1. ISBN: 1-4180-0133-3

2. Chapter 1 Health Care Delivery for the 21 st Century

3. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.3 Health Care Delivery 1980 - Present Professional and nonprofessional workers provide patient care Before the mid-1980s: –Health care facilities had many departments –Each department provided a distinct service

4. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.4 Workplace Reorganization Changes in health care delivery require nurses to learn new procedures Unlicensed nursing care workers require advanced technical skills –Requires multi-skills and cross-training

5. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Effects of Workplace Reorganization Fewer workers provide a broader spectrum of services These changes to health care delivery are called: Workplace redesign Restructuring Re-engineering

6. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Patient-Focused Care Brings services to patients instead of bringing patients to services Is more cost effective then older systems Is more flexible in meeting patient needs Empowers workers to make more decisions

7. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Quality Assurance Internal reviews to identify problems and find solutions for improvement Each facility has a name for this process: –Process improvement –Quality improvement (QI) –Continuous quality improvement (CQI)

8. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Benchmarking Compares services with other similar organizations to: –Improve processes –Achieve excellence A standard reference point to measure performance

9. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Quality Indicators (QI) decision-making and research tools –Measurable items that reflect the level and type of services a facility provides –Can be modified if a facility is unhappy with its results

10. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Adverse Events –Negative events associated with patient care –May be deliberate or accidental Close calls –Events that could have had a negative effect on the patient but did not –Called “near miss”

11. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Adverse Events Intentionally unsafe acts result from: –Criminal activities –Purposefully unsafe acts –Alcohol or substance abuse –Abuse or neglect

12. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Adverse Events Root cause analysis –Process for investigating an incident that had an unfavorable outcome –Intense, focused review of unsafe acts, adverse events, close calls, or sentinel events

13. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Adverse Events Sentinel events are the most serious and can result in: –Patient death –Serious physical or psychological injury –Risk of death or serious injury

14. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Standards of Care Standard of care –Reasonable, prudent action based on education and experience Negligence –Failure to act in accordance with standard of care –Accidental or deliberate

15. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Malpractice –Failure to abide by standard of care, resulting in injury to the patient –Scope of practice is described in your job description –Health care workers are ethically responsible to maintain competence

16. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Age-Appropriate Care You must provide care appropriate to age of patient Three areas of care relative to patients’ age: –Communication –Safety and security –Personal care and comfort

17. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.17 Professional Boundaries Limit and define how workers interact with patients –Identify boundaries –Avoid taking advantage of a patient’s situation –Avoid inappropriate involvement with a patient and/or family

18. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.18 Family Dynamics Family is an extension of the patient Family adjustments must be made when a loved one is admitted for health care Can be a very emotional time –Relief in getting the needed health care –Guilt for being unable to care for a loved one

19. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.19 Developmental Tasks Intellectual, social, and emotional skills must be accomplished Tasks become more difficult as we age Depending on diagnosis, length of stay, and condition, not all patients will complete tasks during their stay