1. ASN 180 Transition to Professional Nursing Objective 4

2. Objective  Discuss issues in quality, access and cost of care.

3. Factors Influencing the Delivery of Health Care  Cost  Access  Quality  Nursing Supply and Demand

4. Responses to Health Care Changes  Nursing Agenda for Health Care Reform –Health care services in environments that are easily accessible, familiar, and consumer- friendly –empowerment of consumers for self-care  Public versus Private Programs –Nursing supports integration –National standards needed

5. Responses to Health Care Changes, cont.  Vulnerable Populations –Children –Older adults –People with AIDS –Homeless –People living in poverty –Rural –Unemployed

6. Responses to Health Care Changes, cont.  Community Nursing Organizations (CNOs) –HCFA funding – 1992 –Nursing organizations that bridge healthcare gaps for uninsured and indigent  North Carolina Maternal and Child Health Migrant Project –nurses train women in migrant camps to provide health teaching and first aid

7. Quality Management in Health Care  Defining Quality –Quality = “Meeting or exceeding requirements of the customer or client.” –Performance Improvement = “Those activities and behaviors that each individual does to meet customers’ expectations. It is doing the right thing well and continually striving to do better.” JCAHO

8. Defining Quality, cont.  Quality Management  Quality Assurance (QA) – monitors individual performance and deviation from standards, focus on problem-solving  Continuous Quality Improvement (CQI) – scientific, data-driven approaches are used to study work process that lead to long-term improvement  Total Quality Management (TQM) – the method of management and system operation used to achieve CQI

9. Factors Influencing Quality in Health Care  Consumer Demands  Financial Viability  Professional Accountability  Regulatory Requirements  Progress in Quality Improvement Techniques  Changes in Health Care Delivery  Legal Implications of Quality Improvement

10. Quality Management in Health Care, cont.  Quality and Health Care Economics –Duplication, lost time and resources, litigation –Poor quality negatively affects reimbursement  Principles of Quality Improvement –Organizational culture for quality improvement  Customer Satisfaction –Tarnished reputation –Loss of business

11. Organizational Structure for Quality Management  Factors that affect quality management –Organizational culture – positive; formal and informal –Workforce diversity –Empowerment –Leadership – create the culture –Teamwork  Functional team – unit/department specific  Cross-functional team – interdepartmental/ multidisciplinary

12. Process Improvement  Tools for Measuring Quality –Audit – reviewing client records –Peer Review – colleagues evaluating care –Benchmarking – measuring against competition –Clinical Pathways – measure performance against outcomes

13. Nursing’s Role in Quality Management  The primary purpose of nursing is to provide quality care to clients.  Provide leadership roles  Participate in every phase from providing quality care to monitoring/auditing and CQI

14. Trends in Health Care Delivery  Change and chaos  Current debate in congress will shape health care throughout the U. S. for the future

15. Objective  Discuss issues in quality, access and cost of care.