Introduction
Patient-centered care continues to gain recognition as the main approach to healthcare. Currently, many organizations revise their models and standards to adhere to this philosophy and improve their relations between patients and care providers (Cherry & Jacob, 2016). In the present case, the delivery care model of a hospital’s department is reviewed to showcase how its current structure may not be adequate to provide safe and quality care. Furthermore, a solution is proposed to implement a new team-based approach that is focused on patients as much as intra- and interprofessional relations among nurses. The needs of all stakeholder groups, including patients and their families, nurses, and the organization are analyzed. This project aims to show how a team-based nursing care delivery model can benefit the department and its clients.
Background
At the present time, the department of inpatient care utilizes the model of total patient care (TPC). This method is the oldest approach to nursing care, and it still has some benefits for nurses and patients (Cherry & Jacob, 2016). Nurses have many responsibilities since each of them participates in organizing, planning, and performing patient care. All aspects of care are dependent on nurses’ contribution, and each Registered Nurse (RN) is assigned a group of patients for a shift (Salmond & Echevarria, 2017). As a result, patients establish strong relations with nurses and receive unfragmented care. The staff also comments on the easiness with which they can communicate with each other about the clients’ condition and future plans. Thus, the TPC model has some benefits that cannot be disregarded.
Nonetheless, the department’s current structure also has many disadvantages that can be linked to the model of care delivery. First of all, the organization relies on RNs, disregarding the possibility of hiring more less trained, but still capable, personnel. RNs note that they perform many tasks that they would rather delegate to someone else. The high degree of autonomy also strains their engagement with the job. As a result, the department currently suffers from a nursing shortage – a high turnover rate affects the organization and its clients negatively. High costs should be noted as well – RNs are more qualified than other staff, meaning that they expect higher wages and expensive continuous training. The combination of these issues creates a structure that has high demands from nurses without any ability to delegate or work in teams.
Proposed Solution
To resolve the discussed problems, the department can implement a team-based approach to care delivery. Team-based care (TBC) is another traditional approach to nursing that first appeared in the middle of the twentieth century, gaining recognition in the 1950-the 1970s (Fairbrother, Chiarella, & Braithwaite, 2015). It was first based on the organizational psychology of Rogers, although it has been reimagined and restructured many times during the course of its use (Fairbrother et al., 2015). Currently, the popularity of TBC is increasing again due to its commitment to effective collaboration and recognition of different nursing skills (Cherry & Jacob, 2016). According to this model, RNs are not the main task performers, but team leaders who supervise the activities of an assigned small group of ancillary personnel. Each team contains a mix of skills and certifications and cares for several patients together, communicating and delegating based on the staff’s abilities and knowledge.
The TBC model also possesses some drawbacks that have to be addressed before implementation. According to Cherry and Jacob (2016), the continuity of care may be insufficient for patients who will encounter many caregivers as opposed to a small number of RNs. Therefore, it is necessary to analyze how the department can foster a relationship between several providers and the client without losing trust and decreasing patient satisfaction. TBC requires each team to have a leader with developed communicative and organizational skills to guide other members. If the department RNs do not possess the necessary experience and knowledge, they may not be suitable for the role, thus lowering the effectiveness of groups (Bender, Williams, Su, & Hites, 2016). The focus on leadership training is a vital part of the project as well. Overall, by addressing these potential risks, the TBC model’s introduction will lead to successful results.
Needs of Population: Stakeholders
To recognize the benefits of the TBC model, one can investigate how it will meet the needs of the major stakeholders. The first population the opinion of which should be considered is the department’s patients. The primary need of this group is medical care that is effective, resultative, high-quality, and accessible. However, patients may require a comfortable inpatient experience, participation in health-related decision-making, and communication with nurses that are not limited to treatment but also supports mental and spiritual improvement and empowerment. According to Dickerson and Latina (2017), the implementation of TBC results in better patient outcomes and higher rates of patient satisfaction. When patients see that they are cared for by a team of professionals with clear goals, they may feel secure in their treatment.
Nurses are another significant group of key stakeholders to consider. Their contribution to patient care makes them invaluable to any department, thus making their abilities and opinions crucial to organizational performance. First of all, nurses expect a job with an adequate workload, pay, and other rewards. This implies that their shifts have to be balanced and based on their experience. TBC, in contrast to TPC, offers the opportunity to show one’s best skills and use them to perform a set number of duties. Nurses, similarly to other medical staff, may expect teamwork and a level of empowerment from their leaders. Nursing leaders, on the other hand, want to use their position to guide others. The TBC model is rooted in collaboration, giving all members the ability to contribute.
The final group of stakeholders includes the health organization as well as insurance companies, pharmaceutical, and other businesses, and the government. These stakeholders are interested in increasing positive patient outcomes and financial growth. For the discussed hospital, the introduction of TBC provides an opportunity to hire less qualified staff for lower pay, while lowering turnover and increasing teamwork. These changes contribute to financial stability as they lead to higher-quality and safer care (Hastings, Suter, Bloom, & Sharma, 2016). Nurses’ ability to delegate tasks and work in a supportive environment may also improve patient outcomes, thus increasing the quality of the hospital’s performance. This outcome raises the status of the organization, lowers operational costs, and addresses the problem of waste (Salmond & Echevarria, 2017). As for the other groups, TBC can provide opportunities for the hospital’s future growth and technological advancement, which supports the enhancement of business relations.
Needs of Population: Cost
The TBC approach to nursing is often followed by another change in payment standards – a shift from pay for service to pay for performance models. According to Salmond and Echevarria (2017), this principle establishes some quality metrics for providers to achieve to receive rewards. Thus, higher levels of quality care lead to better financial performance. As it was noted before, TBC leads to better patient outcomes and contributes to safe, efficient, patient-centered care. Therefore, this model can increase the financial growth of the organization without raising the operational costs significantly. The patient will appreciate high-quality care that is focused on delivering the best results instead of centering on the price of every activity.
Needs of Population: Payer
The cost of the proposed change depends on the specific steps that the organization will choose to take during the project’s completion. One may consider the elements which will demand an increase in spending during the initial phase and across the entirety of the implementation process. The costs of investment can be divided into two categories: “one-time transition costs and ongoing operational costs” (Reiss-Brennan et al., 2016, p. 828). The first group refers to such activities as the purchase of new technology and devices (computers, phones, software, and other items for group work) and the expansion of the infrastructure (Reiss-Brennan et al., 2016). Operational costs include pay for nurse managers, assistants, and other members of care teams, as well as training expenses for employees’ education and preparation for TBC.
Proposed Change Process
The TBC model requires nurses to create teams of professionals that will take on caring for patient groups. One group (or module) will include an RN (leader), one or two Licensed Practical Nurses (LPNs), and other staff members according to their necessity (for example, Health Care Aides (HCA)). Apart from that, to establish interprofessional collaboration, the department will implement a number of initiatives. Hastings et al. (2016) propose new care processes, including initial patient assessment and orientation during which an RN or an LPN performs an assessment of the patient and communicates the department’s functioning aspects (Hastings et al., 2016). This will introduce the patient to the providers and explain what to expect from the team. Comfort rounding will be completed every two hours to check on patients’ concerns, pain, toileting, and positioning. Upon shift changes, RNs (team leaders) will report to each other at the patient’s bedside to include patients and their caretakers in the discussion.
All patients will have whiteboards near their beds that will state all necessary information and allow patients to leave comments. Moreover, the members of the nursing teams and physicians will meet daily for interprofessional rounds, discussing patients’ current state, treatment and discharge plans, and potential issues. Finally, inside teams, RNs will assume leadership, assigning duties to other members. Each team will meet during the shift to discuss daily goals and reassess their progress (Hastings et al., 2016). These steps are focused on increasing collaboration and separating duties for each professional according to their skillset. It is vital for nurses to undergo leadership training before implementing the new model (Bender, 2017). The lack of necessary qualities can undermine the success of the project and lead to low levels of collaboration and clarity in operations.
Expected Outcomes
The introduction of the TBC model to the department is expected to influence patient and staff experiences as well as the status and performance of the organization. Patients should report higher levels of satisfaction with services, and the rates of readmission, falls, complications, and complaints will decrease (Hastings et al., 2016). It is believed that nurses will demonstrate their skills, taking on new responsibilities as team leaders and delegating tasks to other members. Their reports will include better collaboration among the staff, patient participation, and empowering and engaging environment. The organization should expect higher performance indicators, decreasing staffing problems, and a balanced level of spending and gains. The results of employee and patient surveys and hospital patient data are the sources of this information.
Implications
The change in care delivery models requires considerable resources from the department and the organization. Training and the reorganization of the unit’s infrastructure may be impossible or difficult without funding from outside sources such as grants. Nevertheless, the project, if successful, will provide long-term benefits for the hospital. The departments’ spending to cover high rates of patient readmissions and nurses’ turnover will decrease, thus providing the hospital with additional opportunities to invest in its services. Moreover, it is possible that TBC will change the workload of RNs and other members, thus allowing them to care for more patients efficiently. Overall, this initiative’s potential for improvement highlights the benefits of it becoming the new standard for the department.
Conclusion
The proposed change reviews the shift from a total patient care model to a team-based approach. The established structure places a significant burden on nurses and limits the responsibilities of other employees. The implementation of teams and collaborative activities ensure that all professionals are utilizing their best skills while including patients and their caretakers in the decision-making process. The introduction of the change will happen gradually, starting with data collection and a step-by-step introduction of new activities. RNs will form small teams with LPNs and HCAs, exercising their leadership training. This intervention is expected to bring long-lasting benefits to the organization, improving safety and quality care, increasing nurses’ job satisfaction and reducing wasteful spending.
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