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The healthcare system has witnessed a profound change in the delivery of services with organizations moving towards quality and value. Traditionally, the United States healthcare system has relied on fee-for-service compensation where rewards are given regardless of the observed patient outcomes. Today, the need for quality has led to the incorporation of value-based purchasing (VBP) that ensures healthcare organizations are rewarded according to performance (Chee et al., 2016). To better conceptualize, develop and implement VBP in healthcare, frameworks have been created to outline the components that define the practice. Organizational leaders must understand the multiple factors essential in designing, implementing, and evaluating these programs for better realization of results. This discussion focuses on the degree of VBP in my organization and develops a strategic plan to improve the practice in the organization.
Part A: VBP Degree of Implementation
The hospital value-based purchasing program is an initiative that rewards acute-care hospitals with incentives according to the quality of services provided. Healthcare organizations are rewarded by the Centers for Medicare and Medicaid Services (CMS) depending on how closely they follow clinical practice guidelines and the patient experiences (Brooks, 2016). My healthcare organization has used this approach to implement quality improvement practices and setting policies to guide the clinical care of patients. One area that is outstanding is the incorporation of technology into the routine care of patients to improve quality and patient experiences. For instance, the healthcare organization has fully adopted the use of electronic health records systems (EHRs) across all physician offices and other pertinent departments. This technology allows for easy documentation of patient data and retrieval of information to guide decision making. Today, departments such as the ER and intensive care units have improved the efficiency and accuracy of patient care leading to improved patient satisfaction.
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The second aspect that determines the degree of VBP in healthcare organizations is the improvement of clinical processes of care. The CMS has described a list of clinical care measures that dictate what should be improved across acute care facilities. In my healthcare organization, much focus is observed in areas of healthcare-associated infections and the accuracy of surgeries done to patients. For instance, the use of prophylactic antibiotics including timely administration and discontinuation of the drugs is highly followed. Various surgical care improvement projects are observed in the operating room to ensure nurses and other healthcare providers are prepared to meet the set standards. The organization is striving to improve VBP across all units through the use of evidence-based practices and setting more policies.
Part B: Strategic Plan
A variety of payment models aim to improve healthcare value, with varying degrees of accountability and financial risk. The value-based purchasing model uses a broad set of performance-based payments that link healthcare organizations to various quality measures. To ensure effective implementation of the new change, leaders must form policies and involve staff in redesigning the healthcare system (Cattel & Eijkenaar, 2020). Interprofessional collaboration is one of the key factors that can ensure organizations work towards the same goal. Different departments must work together to improve care delivery to achieve VBP. Three critical departments that are important in promoting VBP include the nursing department, the theatre unit/operating room, and the intensive care unit (ICU).
B1-B1a. Department One: Nursing DepartmentNurses form the largest members of healthcare professionals in any healthcare organization making them crucial to the achievement of quality. The nursing department will be involved in a value-based purchasing strategic plan to improve on the aspects of the patient experience. To improve VBP in the organization, the nursing department will focus on improving communication. The improvement of communication will ensure the safe delivery of care to the patients and it will translate to improved HCAHPS scores. Through the involvement of the nurses, the patient experience domain will be improved in the facility. |
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| B2. Goal
The goals of the nursing department are as follows: v To improve communication between nursing teams, especially during shift handoffs. v To engage nursing teams in the implementation of standardized handoff procedures for improvement of communication. v To demonstrate 100% compliance with bedside shift reporting using the identified standardized handoff strategy. |
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B3. Attaining Quality Outcomes in patient care over the next 3 years.ü The first strategy will involve the improvement of communication among nursing and healthcare teams. Improved communication will ensure patients receive the right care. ü The engagement of nursing teams will ensure interprofessional collaboration during patient care. Effective communication between these teams will translate to improved outcomes like reduced readmission rates (Shahid & Thomas, 2018). ü The implementation of communication strategies will involve education and training. Education and training will lead to increased knowledge that will ensure quality is achieved. Patient involvement in planning for their care is one of the expected outcomes. |
Attaining Quality Outcomes in reimbursement over the next 3 years.ü Increased patient satisfaction is the first outcome related to reimbursement that will result from the strategy. Communication is one of the metrics measured using the HCAHPS scores. ü Decreased readmission rates as a result of improved communication and reduced medical errors (Shahid & Thomas, 2018). ü Reduced cost of healthcare that results from errors caused by poor communication. Also, decreased readmissions will save the institution unnecessary costs.
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B4. Key Points1. The SBAR (situation-background-assessment-recommendaton) communication tool will be implemented as a strategy to address the identified problem. 2. The tool, adopted from the Institute for Healthcare Improvement (IHI), will standardize communication during shift-handoffs (Shahid & Thomas, 2018). 3. Education and training will be an essential component during the implementation of the standardized handoff. 4. Improvement of communication will improve patient outcomes that will have a positive influence on reimbursements to the institution. |
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B4a. Marketing Key pointsØ The first strategy will involve face-to-face meeting with the nursing team to elaborate on the need for improved communication. Ø The SBAR tool adapted from the IHI will be emailed to the nurses for easy accessibility. Emails will also be used regularly to communicate the progress of the new strategy implementation. Ø Briefing and de-briefing sessions in the nursing units will be done to serve as an education strategy for SBAR communication. Ø The hospital website and newspaper will be used to communicate patient outcomes pertinent to the implemented communication strategy. |
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B6 Coordinating Informational Eventsl The initial step will involve the conduction of a survey to create awareness of the new change. l Creation of an implementation committee to monitor the process. l Sharing of information through the nurse leaders and the organizational website. l Sharing of HCAHPS scores upon completion of the exercise via the organizational website. |
B6 coordinating Educational Events
l The clinical nurse educator will be in charge of the education and training to improve communication. l All nurses across different departments will be educated about SBAR communication during bedside shift handoffs. l Continued education offered quarterly throughout the three years implementation period. l Ongoing education for staff and new employees for sustainability of the change. l Regular updates on the progress and the use of external speakers to further educate staff. |
C162 Healthcare Business and financial Management
B1-B1a. Department Two: Operating Room/TheatreValue-based purchasing measures on clinical processes of care address the issue of surgical management of patients. The operating room (OR) deals with thousands of patients requiring surgical care yearly making the OR an important department in improving VBP. Apart from influencing the quality of life of the population served the OR staff work to ensure increased productivity through a reduction in the rate of healthcare-associated infections (HAIs). Through the use of different approaches, the department can help decrease the costs related to prolonged hospitalization. The OR will be important during the implementation of VBP through prophylactic use of antibiotics and practicing hand hygiene to reduce the rate of healthcare-associated infections. |
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| B2. Goal
The goals of the OR are as follows: v To analyze the rate of HAIs and design a strategy to decrease these rates within the first year. v To implement the use of WHO guidelines on hand hygiene in the unit to reduce the rate of HAIs. v To attain 100% compliance to hand hygiene and reduce the rate of HAIs by 50%. |
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| B3. Attaining Quality Outcomes in patient care over the next 3 years.
ü Implementation of WHO hand hygiene guidelines use will decrease incidences of post-surgical complications for better patient outcomes (Arias et al., 2016). ü Proper hand hygiene will decrease prolonged hospitalization resulting from infections. ü Healthcare professionals in the OR will improve their knowledge on quality care delivery and improvement of patient safety. ü Increased collaboration between professionals to attain quality care and patient safety.
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Attaining Quality Outcomes in reimbursement over the next 3 years.
ü There will be decreased hospital stays which will reduce healthcare expenditure. ü Increased patient satisfaction that will improve HCAHPS scores. ü Decreased readmission rates as a result of minimal post-surgical complications (Arias et al., 2016). ü Improved trust in the community that will translate to more census. |
| B4. Key Points
1. Hand hygiene is the most basic and recommended approach to reducing HAIs (Arias et al., 2016). The WHO provides a comprehensive protocol on hand hygiene to improve patient safety. 2. During the analysis of VBP by the CMS, the operating room is among the crucial departments especially on areas of prophylactic administration of antibiotics and clinical processes leading to successful surgery. 3. Importance of collaboration and teamwork during quality improvement in the unit. 4. Impact of HCAHPS scores on financial reimbursements and stability of the organization. |
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| B4a. Marketing Key points
Ø Emails to employees to increase awareness of the need for the new change Ø Departmental meetings to discuss the WHO tool and the implementation process. Ø Staff meetings and the use of hospital website to discuss and share HAIs rates. Ø OR pre-shift huddles to discuss the new WHO hand hygiene guidelines |
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| B6 Coordinating Informational Events
l Survey the OR to observe current hand hygiene practices and create awareness of the new change. l Use the nurse leaders in the organization to influence the acceptance of the new change. l Work with the IT department to share WHO hand hygiene guidelines via email and posters in the unit. l Provide quarterly results through meetings. |
B6 coordinating Educational Events
l The nurse educator to identify the team to educate staff on the use of the new hand hygiene protocol. l Mandatory education and training for all staff in the OR including periodic assessment of training compliance. l Regular follow-up and monitoring of staff. l Continuing education after successful implementation of the strategy. Designing education sessions for new employees in the OR. |
| B1-B1a. Department Three: Intensive Care Unit (ICU)
The care provided to patients in the ICU can have a great impact on patient experience upon leaving the facility. Additionally, the ICU is one of the units that determine the mortality rates in healthcare that form part of the patient outcome domain. To improve care in this unit, the use of evidence-based practices is required to engage both the nurses and physicians in delivering high-quality care. The area of focus in the ICU for the achievement of VBP will involve a reduction of central line-associated bloodstream infections (CLABSI). |
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| B2. Goal
The goals for the ICU are as follows: v To engage the nurses and physicians in implementing a CLABSI prevention protocol for reduction of mortality and morbidity. v To fully implement the Centers for Disease Control and Prevention (CDC) CLABSI prevention bundle in the unit. v To demonstrate 100% compliance to the CDC guidelines for CLABSI prevention and sustainability of the practice in the ICU. |
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| B3. Attaining Quality Outcomes in patient care over the next 3 years.
ü The new protocol will ensure interprofessional collaboration between nurses and physicians to improve quality. ü There will be decreased incidences of prolonged hospitalization resulting from CLABI (Woodward & Umberger, 2016). ü Improved education among staff, patients, and family regarding infection prevention in the ICU. ü Better standardization of care and following of clinical practice guidelines. |
Attaining Quality Outcomes in reimbursement over the next 3 years.
ü Decreased mortality rates ü Decreased readmissions related to better outcomes. ü Decreased healthcare costs related to prolonged hospitalization. ü Improved patient satisfaction leading to more reimbursements. ü Increased census related better patient outcomes and improved community reputation of the facility. |
| B4. Key Points
1. Interprofessional collaboration is crucial for the improvement of quality in healthcare. 2. Evidence-based practice supports the use of CLABSI prevention bundles to improve patient outcomes (Woodward & Umberger, 2016). 3. The CMS rewards organization depending on the quality of care provided, how close professional practice guidelines are followed, and patient satisfaction upon leaving the hospital. 4. Education and training for CLABSI prevention using the CDC guidelines is necessary. |
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| B4a. Marketing Key points
Ø Communication of the new strategy through the unit charge nurse. Ø Awareness creation through departmental meetings focusing on interprofessional collaboration to prevent CLABSI. Ø Emails and hospital newspapers for internal communication of the new strategy. Ø Briefing and debriefing sessions in the ICU to stress on the need to adhere to CLABSI prevention guidelines. |
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| B6 Coordinating Informational Events
l Creation of the implementation committee to survey awareness of CLABSI prevention in the unit. l Meetings organized by the clinical nurse educator to increase awareness of CLABSI prevention. l Regular communication of progress using emails and intermittent meetings. |
B6 coordinating Educational Events
l Educational meetings organized by the clinical nurse educator. l The use of simulation and role play to demonstrate proper insertion of central lines while following CDC guidelines. l Continuing educational sessions for staff and new employees. |
B5: Ethical Clinical and Ethical Business Practices
The significance of the complexity of ethical issues in healthcare has become a subject of scholarly recognition today. To effectively implement value-based purchasing, healthcare practitioners must practice ethically considering aspects such as clinical competence, respect for the patient, and maintaining the primacy of the patient’s needs (Rasoal et al., 2017). Beneficence is among the key ethical practices that guide the care of patients today. For instance, the implementation of SBAR communication will ensure that nurses serve to deliver high-quality care to patients. The practice will benefit the patients through involvement in their care, reduction in errors and interprofessional collaboration that will translate to better patient outcomes.
Healthcare is a business with integrated economic systems that provide goods and services to patients to re-establish health. One of the ethical practices in the healthcare business is confidentiality. The delivery of care to patients is based on the trust and established relationship between the provider and the patient. The strategic plan will involve interprofessional collaboration, coordination of care with the patients, and the incorporation of technology that are all dependent on trustworthy relationships.
B7: Timeline
| Time Increments | Department One: Nursing Department | Department Two: Operating Room/Theatre | Department Three: Intensive Care Unit (ICU) |
| 0-9 months | l Design a strategy to improve communication among nursing teams in the facility. | Develop a strategy that will engage all healthcare teams to address the issue of HAIs. | Plan for a strategy to improve clinical care processes on CLABSI prevention. |
| 10-18 months | l Identify committee members to survey communication protocols in the facility.
l Market the SBAR communication strategy across all nursing units. |
l Increasing awareness of the new strategy among the OR staff.
l Selection of an implementation team. l Market the use of WHO hand hygiene guidelines to reduce HAIs. |
l Selection of an implementation team in the ICU.
l Survey of CLABSI rates and current prevention measures. l Marketing of the CDC CLABSI prevention guidelines to staff. |
| 19-27 months | l Coordination of education and training for nurses regarding SBAR communication.
l Simulation and role play activities to strengthen the implementation of the new change. |
l Organization of education and training for OR team.
l Routine monitoring of the strategy and communication of results to employees. l Role play and simulation to strengthen the new change. |
l Training of staff in the unit on how to use the new CLABSI prevention guidelines.
l Ensure 100% compliance to the training sessions by all staff.
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| 28-36 months | l Ensure standardization of SBAR communication across all nursing units.
l Intermittent evaluation of the new change including making of necessary changes. l Continuing education for staff and training of new employees. |
l Actual implementation of WHO hand hygiene guidelines in the OR.
l Intermittent evaluation of the strategy by the implementation team. l Continuing education for staff and new employees. l Communication of findings to the OR staff. |
l Implement CDC CLABSI prevention guidelines in the ICU.
l Routine monitoring and evaluation of the new change. l Provide quarterly reports on CLABSI rates and strengthening of the new practice through education. |
References
Arias, A. V., Garcell, H. G., Ochoa, Y. R., Arias, K. F., & Miranda, F. R. (2016). Assessment of hand hygiene techniques using the World Health Organization’s six steps. Journal of Infection and Public Health, 9(3), 366-369. https://doi.org/10.1016/j.jiph.2015.11.006
Brooks J. A. (2016). Understanding hospital value-based purchasing. The American Journal of Nursing, 116(5), 63–66.
https://doi.org/10.1097/01.NAJ.0000482974.56328.5a
Cattel, D., & Eijkenaar, F. (2020). Value-based provider payment initiatives combining global payments with explicit quality incentives: A systematic review. Medical Care Research and Review, 77(6), 511-537. https://doi.org/10.1177/1077558719856775
Chee, T. T., Ryan, A. M., Wasfy, J. H., & Borden, W. B. (2016). Current state of value-based purchasing programs. Circulation, 133(22), 2197–2205. https://doi.org/10.1161/CIRCULATIONAHA.115.010268
Rasoal, D., Skovdahl, K., Gifford, M., & Kihlgren, A. (2017). Clinical ethics support for healthcare personnel: An integrative literature review. HEC forum : An Interdisciplinary Journal on Hospitals’ Ethical and Legal Issues, 29(4), 313–346. https://doi.org/10.1007/s10730-017-9325-4
Shahid, S., & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–A narrative review. Safety in Health, 4(1), 1-9. https://doi.org/10.1186/s40886-018-0073-1
Woodward, B., & Umberger, R. (2016). Review of best practices for CLABSI prevention and the impact of recent legislation on CLABSI reporting. Sage Open, 6(4), 2158244016677747. https://doi.org/10.1177/2158244016677747
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