The document summarizes a study that redesigned nursing care delivery models on medical-surgical units to be more efficient and lower cost while maintaining or improving quality. The study trained nursing staff to work in RN-led teams and utilize each member's full scope of practice. Results showed improved clinical outcomes, patient experience, and nurse satisfaction, along with reduced costs from lower salaries and shorter lengths of stay. The redesigned model supported transitioning to a value-based healthcare system through innovative changes to nursing care delivery.

1. Care Redesign Article and Answer the following questions
Care Redesign Article and Answer the following questionsCare Redesign Article and Answer
the following questionsRead the Care Redesign Article (Will attach)Answer the following
questions:Which four (4) components does the article point out are needed for the U.S.
healthcare system to succeed?The one recommendation form the ten cited in the Institute of
Medicine Report to improve quality and reduce cost that is described in the article?A recent
factor to be identified of reducing cost is?Name four (4) factors that influence patient
outcomes described in the article.Name the four (4) different nursing care delivery models
and give a short description of each.What is the meaning of the term “lean” as described in
the article.Summarize the method utilized in the study to offer a higher-quality and lower
cost method for acute care in just a few sentencesJONA Volume 44, Number 7/8, pp 388-
394 Copyright B 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins THE
JOURNAL OF NURSING ADMINISTRATION Care Redesign A Higher-Quality, Lower-Cost
Model for Acute Care Pamela T. Rudisill, DNP, RN, NEA-BC, FAAN Carlene Callis, BS, MHA
Sonya R. Hardin, PhD, RN, CCRN, NP-C Jacqueline Dienemann, PhD, RN, NEA-BC, FAAN
Melissa Samuelson, DNP, RN, NEA, BC OBJECTIVE: The aims of this study were to design,
pilot, and evaluate a care team model of shared accountability on medical-surgical units.
BACKGROUND: American healthcare systems must optimize professional nursing services
and staff due to economic constraints, evolving Federal regulations and increased nurse
capabilities. METHODS: A redesigned model of RN-led teams with shared accountability was
piloted on 3 medical/surgical units in sample hospitals for 6 months. Nursing staff were
trained for all functions within their scope of practice and provided education and for
implementation. RESULTS: Clinical outcomes and patient experience scores improved with
the exception of falls. Nurse satisfaction demonstrated statistically significant improvement.
Cost outcomes resulted in reduced total salary dollars per day, and case mixYadjusted
length of stay decreased by 0.38. CONCLUSION: Innovative changes in nursing care delivery
can maintain clinical quality and nurse and patient satisfaction while decreasing costs.
Healthcare systems in the United States must bridge the transition from volume to value-
based models. Care Redesign Article and Answer the following questionsORDER NOW FOR
CUSTOMIZED, PLAGIARISM-FREE PAPERSComponents required to succeed include clinical
integration, implementation of technology, and clinical performance improvement with
operational efficiencies to manage financial constraints.1 Nursing services encompass the
majority of the workforce in today’s acute care hospitals.2 Historically, models of care have
been based on a mix of registered nurses (RNs) and unlicensed assistive personnel (UAP)

2. with occasional reference to licensed practical nurses (LPNs) and the assignment of
workload. Evidence s that patient needs are best met by planned skill mix and recognition
that nurses are knowledge workers and need to be utilized in that manner.3,4 Models-of-
care redesign that embeds improving efficiency and increasing accountability to patients’
clinical outcomes requires a cultural transformation.1 All major changes in care design
should be evaluated for their evidence-based and desired changes. The purpose of this
study was to evaluate a pilot implementation of a shared accountability delivery model for
medical-surgical patients that allowed licensed nurses and UAP to practice at their full
authority through delegation and collaboration in RN-led teams. Author Affiliations: Senior
Vice President and Chief Nursing Officer (Dr Rudisill), Community Health Systems, Franklin;
and Assistant Vice President Strategic Resource Group, Vice President Strategic Planning
American Group (Ms Callis), HCA, Nashville, Tennessee; Professor (Dr Hardin), College of
Nursing, East Carolina University, Greenville, North Carolina; and Professor Emeritus (Dr
Dienemann), School of Nursing, UNC Charlotte and Nurse Researcher Carolinas Medical
Center University, North Carolina; and Chief Nursing Executive (Dr Samuelson), Poplar Bluff
Regional Medical Center, Missouri. Community Health Systems is a registered trade name of
Community Health Systems Professional Services Corporation. The authors declare no
conflicts of interest. Correspondence: Dr Rudisill, Community Health Systems, 4000
Meridian Blvd, Franklin, TN 37067 (pamela.rudisill@hma.com or pam_rudisill@chs.net).
Care Redesign Article and Answer the following questionsDOI:
10.1097/NNA.0000000000000088 388 Background The healthcare system in the United
States is in a state of rapid and unprecedented change with pressures to improve clinical
quality and patient health and increase patient satisfaction, while curtailing costs. The
Institute of Medicine report5 cites 10 recommendations to ensure better health, higher-
quality care, and lower costs. One recommendation was to optimize operations by
continually improving healthcare operations to reduce waste, streamline care delivery, and
focus on activities that improve patient health. The primary challenge of delivering care in
acute settings is managing increasingly JONA Vol. 44, No. 7/8 July/August 2014 Copyright
© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction
of this article is prohibited. complex patients with shorter lengths of stay (LOSs) while
ensuring integration of care upon discharge and beyond. Recent studies demonstrate that
lowering costs is dependent on increasing patient safety rather than changing nursing
salary or staffing expenses.6 Nursing factors influencing patient outcomes include number
of hours per patient-day (number of staff), quality of work environment, educational level of
nurses, and mix of skills among nursing staff. These factors interact among each other with
varying effects on patient outcomes.7-11 Increasingly, nurse satisfaction is related to
recognition that RNs are knowledge workers whose time should be utilized in decision
making regarding patient care and safety.4 team realized several approaches underutilized
RN delegation, did not utilize LPNs at all, and did not require RNs, UAPs, or LPNs to practice
to their full scope. We did identify 1 computer simulation model utilizing the RN, LPN, and
UAP, which incorporated principles of the lean to enhance the role of the RN, LPN, and UAP
in the care delivery of patients.20 Lean is a concept adapted from manufacturing to
streamline processes, reduce cost, and improve care delivery. Each process must add value

3. or be eliminated as waste (or muda in Japanese) so that ultimately every step adds value to
the process.21 The simulation demonstrated that teams of RN, LPN, and UAP assigned in a
mix to fit patient acuity of a group of patients wasted less time than patient allocation
assignments. Nursing Care Delivery Models Delivery of nursing care has traditionally been
delivered in 1 of 4 ways.12-14 Shirey14 discusses the advantages and disadvantages of
various models. The earliest model is patient allocation or total patient care with groups of
patients assigned to 1 nurse with no UAPs. Because of shortages during and after World
War II, task or functional nursing was emphasized, allocating more complex care to RNs and
routine care to UAPs. Team nursing evolved with RNs as leaders of UAPs for a group of
patients. Primary nursing identified 1 nurse to assume 24-hour responsibility for a patient
with communication to RNs, LPNs, and UAPs who participated in care throughout the
patient stay. This model of care has been coined relationship-based care.12 One new, novel
approach is to expand primary care to coordinating care after discharge, with the RN
assuming care as the primary nurse for readmissions.14,15 This model of care fits in the
new modes of accountable care transition coordination. The recent Institute of Medicine
report on the future of nursing16 advocates for RNs to perform to their fullest potential and
to become effective leaders and partners in the organization. This parallels the American
Organization of Nurse Executives guiding principles for the role of the nurse in future
patient care delivery.17 These position statements call for new innovative models of
nursing care delivery. In 2005, Partners Healthcare in Boston, Massachusetts, conducted a
search of innovative nursing care delivery models for adult, acute care patients that
integrated technology, systems, and new roles to improve quality, efficiency, and cost.
They identified over 40 models that shared common elements of an elevated RN role,
sharpened focus on the patient, smoothed patient transitions and handoffs Care Redesign
Article and Answer the following questions