Transcript Presentation Title

Nursing and Midwifery in Health Reform
Dr. Siobhan O’ Halloran
Nursing and Healthcare
Nursing is inextricably, and rightly so, linked
to societies future and the future of healthcare
Context: Public Service Policy
•Programme for Government
•Future Health
•Haddington Road Agreement
•Nurses and Midwives Act 2011
A single tier health system,
supported by universal health insurance,
where access is based on need,
not income.
Health Sector Infographic
Scale of Activity In July 2013
96,723 Visiting A&E
31,295 Emergency admissions
73,236 Day Cases
6,083 Births
12% av. life expectancy in the last 30 years - now at 80 years
Current Challenges
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• Access/Wait Times
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• Quality/Safety
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• Primary Health Reform •
• Health H.R.
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• Demographics
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• Chronic Disease
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Management
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Infectious Diseases
Multicultural Health
Role Of Private Sector
Health Determinants
New Technology
Capital Infrastructure
Economic Returns
Ethical Challenges
Health Leaders
• The Most Important Job In Ireland
• The Most Difficult Job In Ireland
Important . . .
• Public Opinion
• Expenditure
• The positive impact on individuals, families and
communities
Difficult …
• The Headlines
• The Reports
Preparing Nursing and Midwifery for Tomorrow
Moving away - hospitalisation as the
primary modality for healthcare
Contemporary trend blending hospital
and non hospital care
Critical Questions ?
How can the health system accommodate an
increase in demand while at the same time
improving quality of healthcare services?
What roles can nursing assume to drive reform and
address the increasing demand for safe high
quality and effective healthcare services?
Connection to Health Outcomes
Patient safety-supply of nurses, organisation of the workforce and work
environment gaining increasing attention (Needleman et. al 2007)
Nurse staffing levels associated with decrease in adverse patient events
(Kane et. al 2010)
Joint effects of staffing and elements of the practice environment on patient
outcomes
(Aiken et al 2012, Duffield et.al 2007)
Compelling evidence that practice environments integral to nurse job
outcomes (Lake 2007)
Vision for Nursing
A profession:
• with a steadfast commitment to patient care,
improved safety, quality and outcomes.
• who practice from health promotion, disease
prevention, co-ordination of care to cure and
to palliative care when cure isn’t possible.
• who are confident that through their: adaptive
capacity; close proximity to patients; and
scientific understanding of care can drive
health reform from the bedside to the
boardroom.
A New Style of Leadership
Values Based Leadership
Becoming a leader is synonymous with
becoming yourself
Warren Bennis
Critical acting
Critical caring
Critical thinking
Values Based Leadership
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Balance innovation with risk
Think long term but deliver results
Decentralise but control
Maintain staff morale and teamwork while
making tough service and workforce
decisions
• Continue to tackle inequalities
• Ensure people receive safe effective care
Leadership and Strategic Resilience
Strategic resilience is not about responding
to a one time crisis. It’s not about rebounding
from a setback. It’s about continuously
anticipating and adjusting to deep, secular
trends …. It’s about having the capacity to
change before the case for change becomes
desperately obvious.
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Responsibility of the Chief Nursing Officer
The primary responsibility is to achieve
national public health goals through nursing
and midwifery:
• Public good is the end; the patient is central
• Nursing and midwifery is the means.
Value in healthcare is expressed as the physical
and social health and well being achieved relative
to cost (IOM 2008).
Tension in Role of CNO: Two Domains
Nursing and
Public Service
Midwifery
Leader with Realisable Goals
Leader who is
Corporate
For
an
Identity and Nursing and Midwifery
Agent of
Responsibility
Transformation
Immediate Priorities
Ratios
Strategy
1. Reconceptualise role of
nursing and midwifery
2. Build clinical leadership
3. Develop quality assured
nursing data
Practice
GNP
Skill
Mix
From Strategy to Implementation
Leadership: Create the Future
• The desired future of nursing doesn't
just happen. Nurse leaders create It
• Leaders most important functions is
to cultivate the human capital of
their organisation
• Nurses are knowledge workers in an
information age. Knowledge workers
respond to inspiration not
supervision
Benefits realised - nurses will:
•Bridge the gap between access and coverage
•Co-ordinate increasingly complex care
•Fulfil our potential as primary care givers to the
full extent of their education and training
•Enable the full economic value of our
contribution across care settings to be realised
•Change the reference point from which nursing
is judged.
What will survive as the world changes ?
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Clear ethical values
Being clear about our mission
Putting patients first
Constantly trying to improve
Basing what we do on learning and
evidence
Leadership
The Future is safe when we…
• Care more than others think is wise.
• Risk more than others think is safe.
• Dream more than others think is practical.
• Expect more than others think is possible.
• Passionate, personal, persistent, and patient.