healthcare is a shift in the leadership and management in nursing. Utilization of transformational leadership skills would be a catalyst for the expansion of holistic outlook that would empower the nursing team at all levels. As well, technology would be maximized to ensure organization move beyond patient-centered to patient-directed health care outcomes (Reeves, Macmillan & Van Soeren, 2010).
Teamwork
Teamwork in healthcare would employ the process of collaboration as well as enhanced communication directed toward expansion of traditional roles for the healthcare workers and making the decision to solve issues with common goals. The team would work better in case there are clear purposes and implement procedures and protocols. In addition, use of communication and meeting methods to address the issue is relevant. In this case, information would be shared with debate discussion directed toward improving performance. Teamwork and collaboration would be crucial for patient care within a decentralized health system with various healthcare workers (Calhoun et al., 2008).
Role of the Team
The multidisciplinary team will be created with an aim of solving healthcare issues. A successful healthcare team would be dedicated to communication by understanding patient situations, asking questions about a challenge, making initial assessments and after a discussion making a recommendation (Nembhard & Edmondson, 2006).
Finally, supervisor and team lead assessment tool may be used in comparing skills as to those of supervisors or team. Research and operation team may use this tool in assessing and discussing current practices and identifying specific areas that need to be more effective.
References:
Calhoun, J. G., Dollett, L., Sinioris, M. E., Wainio, J. A., Butler, P. W., Griffith, J. R., & Warden, G. L. (2008). Development of an interprofessional competency model for healthcare leadership. Journal of Healthcare Management, 53(6), 375.
McCallin, A. (2003). Interdisciplinary team leadership: a revisionist approach for an old problem?. Journal of Nursing Management, 11(6), 364-370.
Nembhard, I. M., & Edmondson, A. C. (2006). Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior, 27(7), 941-966.https://www.researchgate.net/publication/227521893_Making_It_Safe_The_Effects_of_Leader_Inclusiveness_and_Professional_Status_on_Psychological_Safety_and_Improvement_Efforts_in_Health_Care_Teams
Reeves, S., Macmillan, K., & Van Soeren, M. (2010). Leadership of interprofessional health and social care teams: a socio‐historical analysis. Journal of nursing management, 18(3), 258-264.
Kaplan, H. C., Brady, P. W., Dritz, M. C., Hooper, D. K., Linam, W., Froehle, C. M., & Margolis, P. (2010). The influence of context on quality improvement success in health care: a systematic review of the literature. The Milbank quarterly, 88(4), 500-559.
