consists of human and physical resources( nurses and nursing, medical practicions, hospital building and medical records , pharmicuticals)
includes the quality of the
• Process performed writhen the health care structures ex.
o Hospital admission,
o surgical operation
o nursing and medical care delivery following standards and guidelines to achieve quality outcome.
Outcomes 4 items
it is component of health care , which refers to the research of good care delivery achieved by using quality structure and quality process and includes the achievement of outcomes such as
• patient satisfaction,
• good health and
• functional activity ,
• absence of health care acquired infections and morbidity.
The World health organization has put forth three primary goals for good health.
1. Ensure that health status of everyone is the best that is possible across lifespan
2. Respond to patients expectation of respectful treatment and include a focus on the pt by health care clinician
3. Provide finicial protection for everyone to pay.
Foundation of primary care
1. Care that is countinous
4. Community oriented
5. Family centered
6. Culturally competent
7. Begean with first contanct with the patient.
Changes in domain of the health care delievery system( hospital , clinic , home care)
Shorter hospital stay due to increased cost , increased usage of home care nursing. Increased usage of community nursing.
Predictors of health statues
Quality of life index- developed to meause the general health and well being of terminally ill individuals
Functional Status Questioner- self administered general health and social well being survey for ambulatiory patient
Duke health profile - which evaluates health status in primary care patients
Sickness impact profile- developed to measure changes in individual behavior as result of illness
Nottingham Health profile- developed as a measure of perceived general health status ofor primary care patients and general population
Content motivation theories
motivation in terms of satisfication of needs.includes Maslows needs hierarchy, model of gowth needs , relatedness gowth .
What is the the Hawthrone effect how is it benficial in health care outcome
Bright lights = higher production Low lights= high production Why? Because they were being watched.
Hawthrone effect is more productive when they are being watched.10. People benifet and more production when they participate in descion making.
Hersey and Blanchard's Theory(how used) 4 Theories
Consider follower readiness in determining leadership style.
Telling relationship style-
Selling leadership style
Participating leadership style-
Delegating Leadership style-
Telling relationship style-
use high task behavior and low relationship behavior. When a group with low maturity whose members are unable or unwilling to participate. Need leader a telling leadership style need to give direction and close supervision.
Selling leadership style
is a match for a group with low to moderate maturity, who unable but willing and confident , need clear direction and supportive feedback to get task done.
Participating leadership style-
is recommended for group with moderate to high maturity . who are able but unwilling or unsure and who need support and encouragement.
Delegating Leadership style-
group of followers with high maturity, who are ready and willing to participate and can engage in taks without direction or support.
Use of these 4 leadership helps a nurse manger assign work to others.
Theory Y(how used)(p22)
Leaders must remove obstacle because under the right working conditions the workers have self control and self discipline. The workers rewards are there involment in work and the opportunities to be creative.
Leader must direct and control because motivation results from reward and punishment. Prefer security, and minimal responsibility . Need coercion and tricks to get a job done.
Use collective decision making long term employment mentoring holistic concern and use of quality cirecle to manage service and quality.
Differences between leadership and management.
Leadership is about creating change and management is about controlling complexity in an effort to bring order and consistency. Leading change involves establishing a direction aligning people thru empowerment and motivation them. Management planning budgeting organizing and staffing problem solving and controlling complexity to produce predictability. Nurses are leaders.
Transformational leadership in practice.
Transformational leadership is a process in which leaders and followers raise one another to higher levels of motivation and morality. Transformation leadership theory is based on the idea of empowering together to engage in pursuing a collective purpose by working together to achieve a vision of preferred future. Two types o leader- transactional leader concerened with the day to day operations
Transformational leader- A leader who is committed to a vision that empowers others
Effective transformational leaders identify themselves as change agents are courageous believe in people are value driven are life long learners have the ability to deal with complexity.
.Lewin's leadership styles 3 leadership styles
2. Democratic leadership-
3. Laissez-Faire leadership-
Involves centralized decision making, with the leader making decision and using power to command and control others. Highly performing groups but feeling of hostility were often present
2. Democratic leadership
participatory with authority delegated to others. To be influential the democratic leader used expert power and the power base afforded by having close personal relationships. Engendered positive feelings in groupand performance was strong whether or not the leader was present.
3. Laissez-Faire leadership
is passive and permissive and the leader defers decision making. Associated with low productivity and feeling of frustration.
Qualifications for Medicare and Medicaid
Medicare Part A Medicaid
1. 65 years or older and has worked 40 quarters, includes that person spouse Certain Categories of low income people< 65 (mainly women of child bearing age and children)
2. Endstage renal disease People over age 65 the blind and totally disabledwho reveive cash assistance under the federal supplemental security income program
3. Totally and permanently disabled individuals( after receiving Social Security disability benefits for 2 years) State children's health insurance program . Children up to age 19 whose families earn up to $36,200 a year( for a family of four)
Medicare Part B
If pay monthly premium(out of pocket or via Medicaid if patient qualifies.)
Health care spending and cost containment measures
Factors contributing to rising health care cost
• Aging Population
• Increased Utilization of pharmaceuticals
• Technological Advances
• Rising Hosptials Costs
• Practitioner abailablity and Behavior
• Cost shifting
• Adminsitrative costs
Cost Containment Strategies-
Capitation and prospective payment have had some of the most sinigcant impact on cost containment.
is the payment of fixed dollar amount per person for the provision of health servies to a patient population for a specified period of time for example one year. .
Propective Payment System-
is a method of reimbursement in which Medicare payment is made based on a predetermined fixed amount for reimbursement to acute inpatient hospital home health agencies hospices hospital outpatient and inpatient psychiatric facilities inpatient rehab facilities long term hospital and skilled nursing facilities
Improvements in the process of care(How demonstrated)
Performance and quality is an essential component of health care improvement efforts. Measured to determine resource allocation.
2. Effective- provide services based on scientific knowledge to all who could benefit and refrain from providing services to those not likely to to benefit avoid over use and underuse.
3. Patient centered-Provide respectful and responsive care to individuals patient preferences needs and values must guide clinical decision makin
4. Timely reduce wait time and harmful delays for those who receice and give care
5. Efficient avoid waste for example of equipment supplies ideas energy and costly resources
6. Equitable provide care consistent in quality irrespective gender ethnicity geographical and socioeconomic factors
Health Care Accreditation Cirteria
Health care accreditation is a mechanism used to ensure that organization meet certain national standards. Seek accreditation to demonstrate their abilities to meet nation quality standards. Joint commission(JC) is the preeminent requaltory body overssing health care quality. Its review processed are extensice and payment to a hospital by government insurers of health care are dependent on the organization ability to meet JC standards with a high degree of compliance..
Healht Care Accreditiation Criteria Difference
• Enviorment of care
• Emergency management
• Human resource
• Infection prevention and control
• Information management
• Life safety
• Medication management
• Medical staff
• National patient safety goals
• Provision of care treatment and services
Public Reporting Findings(IOM)
Instiute of medicine provides independent, objective , evidence based advice to policy makers , health professionals the private sector and the public. Eight principles are intergral to health care reform .
• Scienticfic rigor
. ACE star Model
Is a frequently used model for evidence based practice that provides a framework for nurses to transition thru 5 stages of disvovery of evidence, evidence summary , translation, integration and evaluation
Purpose of practice protocols
• To describe appropriate care based on the best available scientific evidence and broad consensus
• To reduce inappropriate variation in practice;
• To provide a more rational basis for referral;
• To provide a focus for continuing education
• To promote efficient use of resources;
• To Act as focus for quality control, including audit;
• To highlight shortcomings of existing literature and suggest appropriate future research.
Levels of nursing management
A tirst level managerial role or function in health care organization is the nurse manager at the clinical bedside. First level nurse mangers spend the majority of time directly managing patient care and supervising others as they delivercare. Percentage of itime is spent on planning
Middle mlevel nurse mangager aften called nursing unit manager or nursing director spend less ime in direct supervion and more time in other managerial roles or function particulary planning and coordinating.
Highest level of the organization- usually described as the executive level roles in health care organization usually have the title chief nurse executive or in acute care hospitals the title may be vice president of pt care services.
. Leadership Qualitites
Vision , Passion and Integrity
• Vision- Leaders focus on professional and purposeful vivion that provides direction toward the preferred future.
• Passion- Passion expressed by the leader involves the ability to inspire and align people toward the promises of life. Passsion is an inherent quality of the nurse leader. Helps the patient and significant other live life to the fullest extent possible
• Integrity - based on knowledge of self,honesty and maturity that is developed thru experience and growth.
. Evaluation of Research for use
There are levels of evidence that identify the strength or quality of evidence generated from a study or report.
Level 1 - Systematic reviews or meta analysis of randomized controlled trials(RCTS) and evidence based clinical practice guidelines is consdider to be the stongest level of evidence upon which to guide decisions.
Level 11- Evidence obtained from at least one well designed RCT(Randomized controlled trial)
Level 111- Evidence obtained from well designed controlledtrials without randomization
Level 1V- Evidence from well designed case control and cohort studies.
Evidence based practice and care
Way to integrate individual clinical medical experience with external clinical evidence using a systemative research approach. A systematic critical appraisal of literature is an effective strategy for identifying recommendation for improving practice.
The Ace Star Model is frequently used model for evidence based practice.