Nursing Model Change in a Primary Care Unit

Introduction

Salmond and Echevarria (2017) state that primary care has received little attention due to policymakers’ focus on acute care. However, primary care is the core of the US healthcare system as these practitioners address various health problems (such as hypertension, diabetes, and numerous chronic conditions) and refer people to other specialists if needed. The efficiency of the system is doubtful, however, since the spending on the medical sphere is considerable, but patient outcomes are rather moderate. It has been estimated that a third of the money spent on medical care is a waste. The total annual losses of the healthcare system reach $750 billion (Salmond & Echevarria, 2017). These flaws indicate that the currently used models are not working anymore and new strategies should be developed.

Background of Issue

One of the indicators of the quality of care is the readmission rate. In the USA, approximately 20% of patients are readmitted within 30 days and almost 35% are readmitted within 90 days (Salmond & Echevarria, 2017). Understaffing and insufficient reimbursement result in a high turnover rate, which leads to the decreased quality of care delivered. The level of patient satisfaction at the department of primary care is decreasing. Currently, self-efficacy model is employed, but it has proved to be ineffective. Nurses lack skills and knowledge, as well as motivation, to provide care within the scope of this model.

The Proposed Solution

In order to improve the quality of the provided care, it is possible to change the current nursing model to the team-based patient activation framework. This model is characterized by the focus on patients’ needs, collaboration, and motivation (Bodenheimer, Ghorob, Willard-Grace, & Grumbach, 2014). Importantly, all the involved stakeholders including patients, healthcare providers, and policymakers should share these values. All of them should concentrate on patients’ needs, be motivated, as well as willing and prepared to collaborate.

Team-Based Patient Activation

The model involves the development of cross-functional teams involving physicians, nursing professionals, pharmacists, and other medical staff (according to the patient’s health condition). The functioning of these teams can be ensured through the use of a sophisticated information system. All the members of the team should have access to the information. Patients should also be able to access certain medical data. The coordination of care is vital and can be implemented by a nurse leader. One of the peculiarities of the model is its focus on patients’ needs. Salmond and Echevarria (2017) stress that the medical staff should not simply tell the patient what is needed, but ask about the patient’s priorities and expectations. One of the central points of the model is linked to funding as it requires proper reimbursement, which will result in medical staff high performance. Training and development will also be necessary as the medical staff may need to acquire new skills and knowledge.

How Solution Meets the Need of Population

Greene, Hibbard, Sacks, Overton, and Parrotta (2015) note that patients’ activation has a positive effect on patient outcomes as people’s compliance with treatment plans. It has been found that the rate of readmission among activated patients is considerably lower than that of inactivated patients. Greene et al. (2015) add that higher activation of patients translates into the reduction of costs. The increase of salaries will be instrumental in addressing such issues as turnover, inappropriate performance, and higher quality of the delivered care. Since the nurse-patient ratio will be increased, more people will be able to access high-quality care.

Proposed Change Process

Lewin’s model of change is suggested as a framework for change implementation. The first stage – unfreeze – will include the implementation of research aimed at collecting potential engagement of people, current performance, satisfaction levels, and so on. The discussions of the urgency of the problems and the proposed solution will be conducted regularly. The plan for the change process will be created based on the obtained evidence. The second stage of change implementation – change – will include the use of a more sophisticated information system that will ensure easy access of the stakeholders. The cross-functional teams will be formed based on the patient histories. Training is the key to the success of this model so the medical staff should be trained to communicate, collaborate, and treat patients. A research will be carried out to trace the changes related to patient outcomes and satisfaction, medical staff motivation and performance, costs, and readmission rates. If some flaws are identified, the implementation plan should be corrected accordingly. The final stage of the change process – freeze – will involve the creation of new standards. This new plan will be the foundation for new policies and guidelines to make the new model a part of the organizational culture.

Potential Challenges

As any other change, this model is likely to be associated with some challenges. People may be resistant to the change, so they may lack engagement or can even sabotage the implementation of the new framework. Proper communication and training will diminish resistance and make people believe in the benefits of the model. The lack of resources is another problem as insufficient funding can hinder the effectiveness of the new nursing paradigm. However, it is essential to communicate with the administration and make sure that funds will be allocated so that the changes could be implemented. The focus should be on the expected reduction of the costs of care in the short term. It can also be difficult to staff the department as people will be still unaware of the upcoming changes and new opportunities for them.

Expected Outcomes

One of the most important outcomes of the new model will be the activation of patients who will be motivated to change their behavior and lifestyles. The effective collaboration of the stakeholders will lead to the higher performance of healthcare professionals, as well as the satisfaction of the medical staff and patients. Reduced costs and lower readmission rates are also expected to be apparent within a year or two after the start of the project.

Implications

The implications of this project implementation are manifold and can be beneficial for the entire healthcare system. First, the new model will help in improving the quality of care provided at the primary care unit. The model that have been implemented in different settings will be applied to primary care. The project will also unveil the existing gaps related to such spheres as information systems, collaboration, and others. The need to allocate funds to implement the change will foster hospital administration to manage resources more effectively. The model can become a standard and be the foundation of the delivery of care in the USA.

Conclusion

The team-based patent activation model can shape the healthcare system and help Americans to achieve their goal make wellness (rather than treatment) their priorities. Nurse leaders can be the change agent and coordinate the process of transformation. The success of the new model will largely depend on the ability to communicate and collaborate effectively.

References

Bodenheimer, T., Ghorob, A., Willard-Grace, R., & Grumbach, K. (2014). The 10 building blocks of high-performing primary care. The Annals of Family Medicine, 12(2), 166-171. doi: 10.1370/afm.1616

Greene, J., Hibbard, J. H., Sacks, R., Overton, V., & Parrotta, C. D. (2015). When patient activation levels change, health outcomes and costs change, too. Health Affairs, 34(3), 431-437. doi: 10.1377/hlthaff.2014.0452

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopaedic Nursing, 36(1), 12-25. doi: 10.1097/nor.0000000000000308