Designing your health benefit plan

A health care benefit plan should meet the needs and expectations of your organization and its insureds. Each organization is unique, so a health care benefit plan shouldn't be "off the shelf" but be uniquely tailored for your organization. Analyze current demographic, utilization and other data to determine which services members and their families are using and what type of services may be needed in the future.     

Staffing for end of life: challenges and opportunities

What would staffing look like if we committed to end-of-life experiences that were designed to honor the needs of the person dying, their loved ones, and the needs of the nurses and care team involved in the dying experience? When we think about the experience of death in a health care setting, it is essential we look at the needs of both patients and caregivers. Attending to the needs of patients and their families facing death, even if well defined, can be difficult to design into staffing plans and budgets in a way that would not put an organization at further financial risk. If we are going to commit to staffing practices that honor dying, in all it's dimensions and for all who are potentially impacted, we will most likely have to step outside traditional thinking to find answers.     

Patient as center of the health care universe: a closer look at patient-centered care

We need to consider how the health care system should revolve around the patient, rather than the patient rotating around the hospital. Considering a patient-centric point of view when implementing and optimizing the use of health information technology (HIT) provides new perspectives on the meaning of "integrated" health care. ot only do we need to give patients the opportunities to participate as true partners in their health care, we must convince them why this partnership makes sense. We should not be naive and believe all patients want this involvement in their care today and are ready to do all their health care transactions electronically. But considering and using these practices are important steps in the health care reform journey to improve quality and decrease cost. Many patients will benefit by our working with them to demystify the health care experience through patient-centric practices and the use of HIT.     

Courage, leadership, and end-of-life care: when courage counts

As leaders, we must feel a sense of moral obligation to implement evidence about end-of-life care in our practice setting. Nurse leaders can help patients and families orchestrate a beautiful experience that is an alternative to futile, expensive end-of-life care. Preparation is key in helping staff provide the best level of care. A plan built around the best care for patients can integrate with many diverse positions and people. Courageous nurse leaders are well adapted to maneuvering through political traps and advocating for patients and their families. Everyone benefits personally and financially, including our communities and nation, when courageous leaders advocate successfully for effective end-of-life care.     

The nursing informatics workforce: who are they and what do they do?

Nursing informatics has evolved into an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care. New nursing informatics workforce data reveal changing dynamics in clinical experience, job responsibilities, applications, barriers to success, information, and compensation and benefits. In addition to the more traditional informatics nurse role, a new position has begun to emerge in the health care C-suite with the introduction of the chief nursing informatics officer (CNIO). The CNIO is the senior informatics nurse guiding the implementation and optimization of HIT systems for an organization. With their fused clinical and informatics background, informatics nurses and CNIOs are uniquely positioned to help with "meaningful use" initiatives which are so important to changing the face of health care in the United States.     

The transparent organization: leadership in an open organization

The impersonal approach to health care leadership is over. Specialization, hierarchies, and impersonal decisions have led the public to distrust health care organizations. The charges of unnecessary cardiac surgery and abuses led the public to question our integrity. Annison and Wilford (1998) note that the character of a person and the character of an organization lead one to trust or distrust. They note that openness is one of the most important characteristics upon which we judge the character of a person or an organization. As the operating framework of partnerships and transparency becomes one that our staff and patients expect, our ability to handle openness will be an important way in which we are judged.     

The AACN Synergy Model for Patient Care: a nursing model as a Force of Magnetism

One of the 14 Forces of Magnetism requires a health care organization to have a professional model of care. The eligibility requirements stipulate that this model must be utilized throughout the health care system and that the same philosophy must be used throughout the system. The American Association of Critical-Care Nurses Synergy Model for Patient Care describes nursing practice based on eight patient characteristics, and also describes eight nurse competencies. The core concept of the model is that the needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses. Synergy results when the needs and characteristics of a patient, clinical unit, or system are matched with a nurse's competencies. The synergy model is an excellent framework to organize the work of patient care throughout the health care system. It can be used and applied in various ways and provides a comprehensive framework for assuring success in building a philosophy that supports the Forces of Magnetism.     

Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance

Many doctors in developing countries provide considerably lower quality care to their patients than they have been trained to provide. The gap between best possible practice and actual performance (often referred to as the know-do gap) is difficult to measure among doctors who differ in levels of training and experience and who face very different types of patients. We exploit the Hawthorne effect-in which doctors change their behavior when a researcher comes to observe their practices-to measure the gap between best and actual performance. We analyze this gap for a sample of doctors and also examine the impact of the organization for which doctors work on their performance. We find that some organizations succeed in motivating doctors to work at levels of performance that are close to their best possible practice. This paper adds to recent evidence that motivation can be as important to health care quality as training and knowledge.     

Technicity in nursing and the dispensation of thinking

While technology and health care delivery are inextricably and increasingly intertwined and technology has driven major advances in quality and efficiency in health care, technology does not replace the need for a thinking human being in care delivery. The term "technicity" refers to the tension created by the ability of humans to think versus their risk of being exploited as objects subservient to technologies. Drawing upon the philosophical works of Thoreau, Heidegger, and others, the authors pause on the conundrum created by expanding technology with the assumption that technological "improvements" should be evaluated with caution. Health care information systems are an example of tools that have improved our ability to collect and store information, but when systems "go down," staff can be rendered helpless. Similarly, technology can impose personal distance between the patient and provider in instances where staff are positioned as a mechanism for collecting data rather than a person interacting with another person. In some cases, health care providers function as navigators helping patients reach the correct pharmaceutical, rather than as teachers helping patients seek better health. Lastly, the tendency toward systems analysis in the context of the complex hospital environment leads solely toward uniform solutions rather than instances where a customized solution is warranted.     

Complex home care: Part I--Utilization and costs to families for health care services each year

As many as 120 persons per million people in the United States are dependent on the lifelong, complex, technology-based care of home parenteral nutrition (HPN) infusions. However, data for costs paid by families for HPN-related health care services and for non-reimbursed expenditures are rarely tabulated and most often underestimated. The goals of this study were to describe health care services used by families to manage HPN, report the frequency of each service used annually, and estimate the average annual non-reimbursed costs to families for these health services. The numerous and varied types of services reported and the time required to coordinate and access HPN services illustrates the challenges faced by patients and their family caregivers. The lack of a coordinated and efficient system for delivering complex chronic care results in poorer outcomes for HPN patients and their families on-reimbursed costs and the extensive amount of time required to coordinate multi-professional services negatively impacts the clinical outcomes and quality of life of complex chronic home care.     

Quality in life and death: can we have the conversations?

As nurses, we participate in providing social justice through the delivery of health care. While much of what we do supports healthier lifestyles and healing, we must also acknowledge that for an increasing number of our patients, life may have become irreversibly painful and unwanted. Nurses have acute sensitivity to the dilemmas faced by dying patients and their families. Our empathy and know-how in such cases dictates that we make an effort to relieve such suffering. Easing suffering will require assessments of the changing terrain of end-of-life care and the populations receiving that care. Dialogues can bridge the interest of patients, providers, and policymakers and ultimately legislation that reinforces ethical end-of-life care and ensures a voice for those who will be most affected.     

'The environment matters' and 'designing toward the whole'

A nurse/health care executive/architecture specialist and an artist/designer offer insights to creating environments that effectively support the delivery of care, the wellbeing of patients and their families, and the well-being of the health care workforce. The care environment is more than bricks, mortar, doors, windows, walls, and flooring. It is a sanctuary where healing can take place, where the spirit can be released, and where the provision of care, often fairly intimate, can happen through the connection between patient and care providers. Evidence-based design has brought forth the kind of inquiry and solutions that begin to address what an environment for healing requires. The interaction of built environment, staff, patients, families, and doctors is an overlapping ebb and flow that relies at its heart on the ability to hold all the parts as having equal priority.     

The effect of workforce issues on patient safety

The workforce of any health care organization is vital to its continued survival, but a highly competent and committed workforce is vital to its success. The evidence is clear: employees influence not only the financial performance of the organization, but also the safety and quality of the clinical care provided to patients. Health care organizations must understand these important linkages and have in place corporate strategies to manage workforce issues with a systems focus that ensures excellent leadership and operational processes, a healthy culture, and optimum patient outcomes. New levels of knowledge, resources, and implementation are needed to move health care in the United States to the next level of quality performance. Staff satisfaction and retention should be at the heart of the clinical improvement strategies. Such an approach will allow organizations to cope and thrive in an environment of workforce shortages and increasing consumer demand for quality. To quote Robert Waller, MD, of the Mayo Clinic, "The goal is the best care for every patient, every day. Our patients deserve nothing less.     

A nurse-run business to improve health care for nursing home residents

The costs of health care for the rapidly growing segment of our population over age 75 are staggering. EverCare is a nurse-run business that seeks to improve cost-effectiveness and quality of health care for nursing home residents enrolled in a health maintenance organization.     

Engaging patients and families in ehealth

National Health IT Week, which ran from September 11-16, 2011, served as a time to highlight the importance of efficient information systems that protect the privacy and security of personal health information while improving the delivery of health care in the United States. During the week, the health IT community came together to raise national awareness regarding the consistent breakthroughs and hard work industry professionals, providers, and consumers have put forward to ensure they are moving toward the common goal of advancing the future of health care through private and secure health IT. Two events during the week (the Consumer Health IT Summit and the launch of the HealthlT.gov web site) brought home a theme increasingly seen as important to improving our health care system--patients participation in their care. Nurses will need to work with patients so they understand the importance of their participation as a partner in their care, instead of playing a passive role. One way we can do that is to encourage our patients to actively use technology to manage their own health care and to share information with their health care providers.     

Complex home care: Part 2- family annual income, insurance premium, and out-of-pocket expenses

Annual costs paid by families for intravenous infusion of home parenteral nutrition (HPN) health insurance premiums, deductibles, co-payments for health services, and the wide range of out-of-pocket home health care expenses are significant. The costs of managing complex chronic care at home cannot be completely understood until all out-of-pocket costs have been defined, described, and tabulated. Non-reimbursed and out-of-pocket costs paid by families over years for complex chronic care negatively impact the financial stability of families. National health care reform must take into account the long-term financial burdens of families caring for those with complex home care. Any changes that may increase the out-of-pocket costs or health insurance costs to these families can also have a negative long-term impact on society when greater numbers of patients declare bankruptcy or qualify for medical disability.     

Improving the patient experience with information technology

It has been proven in many different studies that information technology solutions can improve information transfer, workflow, and communication, resulting in marked improvements in patient safety and overall quality of care. However, equally important but not often emphasized is the potential for information technology to improve the patient experience by making a positive impact on the care that matters most to patients and their families.     

Streamlining regulatory compliance through clinical systems

The Joint Commission states that its mission is "to continuously improve the safety and quality of care provided to the public through the provision of healthcare accreditation and related services that support performance improvement in healthcare organizations.... Accreditation is a risk-reduction activity; compliance with standards is intended to reduce the risk of adverse outcomes" (JCAHO, 2003). The focus of JCAHO is not much different from that of every health care organization. Clinical information systems should be employed to help deliver safer, more efficient patient care, and at the same time ensure that health care organizations achieve regulatory compliance.     

Governing for improved quality and patient safety

Board members have a critical oversight role to play in monitoring and providing direction to improve health care quality and safety. In the emerging environment of health care reform, the board's role in overseeing quality and safety on behalf of stakeholders will become as or even more important than its financial oversight role. Nurses can expand their impact by joining the ranks of health care organization governing boards to lead and guide the entire health care enterprise to realize the goal of improved care and outcomes for all patients.     

‘Medical altruism in mainstream health economics: theoretical and political paradoxes’ comments

In this article, which was published in the September 2014 issue of the Review, Batifoulier and Da Silva examine the role of medical altruism in health economics. They argue that abandoning homo economicus and the mainstream practice of incorporating patient well-being in the doctor’s utility function in order to explain the clinical behavior of doctors and switching from profit maximization to medical altruism both lead to a dead end. We agree but the authors leave us with no way out. We argue instead that the doctor’s clinical behavior whether expressed in terms of utility or altruism is not a fit subject for economics. The way out is to restrict economics to health care issues with financial dimensions. In their article, Batifoulier and Da Silva bring their French experience to the table. We bring to the table our American experience with more than 40 years of hands-on care for patients along with the experiences of four other physicians in our extended family. The specialties include intensive care pediatrics, emergency medicine, intensive-care pulmonary medicine, dermatology, and otolaryngology. Our premise in responding to Batifoulier and Da Silva is that apart from payment for services rendered, there probably are no serious differences in the actual practice of medicine in France compared to the United States. And even if there are such differences, they are matters to be taken up by medicine not economics.