Health Care Delivery for the 21thCentury

Advanced Skills for Health Care Advanced Skills for Health Care Providers, Second EditionProviders, Second Edition

Barbara Acello Barbara Acello Thomson Delmar Learning, 2007Thomson Delmar Learning, 2007

Objectives

Spell and define terms.

Define workplace redesign and describe changes in the nursing department that have occurred because of restructuring.

Define the role, responsibilities, and scope of practice of the Patient Care Technician, and explain why standards of care are important

Objectives, continued

List the five rights of delegation and give examples of situations in which

delegating a procedure to a PCT is not appropriate.

Objectives Continued

Diffentiate an intradisciplinary team from an interdisclipinary team and list some general responsibilities of teams

List at least ten desirable qualities of the PCT

Identify professional boundaries in relationships with patients and families

SPELLING TERMS WORKPLACE REDESIGN RESTRUCTURING RE-ENGINEERING MULTISKILLING CROSS-TRAINING PROCESS IMPROVEMENT QUALITY IMPROVEMENT (QI) QUALITY ASSURANCE (QA) CONTINUOUS QUALITY IMPROVEMENT BENCHMARK BENCHMARKING

SPELLING TERMS CONTINUED

CRITICAL THINKING QUALITY INDICATOR ADVERSE EVENTS CLOSE CALLS INTENTIONALLY UNSAFE ACTS SENTINEL EVENTS ROOT CAUSE ANALYSIS (RCA) TRANSPARENCY INSTITUTE FOR HEALTHCARE IMPROVEMENT

(IHI) PATIENT FOCUSED CARE UNLICENSED ASSISTIVE PERSONNEL (UAPs)

SPELLING TERMS CONTINUED

NURSE PRACTICE ACT STANDARDS OF CARE NEGLIGENCE MALPRACTICE DELEGATION DELEGATED ASSIGN INTRADISCIPLINARY TEAMS INTERDISCIPLINARY TEAMS INTRADEPARTMENTAL TEAMS INTERDEPARTMENTAL TEAMS PARAPROFESSIONALS TACT

Health Care Delivery from 1980 to the Present

Health care is provided in many settings The type of care given is determined by the

type of services the agency delivers Health care workplace organization remained

largely the same for many years. Before the mid-1980’s, health care facilities

were set-up so that many departments provided services to patients

CHANGES IN REIMBURSEMENT

Changes in reimbursement for health care services began with the federal government in the late 1970s.

This was done to save Medicare money In the mid-1980s, changes began to have a

profound effect on the health care industry. These changes caused modifications in the

operation of physicians’ offices, clinics, laboratories, hospitals, long term care facilities.

WORKPLACE REORGANIZATION

Most health care facilities studied their operations to see how they could become more efficient.

This was necessary because reimbursement for services was less than it had been previously

Organizations had to figure out how to provide the same services at a lower cost.

Some hospitals closed because they could not operate on lower revenues

WORKPLACE REORGANIZATION

Many agencies learned that they could save money if they combined the services that departments and workers deliver.

Small departments merged, becoming part of larger departments

The workers were taught to perform new patient care procedures.

Now fewer workers provide a broader spectrum of care.

Collectively, these changes are called workplace redesign.

EFFECTS OF WORKPLACE REDESIGN

In most health care agencies, the nursing department’s responsibilities have been expanded

Staff is given additional training in procedures that nursing was not responsible for previously

Training of this type is called multiskilling or cross-training

EFFECTS OF WORKPLACE REDESIGN

The multiskilled worker has completed a basic nursing assistant or other educational program to learn to provide personal care and basic comfort measures to patients

The assistant attends classes to learn additional technical skills.

Most agencies have changed the assistant’s title to reflect the changes in responsibility.

QUALITY ASSURANCE

All health Care Facilities have an interval program for process improvement. This is commonly called quality improvement or quality assurance or continuous quality improvement.

The purpose of quality assurance is to identify problems and potential and find solution for improvement.

BENCHMARKING

Benchmarking is an important part of the quality improvement process.

Benchmarking is an activity in which an organization establishes best practices by comparing what it is doing with what other similar organizations are doing

By benchmarking with other organizations, the facility can improve its processes and achieve excellence

QUALITY INDICATORS

Quality indicators are decision-making and research tools that are used for tracking changes, recognizing potential quality problems and identifying areas that warrant further study and research

Serious Events

Adverse events- incidents, accidents, events and injuries associated with patient care and services.

Close calls- Situations that could have resulted in an adverse event but did not.

Intentionally unsafe acts- results from criminal acts, purposefully unsafe actions

Sentinel events- Serious injury that result in patient death or serious physical or psychological death

ROOT CAUSE ANALYSIS

Root cause analysis or RCA is a process for identifying the cause or contributing factors associated with untoward events

Every facility has guidelines for conducting a root cause analyses investigation

Transparency- is the part of the investigative process that involves keeping people informed

PATIENT- FOCUSED CARE

The purpose of patient focused care is to bring services to patients, instead of bringing patients to services.

Fewer workers are needed to provide services to each patient under this model of care.

Role and responsibilities of the Patient Care Technician

The role of the PCT vary from one agency to the next.

Understanding what you can and cannot do is very important

Your employer will give you a job description, listing your responsibilities. A sample job description is given in figure 1-3

Nurse Practice Acts

Nursing practice is regulated by a board of nursing or other governing body in each state.

The nurse practice act describes the nurses scope of practice in your state.

Never perform procedures that you have not been taught to provide, or that are illegal for patient care technicians in your state.