Presentation by: Mae Michelle F. Aguilar R.N.
NRSG125A-1
ORGANIZING
PATIENT CARE
Learning Objectives
1. Get reacquainted with the Traditional Models
of Organizing Patient Care their brief
background as w...
• FIRST and MIDDLE-LEVEL MANAGERS–
influences the organizing phase of the
management process at the unit or
department lev...
• UNIT LEADER-MANAGER – determines how
best to plan work activities so that
organizational goals are met effectively and
e...
• TOP LEVEL MANAGER – influence on the
philosophy and resources necessary for any
selected care delivery system to be effe...
Leadership Roles and Management Functions
Associated with Organizing Patient Care
LEADERSHIP ROLES
1. Periodically evaluates the effectiveness of the
organizational structure for the delivery of
patient c...
3. Examines the human element in work
redesign and supports personnel during
adjustment to change.
4. Inspires the work gr...
5. Inspires subordinates to achieve higher levels
of education, clinical expertise, competency,
and experience in differen...
1. Examines the unit philosophy to ensure that
it supports any change in the patient care
delivery system.
2. Selects a pa...
3.Uses scientific research and current literature
to analyze proposed changes in nursing care
delivery models.
4. Uses a p...
5. Ensures that nonprofessional staff are
appropriately trained and supervised in the
provision of care.
6. Organizes work...
7. Groups activities in a manner that facilitates
communication and coordination within and
between departments.
8. Organi...
9. Make changes in work design to facilitate
meeting organizational goals.
8. Clearly delineates criteria to be used for
d...
TRADITIONAL MODES
OF ORGANIZING
PATIENT CARE
TOTAL PATIENT CARE/
CASE METHOD NURSING
• Nurses assume total responsibility during their
time on duty for meeting all the...
Charge Nurse
Nursing
Staff
Patients
Nursing
Staff
Patients
Nursing
Staff
Patients
• 19th Century – total patient care was provided in the
homes.
• Great Depression of the 1930’s
– people can no longer afford
home care and began using
hospitals. Nurses and students
al...
• Provides nurses with high autonomy and
responsibility.
• Assigning patients is simple and direct.
• Lines of responsibil...
• The patient may receive three different
approaches to care, often resulting in
confusion for the patients.
• Requires hi...
FUNCTIONAL METHOD
• Personnel were assigned to complete certain
tasks rather than care for specific patients.
• “Care trough others” - Nurses became
managers of care rather than direct care
providers.
• UAP – Unlicensed Assistive Pe...
Patients
Medication
Nurse
Treatment
Nurse
Nursing
Assistants/
Hygienic Care
Clerical/
Housekeeping
Charged
Nurse
• Evolved as a result of World War II and the Hill
Burton Act.
• Continued due to the “Baby Boom” after the War.
• Economical means of providing care.
• Task are completed quickly with little
confusion regarding responsibilities.
• All...
• May lead to fragmented care and the
possibility of overlooking patient priority
needs.
• May result to low job satisfact...
TEAM and MODULAR NURSING
• Ancillary personnel collaborate in providing
care to a group of patients under the direction
of...
Charged
Nurse
Team
Leader
Nursing
Staff
Patients
Team
Leader
Nursing
Staff
Patients
Team
Leader
Nursing
Staff
Patients
• Developed in the 1950’s
to decrease problems
associated with
functional organization
of patient care.
• Nurse acts as a Team Leader responsible for
knowing the condition and needs of all the
patients assigned to the team and...
• A team should consist of not more than 5
people.
• Most team nursing was never practiced in its
purest form but was in c...
MODULAR NURSING
MODULAR NURSING – a mini-team (2-3
members approach)
• Members are sometimes called “care pairs”.
• A smal...
• Allows members to contribute their own
special expertise or skill.
• Comprehensive care can be provided for
patient desp...
• Disadvantages are associated with improper
implementation rather than with the
philosophy itself.
e.g. insufficient time...
PRIMARY NURSING
• Primary Nurse assumes 24-hour responsibility
for planning the care of one or more patients
from admissio...
• A.K.A Relationship-based Nursing.
• Provides total direct care for patients.
• Requires a nursing staff made up of only
...
• Developed in the 1970’s
and uses some
concepts of total
patient care and brings
nurses back to the
bedside to provide
cl...
Primary
Nurse
Patient
Charge
Nurse
Health Care
Organizations
Resources
Associate
Nurse
(Days)
Associate
Nurse
(Nights)
Ass...
• Associate Nurses – follows the care plan
established by the primary nurse when the
primary nurse is not on duty.
• This ...
• Clear interdisciplinary group communication
and consistent, direct patient care by
relatively few nursing staffs allows ...
• Disadvantages in this method lie in improper
implementation.
• Many nurses may be uncomfortable in this
role due to lack...
CASE MANAGEMENT
• Introduced in the 1970’s by insurance
companies as a method to monitor and control
expensive health insurance claims.
• ...
• Mid 1980’s hospitals had recognized the need
for a case management model to manage
treatment plans and length of stay of...
What is…
• A collaborative process that assesses, plans,
implements, coordinates, monitors, and
evaluates options and serv...
• Focus is on individual patients, not populations
of patient.
• Case managers handle each case individually,
identifying ...
• Case Management Nurses can choose to
specialize in treating people with diseases like
HIV/AIDS or cancer, or you can wor...
• ACUTE-CARE CASE MANAGEMENT– integrates
utilization management and discharge
planning functions and may be unit based,
as...
• Additional work efficiency due to geographic
proximity, but more importantly, the benefit
of establishing solid working ...
• Use Critical Pathways and Multidisciplinary action
plans (MAPs) to plan patient care.
• Care MAP – combination of Critic...
• Cycle Time Reduction – involves reviewing the
existing process that provides a product or
service; determining wasted ti...
BECOME A…
CASE MANAGEMENT NURSE
GET YOUR…
Case Management nurse certification from the American Nurses Credentialing Cente...
• Effective case managers should have 3-5 years
of direct care experience, preferably within
the specialty area in which t...
Qualities of a Case Manager
• Extremely Bright
• Well-developed interpersonal skills
• Able to multitask
• Strong foundati...
DISEASE MANAGEMENT
• One role increasing assumed by Case
Managers is coordinating disease
management programs.
• DISEASE MANAGEMENT (DM) – also
known as population-based health care and
continuous health care improvement, is a
compre...
• Includes early detection and early intervention
as well as comprehensive tracking of patient
outcomes.
• The difference ...
• GOAL: Serve the optimal number of covered
lives required to reach operational and
economic efficiency.
• National Committee for Quality Assurance
(NCQA) – began an accreditation process in
January 2002 for organizations that ...
Common Features
1. Focus is on prevention as well as early
disease detection and intervention.
2. Population-based.
3. Emp...
5. Use integrated data management systems.
6. Frequently employs professional nurses in the
role of case manager or progra...
DIFFERENTIATED NURSING PRACTICE
“Expecting similar performance from nurses with
varying educational preparation can lead t...
• Refers to an attempt to separate nursing
practice roles based on education or
experience or a combination of both.
2 BASIC DIFFERENCIATED PRACTICE MODELS
1. Education Model
• Differentiation is based on type of educational preparation
(A...
Rationale
• To match patient needs with nursing
competencies.
• Facilitate the effective and efficient use of
nursing reso...
The Future for Patient Care and
Delivery Models
• Nurse as clinical expert leading other
members of a team of partners.
• Creation of a new nursing role (the clinical-
nurse leader) that is more responsive to the
realities of the modern healt...
• A cooperative model of care delivery through
lay care partners. They are taught to recognize
systems, identify problems ...
5 Components of Determining the Model of
Nursing Care Delivery (Reno et. Al 2005)
A. Conversion of manual systems into
aut...
When Evaluating the
Current System and
Considering a
Change…
• Is it in line with the organizational philosophy?
Does it facilitate or hinder organizational
goals?
• Is it organized i...
• Will it satisfy the patient and their families?
• Will it provide some degree of fulfillment and
role satisfaction to nu...
• Does it promote and support the profession of
nursing as both independent and
interdependent?
• Does it facilitate adequ...
• How will it change the patient care delivery
system, alter individual and group decision
making? Will autonomy increase ...
• Will the change require a wider or more
restricted range of skills and abilities on the
part of the caregiver?
• Will it...
Organizing patient care
Organizing patient care
Organizing patient care
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Organizing patient care

  1. 1. Presentation by: Mae Michelle F. Aguilar R.N. NRSG125A-1 ORGANIZING PATIENT CARE
  2. 2. Learning Objectives 1. Get reacquainted with the Traditional Models of Organizing Patient Care their brief background as well as its advantages and disadvantages. 2. List the essential components of case management and disease management. 3. Know the different Leadership and Managerial Functions in Organizing Patient Care.
  3. 3. • FIRST and MIDDLE-LEVEL MANAGERS– influences the organizing phase of the management process at the unit or department level.
  4. 4. • UNIT LEADER-MANAGER – determines how best to plan work activities so that organizational goals are met effectively and efficiently.
  5. 5. • TOP LEVEL MANAGER – influence on the philosophy and resources necessary for any selected care delivery system to be effective.
  6. 6. Leadership Roles and Management Functions Associated with Organizing Patient Care
  7. 7. LEADERSHIP ROLES 1. Periodically evaluates the effectiveness of the organizational structure for the delivery of patient care. 2. Determines if adequate resources and support exist before making any changes in the organization of patient care.
  8. 8. 3. Examines the human element in work redesign and supports personnel during adjustment to change. 4. Inspires the work group toward a team effort.
  9. 9. 5. Inspires subordinates to achieve higher levels of education, clinical expertise, competency, and experience in differentiated practice. 6. Ensures that chosen nursing care delivery models advance the practice of professional nursing.
  10. 10. 1. Examines the unit philosophy to ensure that it supports any change in the patient care delivery system. 2. Selects a patient care delivery system that is most appropriate to the needs of the patients being served. MANAGEMENT FUNCTIONS
  11. 11. 3.Uses scientific research and current literature to analyze proposed changes in nursing care delivery models. 4. Uses a patient care delivery system that maximizes human and physical resources as well as time.
  12. 12. 5. Ensures that nonprofessional staff are appropriately trained and supervised in the provision of care. 6. Organizes work activities to attain organizational goals.
  13. 13. 7. Groups activities in a manner that facilitates communication and coordination within and between departments. 8. Organizes work so that it is as cost-effective as possible.
  14. 14. 9. Make changes in work design to facilitate meeting organizational goals. 8. Clearly delineates criteria to be used for differentiated practice roles.
  15. 15. TRADITIONAL MODES OF ORGANIZING PATIENT CARE
  16. 16. TOTAL PATIENT CARE/ CASE METHOD NURSING • Nurses assume total responsibility during their time on duty for meeting all the needs of assigned patients. • Sometimes referred to as Case Method of Assignment.
  17. 17. Charge Nurse Nursing Staff Patients Nursing Staff Patients Nursing Staff Patients
  18. 18. • 19th Century – total patient care was provided in the homes.
  19. 19. • Great Depression of the 1930’s – people can no longer afford home care and began using hospitals. Nurses and students also became caregivers in hospitals and in public health agencies. • 1930’s and 1940’s – hospitals grew and provided total care continued as the primary means of organizing patient care.
  20. 20. • Provides nurses with high autonomy and responsibility. • Assigning patients is simple and direct. • Lines of responsibility and accountability are clear. • Patient theoretically receives holistic and unfragmented care during the nurse’s time on duty.
  21. 21. • The patient may receive three different approaches to care, often resulting in confusion for the patients. • Requires highly skilled personnel and thus may cost more than some other forms of patient care. • May result to unsafe care when Nurses have a heavy patient load.
  22. 22. FUNCTIONAL METHOD • Personnel were assigned to complete certain tasks rather than care for specific patients.
  23. 23. • “Care trough others” - Nurses became managers of care rather than direct care providers. • UAP – Unlicensed Assistive Personnel
  24. 24. Patients Medication Nurse Treatment Nurse Nursing Assistants/ Hygienic Care Clerical/ Housekeeping Charged Nurse
  25. 25. • Evolved as a result of World War II and the Hill Burton Act. • Continued due to the “Baby Boom” after the War.
  26. 26. • Economical means of providing care. • Task are completed quickly with little confusion regarding responsibilities. • Allows care to be provided with minimal number of nurses. • Functions well in areas such as the operating room.
  27. 27. • May lead to fragmented care and the possibility of overlooking patient priority needs. • May result to low job satisfaction. • May not be too cost effective because of the need for many coordinators.
  28. 28. TEAM and MODULAR NURSING • Ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse.
  29. 29. Charged Nurse Team Leader Nursing Staff Patients Team Leader Nursing Staff Patients Team Leader Nursing Staff Patients
  30. 30. • Developed in the 1950’s to decrease problems associated with functional organization of patient care.
  31. 31. • Nurse acts as a Team Leader responsible for knowing the condition and needs of all the patients assigned to the team and for planning individual care. • Duties may include: assisting team members, giving direct personal care to patients, teaching and coordinating patient activities.
  32. 32. • A team should consist of not more than 5 people. • Most team nursing was never practiced in its purest form but was in combination of team and functional structure.
  33. 33. MODULAR NURSING MODULAR NURSING – a mini-team (2-3 members approach) • Members are sometimes called “care pairs”. • A small team requires less communication, allowing members better use of their time for direct patient care activities.
  34. 34. • Allows members to contribute their own special expertise or skill. • Comprehensive care can be provided for patient despite a relatively high proportion of ancillary staff.
  35. 35. • Disadvantages are associated with improper implementation rather than with the philosophy itself. e.g. insufficient time for team care planning and communication can lead to blurred lines of responsibility, errors and fragmented patient care.
  36. 36. PRIMARY NURSING • Primary Nurse assumes 24-hour responsibility for planning the care of one or more patients from admission or the start of treatment to discharge or the treatment’s end.
  37. 37. • A.K.A Relationship-based Nursing. • Provides total direct care for patients. • Requires a nursing staff made up of only Nurses.
  38. 38. • Developed in the 1970’s and uses some concepts of total patient care and brings nurses back to the bedside to provide clinical care.
  39. 39. Primary Nurse Patient Charge Nurse Health Care Organizations Resources Associate Nurse (Days) Associate Nurse (Nights) Associate Nurse (Evenings) Physician
  40. 40. • Associate Nurses – follows the care plan established by the primary nurse when the primary nurse is not on duty. • This structure lends itself well to home health nursing, hospice nursing and other health care delivery enterprises.
  41. 41. • Clear interdisciplinary group communication and consistent, direct patient care by relatively few nursing staffs allows for holistic, high-quality patient care. • High job satisfaction.
  42. 42. • Disadvantages in this method lie in improper implementation. • Many nurses may be uncomfortable in this role due to lack of experience and skills necessary for the role.
  43. 43. CASE MANAGEMENT
  44. 44. • Introduced in the 1970’s by insurance companies as a method to monitor and control expensive health insurance claims. • Today virtually every major health insurance company has a case management program to direct and manage the use of health care services for their clients. • Known as external case management.
  45. 45. • Mid 1980’s hospitals had recognized the need for a case management model to manage treatment plans and length of stay of hospitalized patients. • This was called internal case management or case management “within the walls” of the health care facility.
  46. 46. What is… • A collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes (CMSA, 2006)
  47. 47. • Focus is on individual patients, not populations of patient. • Case managers handle each case individually, identifying the most cost-effective providers, treatments and care setting.
  48. 48. • Case Management Nurses can choose to specialize in treating people with diseases like HIV/AIDS or cancer, or you can work with patients of certain age groups like geriatrics or pediatrics.
  49. 49. • ACUTE-CARE CASE MANAGEMENT– integrates utilization management and discharge planning functions and may be unit based, assigned by patient, disease based, or primary nurse case managed.
  50. 50. • Additional work efficiency due to geographic proximity, but more importantly, the benefit of establishing solid working relationships with the nursing and ancillary staff working on the unit. • In general a case manager can handle a load of 25 patients (Smith 2003)
  51. 51. • Use Critical Pathways and Multidisciplinary action plans (MAPs) to plan patient care. • Care MAP – combination of Critical Pathway and Nursing Care Plans. – This indicates the time when nursing interventions should occur and this must be followed by health care providers. – Variance – anything that occurs to alter the patient’s progress through the normal critical path.
  52. 52. • Cycle Time Reduction – involves reviewing the existing process that provides a product or service; determining wasted time or effort; and developing an improved, streamlined way to achieve the same results more efficiently. (Furlow 2003)
  53. 53. BECOME A… CASE MANAGEMENT NURSE GET YOUR… Case Management nurse certification from the American Nurses Credentialing Center PASS YOUR… National Council Licensure Examination (NCLEX-RN) GET YOUR.. Associate Science of Nursing (ASN) Bachelors of Science in Nursing (BSN)
  54. 54. • Effective case managers should have 3-5 years of direct care experience, preferably within the specialty area in which they case manage. (Smith 2003) • Role should be reserved for the advance practice nurse or registered nurse with advance training (Huston 2002)
  55. 55. Qualities of a Case Manager • Extremely Bright • Well-developed interpersonal skills • Able to multitask • Strong foundation in utilization review • Understands payer-patient specifics and hospital reimbursement mechanisms.
  56. 56. DISEASE MANAGEMENT • One role increasing assumed by Case Managers is coordinating disease management programs.
  57. 57. • DISEASE MANAGEMENT (DM) – also known as population-based health care and continuous health care improvement, is a comprehensive, integrated approach to the health care reimbursement of high-cost, chronic illnesses.
  58. 58. • Includes early detection and early intervention as well as comprehensive tracking of patient outcomes. • The difference of DM in Case Management is that the focus is on “covered lives” or populations of patients, rather than on the individual patient.
  59. 59. • GOAL: Serve the optimal number of covered lives required to reach operational and economic efficiency.
  60. 60. • National Committee for Quality Assurance (NCQA) – began an accreditation process in January 2002 for organizations that offer comprehensive DM programs.
  61. 61. Common Features 1. Focus is on prevention as well as early disease detection and intervention. 2. Population-based. 3. Employs multi-disciplinary health care team, including specialists 4. Use standardized clinical guidelines – clinical pathways reflecting best practice research to guide providers.
  62. 62. 5. Use integrated data management systems. 6. Frequently employs professional nurses in the role of case manager or program coordinator.
  63. 63. DIFFERENTIATED NURSING PRACTICE “Expecting similar performance from nurses with varying educational preparation can lead to role confusion, stress and burnout as nurses struggle to develop role competencies for which they have not been prepared.” (Fox 2003)
  64. 64. • Refers to an attempt to separate nursing practice roles based on education or experience or a combination of both.
  65. 65. 2 BASIC DIFFERENCIATED PRACTICE MODELS 1. Education Model • Differentiation is based on type of educational preparation (AND, BSN, MSN) • Components: Provision of Care, Communication and management. 2. Competency Model • Based on individual nurse skill level, expertise and experience. • Benner’s five levels of practice (1984) and 8 ANA standards of nursing. Also suggests the 21 Pew Health Professional Commission Competencies.
  66. 66. Rationale • To match patient needs with nursing competencies. • Facilitate the effective and efficient use of nursing resources. • Provide equitable compensation based on education, productivity and expertise. • Increase nurse satisfaction. • Build loyalty and increase the prestige of the nursing profession.
  67. 67. The Future for Patient Care and Delivery Models • Nurse as clinical expert leading other members of a team of partners.
  68. 68. • Creation of a new nursing role (the clinical- nurse leader) that is more responsive to the realities of the modern health care system. (Tornabeni, Stanhope, and Wiggins 2006)
  69. 69. • A cooperative model of care delivery through lay care partners. They are taught to recognize systems, identify problems and take action.
  70. 70. 5 Components of Determining the Model of Nursing Care Delivery (Reno et. Al 2005) A. Conversion of manual systems into automated ones. B. Differentiated levels of nursing practice. C. Increased knowledge base of nursing practitioners. D. Development of flexibility and nimbleness. E. Attraction of nursing candidates from a more diverse pool of professionals.
  71. 71. When Evaluating the Current System and Considering a Change…
  72. 72. • Is it in line with the organizational philosophy? Does it facilitate or hinder organizational goals? • Is it organized in a cost-effective manner?
  73. 73. • Will it satisfy the patient and their families? • Will it provide some degree of fulfillment and role satisfaction to nursing personnel? • Does it allow implementation of the nursing process?
  74. 74. • Does it promote and support the profession of nursing as both independent and interdependent? • Does it facilitate adequate communication among all members of the health care team?
  75. 75. • How will it change the patient care delivery system, alter individual and group decision making? Will autonomy increase or decrease? • How will social and interpersonal relationship change? • Will the employees view their unit of work differently?
  76. 76. • Will the change require a wider or more restricted range of skills and abilities on the part of the caregiver? • Will it change how employees receive feedback? • Will communication patterns change?
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