Introduction and background

Healthcare centers all over the US have been looking for cost- cutting techniques whilst simultaneously retaining the superior quality of their patient care delivery. Considering the present economic scenario, cost- cutting is vital for healthcare organizations’ continued functioning. An estimated growth in the number of patients lacking the funds to pay for services and Medicare/ Medicaid reimbursement decline together contribute to a financially trying time for the health sector. Facilities’ inability to be proactive in responding to the aforementioned shifting trends may result in dramatic cuts, capable, successively, of greatly limiting small communities’ access to health care. Such a scenario compels healthcare organizations to come up with creative solutions to save, financially. Making adjustments to a facility’s nurse assistant, registered nurse (RN) and licensed nurse practitioner skills mix in a given nursing unit may facilitate the delivery of more effective patient care, thereby enhancing both provider and patient satisfaction (Gier, 2013). Without a sound, competent nursing workforce, healthcare organizations’ care delivery expenses increase in numerous ways. Increased personnel resignations, for instance, mean greater expenditure in the area of recruiting and training. Further, salary hikes are typically needed to draw in fresh candidates (Berlin & Grote, 2013).

Healthcare facilities need to endeavor towards improving their patient flows, decreasing hospitalization duration of patients, and employing more bedside tools and techniques. Planning and developing evidence- based practices necessitates a critical analysis of proofs from prior studies, followed by integrating those proofs with patient requirements and the clinical expertise of nursing staff. Another important factor is the healthcare facility’s extant financial standing. Modern- day patients are more knowledgeable on medicines and treatment as compared to their forebears, which naturally means they anticipate efficient, superior- quality care. Nurse care theories offer the basis to plan and deliver patient care. Furthermore, they are a reflection of the current company culture’s and patient care’s philosophical basis. Nurse care is grounded in every consumer’s unique evolving requirements and condition. Patient care necessitates better planning, interdisciplinary teamwork and coordination. Lastly, the care delivery model adopted impacts human resource numbers, their flexible utilization and, consequently, organizational spending (Mattila et al., 2014).

Proposed solution

Traditionally, medical- surgical divisions have depicted high RN percentage in comparison to other direct- care provider skill levels. RNs perform a large number of functions that nurse assistants are generally not assigned. Several such functions actually belong to nurse assistants’ practice scope and ought to be assigned for the delivery of more effective patient care. The move towards a team care delivery model enables three-member units (which could be 2 RNs and 1 nurse assistant, or 1 nurse assistant, RN and Licensed Practical Nurse (LPN) each) to shoulder the responsibility of caring for a fixed patient cluster. Such a novel model of patient care delivery has the potential to ensure nursing staff deliver improved patient care owing to the fact that nurse assistants can then fulfil their patients’ fundamental needs in a quicker and more effective manner; further, LPNs and RNs involved would enjoy more time for carrying out the tasks critical for their part. The above skills mix can also enhance patient care quality outcomes. With the adoption of the “Purposeful Rounding” practice, nurse assistants can be proactive in their anticipation of patient requirements, fall prevention and reduction in pressure ulcer occurrences. This successively reduces hospitalization duration and overall organizational expenses (Fowler, Hardy & Howarth, 2006). Cost cutting thus enjoyed could be actual cash as well as savings associated with a reduction in healthcare institution- acquired complications.

Akin to other healthcare providers, nursing personnel will typically exhibit dissatisfaction with their jobs in the absence of appropriate involvement with their organization. Collective governance may be counted among the strongest tools which may be employed in increasing nurse engagement, as it accords them increased autonomy, allows them to express their opinions and ideas with regard to workplace conditions, and allows them to team up with other people over an institutional area or unit. Essentially, the concept of collective governance aids nursing personnel in collectively speaking out and contributing to their workplace atmosphere, thus reinforcing their capacity of bringing about patient care improvements (Berlin & Grote, 2013).

Proposed change process to implement delivery model

The changes put forward employ the change theory of Kurt Lewin. The theorist segregated change into the following phases: 1) Unfreezing; 2) Moving; and 3) Refreezing. The first phase entails considerable planning for ensuring acceptance of change and equipping people to adapt to it. Unfreezing necessitates involvement of front- line personnel and assisting them in realizing the need for change. Moving, which is the next phase, entails the implementation of planned change. This stage involves the crucial activities of conversing with the workforce and educating and training them to guarantee project success. The process will incorporate workforce support via group training and delegation, in addition to reinforcement of primary customer (i.e., patient) service skills. Nursing staff must be cognizant of techniques for efficient, proper delegation and its associated answerability (Potter, DeShields, & Kuhrik, 2010). Change implementers need to meet with all nurse assistants for making sure they clearly understand their duties and their accountability as regards their individual performance. Conveying the fluidity of the change process to the workforce is imperative. They need to know that their feedback has weight in this respect. Admitting to the workforce that a first attempt might be ineffective lets personnel realize the import of their feedback and individual contribution. Refreezing or the final stage entails acceptance of change and its establishment as the novel standard in the team. This certainly is a process that cannot occur instantaneously. Further, one must expect several revisions before the final adoption. This necessitates due attentiveness by every worker, particularly departmental leaders, to remain up-to-date on the process, ensuring individual accountability for their participation (Gier, 2013).

Expected outcomes

Taking into account the advantages linked to change is pivotal. The aforementioned care delivery related change has numerous potential advantages with respect to transforming the model of patient care delivery to a team- based model from the prior primary care model, in a medical- surgical acute care department. Through adjustments to caregivers’ skills mix, a healthcare facility may be able to achieve potential savings in the form of actual cash, hospitalization duration, patient result quality, and institution- acquired complications. Moreover, model reform can prove beneficial to the workforce through the provision of extra resources for better facilitating patient care delivery. Such change major open avenues for collaborative efforts on the part of the workforce and a sharing of patient care responsibility by unit staff (Cioffi & Ferguson, 2009). However, most importantly, such change can prove advantageous to patients as more personnel will be at hand for fulfilling primary patient needs in a quicker, more effective manner. Patients do not remain mere care recipients any longer. Rather, they may be regarded as healthcare service consumers who take decisions depending on how satisfied they are with the care received (Wagner & Bear, 2008). ‘Proactiveness’ and timely anticipation of patient needs can eventually increase patient satisfaction, resulting in an overall improved care experience.

Implications

By employing a mix comprising of nurse assistants and LPNs or RNs within the field of medical-surgical acute care, improved patient safety and satisfaction outcomes may be achieved. This is because extra attention on the nurse assistant’s part may reduce institution-acquired cases of pressure ulcers, avert falls, and enhance overall patient experience. Additionally, the model enables LPNs or RNs to devote more time to educating the patient and effectively managing their medication and treatment. Patient satisfaction increases in significance when considering the long run, where Medicare/ Medicaid services reimbursement will partially be grounded in the element of patient satisfaction. Already, patient results are associated closely with reimbursement; in the near future, patient opinions regarding their overall care experience may also play a part. This shift may be cost-effective without foregoing quality, and may simultaneously improve patients’ care experience.

Considering the existing economic issues a large number of healthcare organizations all over America currently encounter, creatively examining alternatives capable of producing superior quality patient results at minimum institutional expense is vital. Medicare/ Medicaid reimbursement has been continually decreasing for several healthcare facilities, causing difficulties when it comes to meeting institutional operating margins. Organizational capability of enduring when faced with such rigid reimbursement conditions is crucial. Healthcare organizations must examine cost from multiple angles, which includes their approach to care delivery. Nurse units possess scant scope for cutbacks in their budgets as salary dollars make up the major part of these budgets. Thus, seeking innovative cost-cutting techniques is imperative. Care delivery reform concentrates on examining the skills mix and model reformation process within a chosen medical-surgical division; a team approach will be adopted that combines nurse assistants with LPNs or RN. Adopting a team-based patient care delivery strategy for managing acute care patients can greatly influence patient as well as workforce satisfaction. Improvements in workforce satisfaction will be able to aid in reducing workforce turnover rates, besides improving retention and recruitment (Gier, 2013).

References

Berlin, G., & Grote, K. (2013). Creating and sustaining change in nursing care delivery.

Cioffi, J., & Ferguson, L. (2009). Team Nursing in Acute Care Settings: Nurses’ Experiences. Contemporary Nurse, 33(1), 2-12.

Fowler, J., Hardy, J., & Howarth, T. (2006). Trialing Collaborative Nursing Models of Care: the Impact of Change. Australian Journal of Advanced Nursing, 23(4), 40- 46.

Gier, K. (2013). The Effects of a Care Delivery Model Change on Nursing Staff and Patient Satisfaction. Gardner-Webb University.

Mattila, E., Pitkänen, A., Alanen, S., Leino, K., Luojus, K., Rantanen, A., & Aalto, P. (2014). The effects of the primary nursing care model: a systematic review.

Potter, P., DeShields, T., & Kuhrik, M. (2010). Delegation Practices between Registered Nurses and Nursing Assistive Personnel. Journal of Nursing Management, 18, 157-165.

Wagner, D., & Bear, M. (2008). Patient Satisfaction with Nursing Care: A Concept Analysis within a Nursing Framework. Journal of Advanced Nursing, 65(3), 692- 701.