With adequate leadership, atten­tion, and resources, improvements can be made.

Innovation and Future Models

"Nursing care delivery methods had been, over time, changed and adapted to better fit external forces and the balance of the needs of the clients and of the needs of the employed organization. With these changes  came variations in in assignment systems, skill mix, and the role of the nurse.  Future trends point to greater integration and multidisciplinary team collaboration models for service delivery as heat care reform drives changes in the organizations within the heath care industry" (Huber, 2009, p.455).

To Err Is Human: Building a Safer Health System, is a report on care delivery process' and structures that have become dysfunctional as the complexity of the healthcare system increases according to the Institute of Medicine.

Click HERE to read the full article

The article states the following strategies for improvement to achieve a better safety record, the report recommends a four-tiered approach:

• Establishing a national focus to create leadership, research, tools, and protocols to enhance the knowledge base about safety.
• Identifying and learning from errors by developing a nationwide public mandatory reporting system and by encouraging health care organizations and practitioners to develop and participate in voluntary reporting systems.
•  Raising performance standards and expectations for improvements in safety through the actions of oversight organizations, professional groups, and group purchasers of health care.
• Implementing safety systems in health care organizations to en- sure safe practices at the delivery level.

Partners Heath Care in Boston collaborated with Health Workforce Solutions to identify innovation models of patient care delivery that met the following criteria for new models of care:

• primarily adult patients served
• nurses served as primary caregivers
• acute hospitals were involved
• technology, support systems, and new roles integrated
• quality, efficiency, and financial outcomes were improved

Researchers identified 10 models the meet the above stated criteria and all of them incorporated the following elements:

• An empowered RN role
• Heightened concentration on patient and family
• Methods for smoothing patient transitions and hand offs across levels of care
• Optimizing technology
• Outcomes management through performance measurement

Innovative Models of Patient Care Delivery

"12 - bed Hospital"

- Breaks a patient care unit into small, manageable segments of 12 or more beds, depending on physical layout of the patient care unit designed to improve communication and continuity through the development of creating a feeling of a small hospital with in a large one.  

- A RN functions as the patient care facilitator for each unit and assumes 24/7 accountability for the individualized patient care.  Places a Patient Care Facilitator in the “lead” role  

- The PCF is the primary point of contact for the interdisciplinary team, as well as the patient and the family.  

- The PCF mentors and educates new staff members on the and is responsible for achieving performance measures identified through a dashboard of quality, financial, and efficiency indicators.

Partnership Care Delivery Model

- a multidisciplinary model of care that is patient and family centered, with all of the disciplines participating in collaborative practice.  

- All partners are equally responsible for patient outcomes of care

- Key components: daily multidisciplinary rounds, partnerships with patients and families, education and support, and a systems approach to care delivery.

Transistional Care Model

- Incorporate the role of advanced practice nurses to provide comprehensive care coordination and home follow up of high risk elders.

- APN in collaboration with the physician and other members of the health care team coordinates care during the patients hospitalization (discharge planning and alignment of resources)

- The APN provides comprehensive assessment of the patients health care status and development of plan of care in the acute care setting as well as follows the patient into the home setting to ensure 

- Implementation outcomes: decreases in time to discharge, total hospital readmission, health care costs and increases patient satisfaction.

Medical Home Model
- Developed as a collaborative effort among several professional physician organizations to provide patient centered care that is focused on prevention, health promotion and coordinated care across the life span.
- Refocuses care from the hospital to the primary care setting
- Key Components: continuity and coordination of care across specialities, access to services, patient responsibility for decision making.

What Model of Care would you recommend for improving patient outcomes?

Reference
Huber, D. H. (2009).  Leadership and nursing care management. 4th edition.  Saunders, Elsevier Health Sciences. Maryland Heights, MO.