NR 506 Drivers of High Performance Healthcare Systems DQ

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NR 506 Drivers of High Performance Healthcare Systems DQ

NR 506 Drivers of High Performance Healthcare Systems DQ

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Select two drivers (for example quality, cost, and access) of high performance healthcare systems and apply it to your current work situation. The application could demonstrate the presence of the driver in a positive manner or it could acknowledge the presence of a concern.

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Chamberlain College of Nursing NR-506 Health Care Policy
Drivers of High Performance Healthcare Systems (graded)
Select two drivers (for example quality, cost, and access) of high performance healthcare systems and apply it to your current work situation. The application could demonstrate the presence of the driver in a positive manner or it could acknowledge the presence of a concern.
Cost and quality are two important drivers with healthcare. Unfortunately, everything has an associated cost factor.
The question becomes how do you balance expense to ensure good quality?
Give work related examples
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from
? Chapter 16:The Changing United States Health Care System
? Chapter 17: A Primer on Health Economics of Nursing and Health Policy
? Chapter 18: Financing Health Care in the United States
? Chapter 34: Filling the Gaps: Retail Health care Clinics and Nurse-Managed Health Centers
? Chapter 41: How Government Works: What You Need to Know to Influence the Process
Teitelbaum, J. & Wilensky, S. (2017 ). Essentials of health policy and law (3rd ed.). Retrieved from
? Chapter 4: Overview of the United States Healthcare System
? Chapter 5: Public Health Institutions and Systems
Blumenthal, D., Abrams, M., Nuzum, R. (2015). The Affordable Care Act at 5 Years. The New England Journal of Medicine, 372, 2451-2458. doi: 10.1056/NEJMhpr1503614 link to article
Buerhaus, P. I. (2010). Healthcare payment reform: Implications for nurses. Nursing Economics, 28(1), 49-54. link to article
Gardenier, D. (2012). Can clinical nurse practitioners be involved in policy making? The Journal for Nurse Practitioners, 8(3), 198-199. doi: link to article
Hughes, A. (n.d). The challenge of contributing to policy making in primary care: the gendered experiences and strategies of nurses. Sociology Of Health & Illness, 32(7), 977-992. link to article
Strech, S. & Wyatt, D. (2013). Partnering to lead change: Nurses’ role in the redesign of healthcare,AORN, 98(3), 260-266. link to article

Page or paragraph numbers must be included with quotes per APA. See APA re how to format references and in-text citations i.e. capitalization issues and use of the ampersand versus the word (“and”).
Including at least one in-text citation and matching reference.
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During this week’s lesson, the focus will be on understanding U.S. healthcare as a complicated and unique combination of open and closed systems. Students will compare and contrast the U.S. system with healthcare delivered in other developed countries. In addition, the various levels of government will be considered for their impact upon healthcare policy. As the week progresses, consider how you can develop your healthcare policy plan more effectively by applying the concepts presented in this lesson.
The U.S. Healthcare System
Healthcare is a multifaceted delivery system that is convoluted and interrelated. One aspect of the system cannot be altered without impacting other aspects of the system. In other words, you may address a gap in a specific area which results in another area being either intentionally or unintentionally impacted. For example, giving greater access to healthcare would have a huge benefit to improve healthcare outcomes, but at the same time, it could over burden emergency departments with non-emergency healthcare issues. This is one reason why the healthcare debate is so intense.
The healthcare system in the United States is a patchwork of private and non-private facilities. Some of facilities are for-profit and some are non-profit. While a limited number of facilities are managed by governmental agencies at the federal, state, and local level, the majority of healthcare facilities in the U.S. are privately owned.
Our complex system is very advanced, but it comes at a high price. For some people, healthcare is not affordable, and their access to it is limited. These are interesting issues to explore as we discuss and compare the U.S. system of healthcare with other developed countries. Any open system has many external interactions while it receives input from and gives output to surroundings. In contrast, a closed system has more limited interactions with its environment. For example, many consider healthcare within the Veterans? Administration to be a closed system.
Open and closed systems coexist in the U. S. system of healthcare. And although the U. S. system is more open than closed, it has features of both. Much of this mixed-system design evolved from our historical roots of individualism and a general dislike and distrust of centralized government. To make matters even more interesting, there are vast differences from state to state in terms of acceptance of health maintenance organizations (HMOs). Before technology exploded in scope and costs, our healthcare system was manageable. Take a look at an old black-and-white movie from the 1930s and 1940s and note how people seriously injured in automobile crashes who spent weeks in a hospital paid in cash on their way out! What happened in this country over the past several decades to make healthcare so expensive?
With today’s escalating costs, a number of people are simply shut out of healthcare, especially those who are not old enough to qualify for Medicare benefits and not quite poor enough to qualify for Medicaid benefits. This is a current issue in today’s policy world, and several states have addressed this gap by lowering the annual income for Medicaid assistance.
In order to pay for healthcare services, some other developed nations create various combinations of taxes and private, national, and out-of-pocket funding to provide basic healthcare for all citizens. Still, even in the United Kingdom, which has a National Health Service, some citizens buy private healthcare policies in order to pay for services above and beyond what the government supplies. Significant portions of personal income taxes help support basic healthcare for the masses, and benefits are limited to what is considered standard. In other words, the average citizen is not eligible for the level and type of advanced, high-tech healthcare services that we in the United States?at least those of us fortunate enough to have solid health insurance?have come to expect.
What do you think about healthcare systems available in other developing countries? What are the positive and negative aspects of each system? Consider how much of our healthcare dollar in the United States goes toward treatment of end-of-life illness. How are such cases handled in these other countries? Does the U.S. healthcare system need to be fixed? Is it out of control in the first place? What parts work best and why? What attempts have been made in the past to overhaul our healthcare system? Why was it unsuccessful? In order to explore these issues more deeply, one must first have a solid grasp of the U.S. government and how it works.
With such a complex healthcare system, how does one go about evaluating it?? Within your textbook the areas of quality, access and cost are presented as evaluation parameters. While each of these could be a large and intense discussion, a quick review would note the following information.
Quality of care is a huge parameter that is frequently discussed in terms of prevention (i.e. no pressure ulcers, no medication errors, and no post-operative pneumonia, etc.). There is a growing trend to consider quality of care with reference to the positive outcomes of the provided interventions. For example achievement of appropriate self-care actions or demonstration of health promotion behaviors would all be examples of patient outcomes that define quality. However, any discussion about quality of care cannot occur without considering patient safety. In fact, it has been suggested that the elements of quality care and patient safety cannot be separated because it is not possible to demonstrate quality care if patient safety is absent.
Access refers to the ability to obtain needed, affordable and effective health care in a timely manner. While economics is part of accessibility, it is also important to consider distance. Many individuals in rural areas simply cannot access healthcare because it is not available. A newer term of equity is being used because it refers to the attainment of the highest level of health for all people. Within the U.S. healthcare system, many healthcare disparities or gaps are present, but resources are limited.
Cost of healthcare must be considered from the viewpoint of consumers, healthcare providers, and developers of healthcare products (i.e. new medications). With growing technology, cost is also increasing, but many wonder if efficiency is also improving or decreasing. There is also concern about the proportion of the healthcare cost that is financed by individuals, government, and business (i.e. third party payers).
The United States is composed of 50 states and three major levels of government. Our federal government sets national laws, and each state establish- its own laws while operating under the federal guidelines. State legislators can interpret their respective state’s rights fairly liberally. At the local level, cities establish local laws. With all of this, each level of government impacts other levels?a true open system! When it comes to healthcare and funding issues, it is imperative that nurses understand this structure. Remember that laws need to be funded and regulations must be in place to be implement the law. Politics and policy making are all about individuals with differing values competing for scarce resources.
Consider why the Clinton healthcare reform initiative of the 1990s and other historical healthcare reforms failed. What successes has the Obama administration had in healthcare reform? What has led to successful passage of legislation? In addition to our discussion so far, consider the group of stakeholders who had the most to lose with a change to the status quo.
Special interest groups play a role in policy and politics. What professional association was first on the list of the top 10 healthcare contributors to federal candidates and parties in recent elections? Look at all ten of those contributors and consider which political party (Republican or Democratic) received the lion’s share of those contributions and why. Where was nursing? Which political party do you think most nursing associations support? Why might that be true? Start to connect the dots and fully realize how interest groups will go to great lengths to protect their pieces of the pie. As you know by now, special interest groups can be extremely powerful entities. Those top ten professional associations listed all have a stake in the status quo, especially as baby boomers age and require more healthcare services.
But can the United States sustain the current methods of healthcare provision for its citizens? In a country that prides itself on a free-market enterprise, the focus has been on illness care versus wellness care. Our healthcare system is designed to provide expensive, highly technical, and problem-focused care. In fact, our system is basically funded using the illness model. What incentive exists, if wellness becomes the focus, to continue funding research for more expensive high-tech care and pharmaceuticals? Who can make money when people are healthy? If we begin in earnest to teach and work with individuals to promote health and prevent illness, a whole new paradigm of healthcare would emerge. But it would indeed take a paradigm shift, and individuals would need incentives to take responsibility for their own health. Personal responsibility cannot be legislated. What kinds of disincentives could be called into play? An important consideration is application of this information to vulnerable populations. With the economic downturn, more people are doing without critical health screenings and illness-prevention care as they simply cannot afford it. What kinds of dire consequences can we expect as a result? Who pays in the end, both in dollars and in lives?
How is this important to nurse advocates? Please review the healthcare payment reform article and its implications for nurses. Do you agree with the implications for nurses? First and foremost, it is important that nurses must have a firm understanding about how government works at all levels. In planning for policy change, understanding each level of government and the interconnectedness of local, state, and federal government is essential in determining strategy. Advocacy at the national level can impact the state and local levels and vice versa.
If you are new to the world of policy making and politics, you may want to start your advocacy efforts on a local level. If you work in an institution in the private sector and are concerned about nurse-patient ratios or other related work-environment issues, examine state NR 506 Drivers of High Performance Healthcare Systems DQ

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Public Health Systems in the United States
The goals and services of the public health systems in the United States are multifold and include (Teitelbaum & Wilensky, 2017):
? Prevention from epidemics and spread of disease
? Protection from environmental hazards or any threats to public health
? Prevention of injuries
? Health promotion
? Disaster response and community recovery
? Quality care
Public health systems in the United States operate on a local, state, national, and global level. It is the primary responsibility of public health to organize and support community based healthcare efforts. Public health provides a rich framework for healthcare policymaking and interfaces with nursing on a daily basis.
Policy Change in the Workplace
Advocating for workplace or private-policy change can be challenging, especially if the policy issue is confined to the institution itself. Each workplace can have its own unique policies and procedures at every level, and the politics involved can directly influence attempts at change. Can you see how similar this is to public policy?
It is human nature to put off any type of change unless and until one sees a significant need for it. In general, people enjoy maintaining the status quo unless it becomes problematic. Anticipatory change involves vision and taking a proactive stance. It saves money and is less taxing to those involved, but it’s difficult to implement because the status quo does not seem so bad. By the same token, reactive change is easier to implement; it is, therefore, more costly and damaging to those individuals involved. Crisis change is much easier to implement, because it is clear that there is a problem that must be immediately resolved, but the costs and general toll on the organization and individuals involved is huge. There is a sense of chasing one’s tail in crisis change, and the energy drain that occurs takes away from the organization’s ability to grow and move forward.

Leadership and acting as an agent of change in the workplace environment involves understanding the politics, values, and culture involved. Communication skills are essential, and knowing how to delegate to the right people is critical. People skills and a healthy emotional intelligence (also known as EQ) are also vital skills for workplace advocacy and change. Valuing and empowering people and knowing how to strike a balance to determine what really important keeps the leader focused is.
Consider the case study below. You are the nurse leader in charge of changing policy in this situation. What type of change does this represent? Where would you start and why? What issues do you anticipate? What levels of government might be impacted and why? Does this institution represent an open or closed system?

This case study exercise represents a very real dilemma for us all. At a time when the average citizen has limited access to basic healthcare, spending millions of dollars, as in the above situation, may involve policy change. Ethical considerations abound in this scenario in regard to freedom. Depending upon the type of system, what issues may impact change? What peripheral costs could be anticipated in this case, immediate and in the future? Who is responsible?
Next week, we will examine more closely the effects of the news media on policy making, as well as issues impacting the workplace. Professional nursing organizations will also be discussed as platforms for strategizing for effective change. Remember, the most powerful and wide-ranging cha

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