Transcript EMPOWERING NURSES TO LEAD

A Primer for The Nurse
To increase your understanding of how
knowledge of the health system will help you, the
nurse, provides patient-centered care to guide
each patient toward desired health outcomes.
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A complex system is a system composed of
interconnected parts that as a whole exhibit one or
more properties (behavior among the possible
properties) not obvious from the properties of the
individual parts
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The American healthcare system … isn’t. It isn’t a “system.”
Patients have multiple providers. These providers rarely
interact. The payment system operates in silos. And patient
care isn’t coordinated.
http://blogs.ajc.com/health-flock/2012/12/05/breaking-downhealthcare-silos-the-need-of-healthcare-integration/
SILOS
SYSTEM
Diagnosis
Problem
Diagnosis
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Problem
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Treatment
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Followup
Treatment
Followup
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ND population in 2012 est. 720,000 individuals
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2014 est. 723,500 individuals
2012
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Documented Patient Visits = 3,796,327
Medical Clinics - Hospital-based only 3,679,739
Hospital admissions
97,028
Nursing Facility residents
12,213
Basic Care residents
4,152
Assisted Living Facility residents
3,195
 Reports were not found for any of the other provider types or
practitioners
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Review the health care system’s provider types and
levels of service, regulation, and reimbursement
mechanisms;
Investigate your organization’s structure and
processes;
Describe your position/role within the organizational
structure; and
Demonstrate your knowledge of the health care system
to help a patient (and family) consider and access
viable options for achieving personally desired health
outcomes.
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Provider Types
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Community Agencies
Outpatient Providers
Inpatient Providers
In-Home Providers
Service Types
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Preventive
Acute
Rehabilitative
Long Term Care
End of Life
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Independent Practitioners
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Physicians
Dentists
Advance Practice Nurses
Chiropractors
Psychologists
Physical Therapists
Dietitians
Pharmacists
Etc.
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Licensure – State
Certification – Federal --Medicare/Medicaid
Accreditation - The Joint Commission, Etc.
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REIMBURSEMENT FOR HEALTH SERVICES
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Private Health Insurance (Much Based On Medicare)
Private Self Pay
Medicare
Medicaid
Population Based - VAMC, IHS, Migrant Health, PHS
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Visual representation of how a firm intends authority, responsibility, and
information to flow within its formal organizational structure. It usually depicts
different management functions
(finance, human resources, marketing,
nursing, environment,) and their subdivisions as boxes linked with lines along
which decision making power travels downwards and answerability travels
upwards. http://www.businessdictionary.com/definition/organization-chart.html
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Patients and families hate it that we can’t make this work
Poor hand-offs lead to delays, lapses in care, adverse drug effects,
and other situations that may be dangerous to health
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Ensure transfer of correct information
Provide patient support to wellness
Track referrals & help resolve problems
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Less waste
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 Enormous waste is associated with duplicate testing, unnecessary
referrals, unwanted specialist-to-specialist referrals, and failed
transitions from hospitals, EDs, & nursing homes.
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Clinical practice will be more rewarding
Fewer problems – for patient and for health system
Improve the health of the population
Encourage personal responsibility for health status
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An established “system” for
change in responsibility for
patient care
Accurate and complete
documentation
 Patient Identification, Diagnoses,
Events, Anticipated Outcomes
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Patient education and
understanding
Verbal Communication
Verification of available
resources
Shared Responsibility (for
the Patient)
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Describe your employer organization using the outline
provided
Define your present position within the employer
organization.
Perform and document a successful patient handoff noting
the following:
The patient’s desired health outcome
Assessment of each of the listed barriers
Indivisuals/agencies involve in thehandoff (remember the patient).
Elements of the handoff (documents, other communication,
transportation, etc.)
◦ 5. Results (2 weeks after the fact) of the handoff.
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Reflect on the complexity of the overall healthcare
system
Reflect on your organization within the system
Reflect on your position within your organization
Reflect on the result of your patient advocacy
experience
How could a different reality make your experience
more successful and satisfying?
What will you do to move toward that different reality?
And so we move into the Change & Innovation Module
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