Essentials of Nursing Leadership Management 4 th

Essentials of Nursing Leadership & Management, 4 th Edition CHAPTER 10 MANAGING CLIENT CARE

Essentials of Nursing Leadership & Management, 4 th Edition The Economic Climate in the Health-Care System § Resources are scarce § Resources have alternative uses § Individuals want different things and have different preferences

Essentials of Nursing Leadership & Management, 4 th Edition Cost Containment Programs § § § Economic stabilization program Voluntary effort Certificate of need Medicare prospective payment system Diagnostic related groups Managed care

Essentials of Nursing Leadership & Management, 4 th Edition Forces Driving Health Care § Cultural diversity § Aging population § New services and technologies

Essentials of Nursing Leadership & Management, 4 th Edition Nursing Shortage § § § High acuity of clients in hospitals Increased demand for nurses Aging nursing workforce Job dissatisfaction Reduction in nursing faculty

Essentials of Nursing Leadership & Management, 4 th Edition Changes in Work Design § Nursing care delivery systems have the structure that allows nurses to plan and provide nursing care to groups of clients § The current acute nursing shortage continues to fuel the frenzy of work redesign in acutecare hospitals across the nation

Essentials of Nursing Leadership & Management, 4 th Edition Organizing Principles of a Delivery System § § Decision-making Care allocation Communication Management

Essentials of Nursing Leadership & Management, 4 th Edition Traditional Models of Care § § § Total care Functional Team Modular Primary nursing

Essentials of Nursing Leadership & Management, 4 th Edition Contemporary Models of Care § § Case management Client-focused care Product line management Differentiated practice

Essentials of Nursing Leadership & Management, 4 th Edition Case Managers § § § Negotiate services/treatments Communicate Coordinate Clinical expert Holistic caring approach Coach

Essentials of Nursing Leadership & Management, 4 th Edition Goals of Case Managers § Achieve outcomes based on standards of care § Collaborative coordination § Efficient use of resources § Timely discharge § Enhance quality of life

Essentials of Nursing Leadership & Management, 4 th Edition Differentiated Practice § Structuring of nursing roles and functions § Education § Experience § Competence

Essentials of Nursing Leadership & Management, 4 th Edition Differentiated Practice Models § Associate degree nurse § BSN or primary nurse § MSN nurse § Advanced practice roles

Essentials of Nursing Leadership & Management, 4 th Edition Quality Management § § Professional organizations Federal/state governments Licensure Private accreditation

Essentials of Nursing Leadership & Management, 4 th Edition Characteristics of Quality Management § § Links to the strategic plan Quality councils Training programs Selection of improvement opportunities

Essentials of Nursing Leadership & Management, 4 th Edition Characteristics of Quality Management § Formation of process improvement teams § Staff support § Motivating personnel policies

Essentials of Nursing Leadership & Management, 4 th Edition Quality Focused Professional Organizations § Joint Commission on Accreditation of Healthcare Organizations (JACHO) § American Nurses Association (ANA) § Institute of Medicine (IOM)

Essentials of Nursing Leadership & Management, 4 th Edition IOM Essential Competencies § § § Provide patient-centered care Work in interdisciplinary teams Employ evidence-based practice Apply quality improvement Use informatics

Essentials of Nursing Leadership & Management, 4 th Edition IOM – Medical Errors § 44, 000 – 98, 000 die each year § $17 - $29 billion total cost § JACHO International Center for Patient Safety § Yearly patient safety goals § Unapproved abbreviations

Essentials of Nursing Leadership & Management, 4 th Edition Nursing Errors § Medication § Knowledge § Procedure

Essentials of Nursing Leadership & Management, 4 th Edition Continuous Quality Improvement (CQI) § § Identify indicators Collect ongoing data on indicators Analyze and evaluate data Implement change

Essentials of Nursing Leadership & Management, 4 th Edition CQI Elements § § Localized improvement efforts Organizational learning Process reengineering Evidence-based medicine and management

Essentials of Nursing Leadership & Management, 4 th Edition Quality Improvement Structure § Facilities § Equipment § Staff § Finances Process Outcome

Essentials of Nursing Leadership & Management, 4 th Edition A Comparison Process – Nursing Process Assessment/Diagnosis Planning Intervention Physical, emotional, psychological needs Deciding Linking clients re-sources to services Reassess and begin process again Development of care plans, critical pathways Acting as a “broker” and advocate Evaluation Ensure needs are met Monitor and document costeffectiveness and client progress

Essentials of Nursing Leadership & Management, 4 th Edition Organizational and Unit CQI § Strategic planning § § § Framework for decisions Basis for detailed planning Explain business to others Assist in benchmarking Stimulate change

Essentials of Nursing Leadership & Management, 4 th Edition Monitoring and Evaluating Quality of Care § § § Guidelines Protocols Algorithms Standards of care Critical pathways

Essentials of Nursing Leadership & Management, 4 th Edition Structured Care Methodologies § Link the process of care and the outcome § Allow for measuring quality care

Essentials of Nursing Leadership & Management, 4 th Edition Structured Care Methodologies § Increase the predictability of services needed § Clarify the responsibilities of interdisciplinary team

Essentials of Nursing Leadership & Management, 4 th Edition Structured Care Methodologies § Facilitate communication among team members § Decrease documentation time § Provide a systemic approach to measurement

Essentials of Nursing Leadership & Management, 4 th Edition Root Cause Analysis § Process of learning from consequences § § Determine influences Establish linked chains of influence Determine necessary and sufficient influences Try and drill down to root causes

Essentials of Nursing Leadership & Management, 4 th Edition Risk Management § Part of CQI § Service occurrence § Serious incident § Sentinel events

Essentials of Nursing Leadership & Management, 4 th Edition Conclusion Regardless of the care model used or the indicators selected, focus attention on the following in patient care delivery:

Essentials of Nursing Leadership & Management, 4 th Edition Conclusion § § § Think critically Plan and report outcomes Make introductory rounds Plan partnership with the client Communicate the plan Evaluate progress