Week 5 Drivers of High-Performance Healthcare Systems

Week 5 Drivers of High-Performance Healthcare Systems In this country, health care reform continues to grow, but we have seen confusion about what high performance healthcare system composed of. Because of innovation in healthcare quality and advancing high performance in healthcare, American Medical Group Association (AMGA) took the stand to be the leader to educate legislators, public and issuers regarding the unique qualities of this system and to help healthcare organizations to improve their patient care (Wylie, Crilly, Toloo, Fitzgerald, Burke, Williams & Bell, 2015). According to Wylie et al., (2015), high-performing healthcare system is defined as an entity that provides efficient provision of services, organized system of care, Quality Measurement and Improvement Activities, Care Coordination, Use of Information Technology and Evidence-based Medicine, and Accountability. I think that quality and cost are relatively two very important drivers that could affect the high-performance healthcare system, which are present in my current workplace. For instance, Shortage in nursing have been a talk and an ongoing issue that is seen in the last decade within the nursing profession. It seems that in my nursing department, we constantly experience short staffing from time to time (not cost effective because we tend to use agency nurses which are paid higher than regular staff). Often, I would, or other coworkers would come in just to help out because of short staffing (over time, which is another budget issue). Because of this costly staffing issue, the management became tighter on nurse patient ratio leading to unsafe patient care, staff burned out, decrease patient satisfaction and decrease employees job satisfaction (causing them to leave their job). I honestly often experience short staffing since I started working as a Rehab Registered Nurse (RN), it is difficult because of increased nurse patient ratio. Having increased patient ratio leads to poor quality of patient care which leads to poor patient outcomes (Morrison, 2014). According to Wylie et al., (2015), the survey showed ten (10) percent do not believe that health care organization cost-containment negatively affects the quality of care, while eighty (80) percent believe that the cost-containment negatively affects the patient quality of care. This survey was conducted in one of hospital’s medical surgical floor in Australia. This article relates to my current workplace, it seems that the focus of my department is all about the number of patient and not the actual patient care while the organization or the management continue to expect excellent customer service. It is expected by the management to provide high quality of care even with short staffing or inappropriate nurse patient ratio due to organizations cost-containment practice. I believe that if issue such as high nurse patient ratio and short staffing continued it will lead to patient harm which may lead to patient’s death. Therefore, every employer needs to assess the issue of short staffing and their cost-containment practice to develop an action plan to stop the unsafe staffing and nurse patient ratio within my current work place. According to Morrison (2014) appropriate nurse patient ratio promotes safe and high quality of patient care. Reference Morrison, G. (2014). Cost containment project - Final report. Journal For Healthcare Quality, 7(3), 15. doi:10.1097/--00014 Wylie, K., Crilly, J., Toloo, G., Fitzgerald, G., Burke, J., Williams, G., & Bell, A. (2015). Review article: Emergency department models of care in the context of care quality and cost: A systematic review. Emergency Medicine Australasia, 27(2), 95-101. Instructor response Stephanie - I really wonder why upper level hospital management is not cognizant of the impact of heavy work loads on personnel morale at the unit level. You would think that they would know/be aware of the impact, but it seems in facility after facility this same issue persists and no one does anything about it. What could be some reasons for ignoring this issue? Hello Dr MJ, Thank you for sharing your input on Stephanie’s discussion this week, I would also like to answer your question towards Stephanie. The heavy workload of nurses is one of many problems in our healthcare system today. According to Weiss (2018), nurses experiences increased workload due to several reasons such as reduced staffing and increased overtime, in adequate supply of nurses, as well as increased demand for nurses. In my experience, we have nursing staff high turnover rate because of low pay rate and heavy work load (when I say heavy work load, its high acuity and high patient ratio). This is one of the reasons why my nursing department cannot keep up with very low staff retention rate. There have been so many suggestions what to do to improve staff retention but none of the hospital corporate listens, they are more worried about their budget rather than the safety of their staff and their patient. As I mentioned in my discussion, it seems that in my nursing department, we constantly experience short staffing from time to time (not cost effective because we tend to use agency nurses which are paid higher than regular staff). Often, I would, or other coworkers would come in just to help out because of short staffing (over time, which is another budget issue). Because of this costly staffing issue, the management became tighter on nurse patient ratio leading to unsafe patient care, staff burned out, decrease patient satisfaction and decrease employees job satisfaction (causing them to leave their job). I honestly often experience short staffing since I started working as a Rehab Registered Nurse (RN), it is difficult because of increased nurse patient ratio. Having increased patient ratio leads to poor quality of patient care which leads to poor patient outcomes (Morrison, 2014). I don’t think that the upper manage ignores our suggestions and the impact of unsafe staffing, I believe it is being influenced by the rules created by hospital corporate that needs to be followed. I found that our nursing management submits all the issues and concerns along with solutions to the hospital corporate, but it only ends up unheard because it does not “meet” the corporate rules. For example, our supervisor follows staffing ratio based on the number of patients created by our hospital corporate (note: some of this people who created these rules are business expert not experienced healthcare worker), did I mention acuity? I did not because our corporate does not care about acuity. This is why a lot of our nursing staff left the job because of unsafe and high acuity patient ratio which is detrimental to patient and the caregivers. Therefore, I conclude that the corporate does not care how heavy the workload of the staff is because they only see the patient as a number not the actual severity of patient’s health issue. According to Weiss (2018), hospital corporation is all about how much profit they will make and does not really care about their stakeholders nor staff. Often, this is how I feel at my workplace, I love my patient, but it seems like the organizations does not care about the patient and us. Reference Weiss, L. D. (2018). Alternative health care industry. Private Medicine and Public Health, 9(3), 95-108. doi:10.4324/8039-7 Hello Stephanie, Your point is spot on, I totally agree with you that most hospital have a budget to maintain. In fact, last year our hospital cut our annual raise from 3% to 2% percent because we didn’t meet the budget for that previous year because apparently, we used “too much” staff when we were low census (meaning they lost profit that previous year). Often, they don’t use agency nurses or nursing tech’s when we are short staff because agency gets paid more. When you pick up extra hours to help out, you will be the number one to get cancelled on the following week. Our staffing is ridiculous to the point that it is not safe at all because according to the staffing rubric created by hospital corporate it doesn’t matter what the patient acuity, they will not care how bad it is having eight (8) with a high acuity patient as long as all the patient are covered. Recently, we have been having one nursing assistant on one floor with sixteen (16) patient (of course high acuity and mostly max of 2 assists), so one of my dilemma was we aren’t allowed to answer the call light using the telephone at the nurses station, the management wants us to physically go in to check what the patient needs, For instance, a patient at the very end of the hall way rang the bell, I would answer using the telephone at the nurses station and ask what they need, instead of walking all the way to the end of the hall when all they need is a cup of water. So, the management wants us the follow their rules that often does not make sense and not appropriate for short staff. So, I advocated for all the staff to allow us to answer the call lights using the telephone that is by the nursing station. Guess what I got denied because they want us to properly provide good customer service. It is ridiculous that we are working so hard and not even give us a fair solution. Regards, Tuto