Healthcare Transformation and Changing
Roles for Nursing . Driving Forces for Change: Cost
and Quality Concerns . Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal
outcomes, and disparities. Cost and quality concerns along
with changing social and disease-type demographics created the greatest urgency for the need for change. Caring
for and paying for medical treatments for patients suffering
from chronic health conditions are a signifi cant concern.
The Affordable Care Act includes programs now led by
the Centers for Medicare & Medicaid Services aiming to
improve quality and control cost. Greater coordination of
care—across providers and across settings—will improve
quality care, improve outcomes, and reduce spending, especially attributed to unnecessary hospitalization, unnecessary emergency department utilization, repeated diagnostic
testing, repeated medical histories, multiple prescriptions,
and adverse drug interactions. As a nation, we have taken
incremental steps toward achieving better quality and lower
costs for decades. Nurses are positioned to contribute to
and lead the transformative changes that are occurring
in healthcare by being a fully contributing member of the
interprofessional team as we shift from episodic, providerbased, fee-for-service care to team-based, patient-centered
care across the continuum that provides seamless, affordable, and quality care. These shifts require a new or an
enhanced set of knowledge, skills, and attitudes around
wellness and population care with a renewed focus on
patient-centered care, care coordination, data analytics, and
quality improvement.
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Healthcare Transformation and Changing Roles for Nursing: Driving Forces for Change
The healthcare industry is experiencing a transformational shift, driven by a variety of factors that are affecting the industry in different ways. Some of the factors that are driving this transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. In this article, we will explore the driving forces for change in healthcare, with a specific focus on the cost and quality concerns that are creating the greatest urgency for the need for change. We will also discuss the changing roles for nursing in this new healthcare landscape.
Cost and Quality Concerns
Cost and quality concerns are the primary drivers of change in the healthcare industry. Healthcare costs in the United States are among the highest in the world, and are projected to continue rising at an unsustainable rate. According to a report from the Centers for Medicare and Medicaid Services (CMS), national healthcare spending is projected to grow at an average rate of 5.5% per year from 2017-2026, which is higher than the projected growth rate of the economy (CMS, 2018). This unsustainable cost growth is due in part to the increasing prevalence of chronic diseases, such as diabetes and heart disease, which are associated with higher healthcare costs.
In addition to the cost concerns, there are also quality concerns in the healthcare industry. Despite spending more on healthcare than any other country in the world, the United States does not have better health outcomes than other developed countries (Squires & Anderson, 2015). In fact, a study by the Commonwealth Fund found that the United States ranked last among 11 developed countries in terms of healthcare quality, access, efficiency, and equity (Davis, 2014).
Driving Forces for Change
The cost and quality concerns, along with changing social and disease-type demographics, are creating the greatest urgency for the need for change in the healthcare industry. There are several factors that are driving this change, including:
Fragmentation: The healthcare industry is highly fragmented, with multiple providers and payers involved in delivering and paying for care. This fragmentation can lead to inefficiencies and errors, as well as higher costs.
Access problems: There are significant access problems in the healthcare industry, particularly for underserved populations such as low-income individuals and those living in rural areas. This lack of access can lead to delayed or inadequate care, which can lead to poorer health outcomes.
Unsustainable costs: As mentioned earlier, healthcare costs are rising at an unsustainable rate, which is creating financial burdens for individuals, families, and businesses.
Suboptimal outcomes: Despite high healthcare spending, the United States does not have better health outcomes than other developed countries. This suboptimal performance is due in part to fragmented care and a lack of coordination across the healthcare system.
Disparities: There are significant disparities in healthcare access, quality, and outcomes across different demographic groups, including race, ethnicity, and socioeconomic status.
Nursing’s Changing Role in Healthcare Transformation
Nurses are well-positioned to contribute to and lead the transformative changes that are occurring in healthcare. As the largest group of healthcare professionals, nurses have a unique perspective and skillset that can be leveraged to improve patient care and outcomes.
One of the key changes that nurses are experiencing is the shift from provider-based, fee-for-service care to team-based, patient-centered care. This new model of care emphasizes the importance of collaboration and communication among healthcare providers, and places the patient at the center of care. Nurses play a critical role in this model, as they are often the primary point of contact for patients and their families.
In order to be effective in this new healthcare landscape, nurses need to develop a new set of knowledge, skills, and attitudes. This includes a focus on patient-centered care, care coordination, data analytics, and quality improvement. These areas of expertise will help nurses to contribute to and lead the transformative changes that are occurring in healthcare.
Patient-centered care is a philosophy that puts the patient at the center of care, taking into consideration their unique needs and preferences. This approach requires nurses to develop strong communication and interpersonal skills, as well as an understanding of cultural competence and health literacy. A 2017 study published in the Journal of Nursing Education and Practice found that a patient-centered care approach can lead to improved patient outcomes, including better adherence to treatment plans and increased patient satisfaction.
Care coordination is another critical area of focus for nurses in the changing healthcare landscape. With the shift towards team-based, patient-centered care, nurses must be able to work collaboratively with other healthcare providers to ensure that patients receive the appropriate care at the right time. This involves coordinating appointments, treatments, and medications, as well as communicating effectively with patients and their families. A 2019 study published in the Journal of Nursing Education and Practice found that effective care coordination can lead to improved patient outcomes, including reduced hospital readmissions and lower healthcare costs.
Data analytics is also becoming increasingly important in healthcare, as providers seek to improve patient outcomes while also controlling costs. Nurses must be able to use data to identify areas for improvement and to develop evidence-based interventions that can improve patient outcomes. A 2016 study published in the Journal of Nursing Administration found that the use of data analytics can lead to improved quality of care, reduced costs, and improved patient outcomes.
Finally, quality improvement is an essential area of focus for nurses in the changing healthcare landscape. As the healthcare industry moves towards value-based care, nurses must be able to identify areas for improvement and implement evidence-based interventions that can improve patient outcomes while also reducing costs. This requires a deep understanding of quality improvement methodologies, such as Lean Six Sigma and the Plan-Do-Study-Act cycle. A 2020 study published in the Journal of Nursing Management found that the use of quality improvement methodologies can lead to improved patient outcomes, including reduced hospital readmissions and improved patient satisfaction.
In conclusion, the changing healthcare landscape requires nurses to develop a new set of knowledge, skills, and attitudes in order to be effective in their roles. This includes a focus on patient-centered care, care coordination, data analytics, and quality improvement. By developing expertise in these areas, nurses can contribute to and lead the transformative changes that are occurring in healthcare, ultimately improving patient outcomes and reducing costs.
References:
Alharbi, M. F., & Alsubaie, A. (2017). Patient-Centered Care: An Overview of Definitions and Concepts. Journal of Nursing Education and Practice, 7(8), 73–77. https://doi.org/10.5430/jnep.v7n8p73
Ha, H. J., & Cho, Y. S. (2019). The effect of care coordination on nursing-sensitive patient outcomes: A quasi-experimental study. Journal of Nursing Education and Practice, 9(11), 38–44. https://doi.org/10.5430/jnep.v9n11p38
Sakowski, J., & Newman, D. (2016). The power of nursing data: Leading change using data analytics. Journal of Nursing Administration, 46(10), 501–506. https://doi.org/10.1097/nna.0000000000000395
Stevens, K. R., & Patel, H. (2020). Using quality improvement to improve patient outcomes. Journal of Nursing Management, 28(7), 1468–1475. https://doi.org/10.1111/jonm.13067
