Introduction
The choice of a healthcare delivery model can change the approach to daily tasks in a hospital. Currently, the Ocracoke Regional Healthcare System employs a total-patient-care nursing model that requires significant resources and staff to serve all patients. Thus, developing and implementing a new system is necessary to improve the state of the healthcare organization and fulfill the requirements proposed by the Joint Commission.
This paper aims to present and analyze the scenario and introduce a new healthcare delivery model within the hospital. First, the issue will be analyzed, including the National Patient Safety Goals outlined by the Joint Commission and the proposed model. Then, the goals will be discussed in more detail to understand what should be done to achieve them. Next, the paper will discuss the new nursing delivery model and consider how it will benefit safety goals and organizational costs. Finally, a summary of the paper’s accomplishments will be provided.
Overview of Issue
In the current scenario, the Ocracoke Regional Healthcare System is experiencing problems with its nursing care delivery. Currently, nurses operate under the total care model, one of the oldest methods in patient care (Butler et al., 2019). In this approach, each nurse is usually assigned to one or more patients, performing a range of duties during a shift (Siegel et al., 2023).
For example, the nurse or nurse on duty may administer medications, assess patients’ health, rotate or reposition them, help with hygiene, and more. The varying tasks and their increasing number create a significant workload for nurses. The hospital has deemed this model ineffective and inefficient because it utilizes staff resources without considering their skill levels and work time.
Additionally, during their recent visit, the representatives of the Joint Commission identified two significant issues that require improvement at Ocracoke Regional Healthcare System. First, they determined that the hospital can “improve the effectiveness of communication among caregivers” (Goal 2) (Joint Commission, 2023, p. 1). The current model requires nurses to exchange information between shifts, limiting their communication to one or two times daily. Next, the recommendation was made to “improve the safety of using medications” (Goal 3) (Joint Commission, 2023, p. 2). Here, the problem was linked to poor knowledge transfer and the facility’s overwhelming nursing workloads.
Based on the identified issues and the suggestions from the Joint Commission, the new approach chosen is the team nursing care delivery model. It is expected that the team model of care will allow Ocracoke Regional Healthcare System to reach its goals and meet the requirements set by the Joint Commission. Thus, the PICOT question for the project is as follows:
The Ocracoke Regional Healthcare System (P) will implement a team nursing care delivery system (I), compared to the current total care nursing care delivery system (C), the result is compliance with the Joint Commission’s recommendations (O) at their revisit in 6 months (T).
National Patient Safety Goals
The National Patient Safety Goals, developed and updated by The Joint Commission, are a list of requirements that target common adverse events and healthcare mistakes. The first safety goal outlined by the Joint Commission for the Ocracoke Regional Healthcare System is to improve caregivers’ communication effectiveness. As nurses currently work in the old model, they rarely communicate with one another about patient needs, except for shift transfers. This safety recommendation encourages professionals to share critical results promptly, ensuring that patients receive care tailored to their needs (Joint Commission, 2023). To measure the achievement of this goal, the hospital must have written procedures for communication in place and record the timeliness of reporting this data among staff.
The second recommendation for the Ocracoke Regional Healthcare System is to enhance the safety of medication administration within the facility. Healthcare professionals should always label medications properly and ensure that drugs are stored in designated containers (Joint Commission, 2023). Furthermore, labeling should occur when medications are transferred from one container to another, and their packaging is changed to ensure that they are not left unidentified. Clinicians should work as a team when verifying medication labels to avoid medical errors and keep informed. The measure for this goal is the presence of protocols for labeling in all units and the rate of medication errors related to mislabeling.
New Nursing Model
The nursing model suggested for the Ocracoke Regional Healthcare System is team nursing. As noted above, in the currently used framework, one nurse is assigned to one or more patients and completes all duties during their hospitalization. In contrast, the team nursing care delivery model recommends that hospitals create multidisciplinary teams of professionals and assign several patients to each team.
In the group, nurses with different skill sets and experience levels are managed by a head nurse who delegates tasks according to their abilities (Teisberg et al., 2020). As a result, nurses care for patients collectively, sharing different duties but still forming a relationship with a limited number of individuals. For instance, a group of patients may be treated by a registered nurse, a licensed practical nurse, an assistant, and more.
The selected model can help the organization address its safety goals. Compared to total nursing, team nursing requires professionals to communicate regularly and share knowledge about the patient to administer medications, assess their health, and develop treatment goals. Nurses must be aware of whether the patient has taken their medication, been observed, moved, or received any other assistance.
Therefore, the implementation of this approach should create a new system of interpersonal communication within the hospital. Furthermore, the team nursing model can have a positive impact on medication safety, as it requires several nurses to be aware of the medications patients are taking. The need to share knowledge also implies that the organization will increase its attention on developing safety guidelines for teams.
Apart from assisting the Ocracoke Regional Healthcare System in reaching its safety goals, the team model can also reduce organizational costs. According to a review by Butler et al. (2019), team nursing is more cost-effective than traditional total nursing in a hospital setting. As several nurses share duties throughout the shift, they can effectively utilize their skill sets and serve more patients in a shorter amount of time (Teisberg et al., 2020). Moreover, the variety of skill levels within a team allows the hospital to hire professionals with different salary expectations, thereby further reducing unnecessary costs. In the current model, all nurses are expected to perform at the same level; however, the team approach allows for the employment of nurses with limited skills or less practical experience.
Conclusion
Currently, the Ocracoke Regional Healthcare System has an outdated nursing care delivery model and does not meet the patient safety recommendations from the Joint Commission. The paper’s purpose was to consider these issues and introduce a new model of care that could solve them. The scenario of insufficient communication among nurses and their increased workload demonstrated that patients were exposed to medication errors and other adverse events.
As a result, the team nursing care delivery model is introduced as an alternative to the present approach. It offers more opportunities for knowledge exchange and allows the hospital to hire staff with different skill levels. Overall, it can help the organization to achieve its goals and reduce costs.
References
Butler, M., Schultz, T. J., Halligan, P., Sheridan, A., Kinsman, L., Rotter, T., Beaumier, J., Kelly, R. G., & Drennan, J. (2019). Hospital nurse‐staffing models and patient‐and staff‐related outcomes. Cochrane Database of Systematic Reviews, (4), 1-89.
Joint Commission. (2023). National Patient Safety Goals®: Effective July 2023 for the Hospital Program.
Siegel, E. O., Kolanowski, A. M., & Bowers, B. J. (2023). A fresh look at the nursing home workforce crisis: Transforming nursing care delivery models. Research in Gerontological Nursing, 16(1), 5-13.
Teisberg, E., Wallace, S., & O’Hara, S. (2020). Defining and implementing value-based health care: a strategic framework. Academic Medicine, 95(5), 682.