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CHAPTER 10 MANAGING CLIENT CARE

CHAPTER 10 MANAGING CLIENT CARE. The Economic Climate in the Health-Care System. Resources are scarce Resources have alternative uses Individuals want different things and have different preferences. Cost Containment Programs. Economic stabilization program Voluntary effort

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CHAPTER 10 MANAGING CLIENT CARE

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  1. CHAPTER 10MANAGING CLIENT CARE

  2. The Economic Climate in theHealth-Care System Resources are scarce Resources have alternative uses Individuals want different things and have different preferences

  3. Cost Containment Programs • Economic stabilization program • Voluntary effort • Certificate of need • Medicare prospective payment system • Diagnostic related groups • Managed care

  4. Forces Driving Health Care • Cultural diversity • Aging population • New services and technologies

  5. Nursing Shortage • High acuity of clients in hospitals • Increased demand for nurses • Aging nursing workforce • Job dissatisfaction • Reduction in nursing faculty

  6. 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 acute- care hospitals across the nation

  7. Organizing Principles of a Delivery System • Decision-making • Care allocation • Communication • Management

  8. Traditional Models of Care • Total care • Functional • Team • Modular • Primary nursing

  9. Contemporary Models of Care • Case management • Client-focused care • Product line management • Differentiated practice

  10. Case Managers • Negotiate services/treatments • Communicate • Coordinate • Clinical expert • Holistic caring approach • Coach

  11. Goals of Case Managers • Achieve outcomes based on standards of care • Collaborative coordination • Efficient use of resources • Timely discharge • Enhance quality of life

  12. Differentiated Practice • Structuring of nursing roles and functions • Education • Experience • Competence

  13. Differentiated Practice Models • Associate degree nurse • BSN or primary nurse • MSN nurse • Advanced practice roles

  14. Quality Management • Professional organizations • Federal/state governments • Licensure • Private accreditation

  15. Characteristics of Quality Management • Links to the strategic plan • Quality councils • Training programs • Selection of improvement opportunities

  16. Characteristics of Quality Management • Formation of process improvement teams • Staff support • Motivating personnel policies

  17. Quality Focused Professional Organizations • Joint Commission on Accreditation of Healthcare Organizations (JACHO) • American Nurses Association (ANA) • Institute of Medicine (IOM)

  18. IOM Essential Competencies • Provide patient-centered care • Work in interdisciplinary teams • Employ evidence-based practice • Apply quality improvement • Use informatics

  19. 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

  20. Nursing Errors • Medication • Knowledge • Procedure

  21. Continuous Quality Improvement (CQI) • Identify indicators • Collect ongoing data on indicators • Analyze and evaluate data • Implement change

  22. CQI Elements • Localized improvement efforts • Organizational learning • Process reengineering • Evidence-based medicine and management

  23. Quality Improvement Structure • Facilities • Equipment • Staff • Finances Process Outcome

  24. A ComparisonProcess – Nursing Process

  25. Organizational and Unit CQI • Strategic planning • Framework for decisions • Basis for detailed planning • Explain business to others • Assist in benchmarking • Stimulate change

  26. Monitoring and Evaluating Quality of Care • Guidelines • Protocols • Algorithms • Standards of care • Critical pathways

  27. Structured Care Methodologies • Link the process of care and the outcome • Allow for measuring quality care

  28. Structured Care Methodologies • Increase the predictability of services needed • Clarify the responsibilities of interdisciplinary team

  29. Structured Care Methodologies • Facilitate communication among team members • Decrease documentation time • Provide a systemic approach to measurement

  30. 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

  31. Risk Management • Part of CQI • Service occurrence • Serious incident • Sentinel events

  32. Conclusion Regardless of the care model used or the indicators selected, focus attention on the following in patient care delivery:

  33. Conclusion • Think critically • Plan and report outcomes • Make introductory rounds • Plan partnership with the client • Communicate the plan • Evaluate progress

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