week 5 Flashcards
Care delivery models
organize the work of caring for patients
Models of Care
based on the needs of clients & availability of competent staff skill levels
Functional nursing
- Divides work into functional units assigned to one team members
- each care provider is responsible for specific duties or tasks
Modular nursing
is team nursing that divides a geographic space into modules of patients with each module having a team of staff led by an RN to care for them
Team nursing
– assigns staff to teams responsible for a group of patients
– Units divided into two (or more) teams each led registered nurse (team leader)
– team leaders supervise & coordinate all of the care provided
– care is divided into the simplest components & assigned to care provider with the appropriate skill level
Functional nursing
Divides work into functional units assigned to one team members
each care provider is responsible for specific duties or tasks
Advantages
Care can be delivered to large numbers of clients
Disadvantages
Care seems disjointed to clients –care delivered by a number of staff
Continuity of care compromised
Primary nursing
defines the responsibility & accountability of the nurse
nurse the primary provider of care
Advantages
Clients & families develop a trusting relationship with the nurse
Disadvantages
High cost nurse skill mix
Emerging Models of Care – Client-Centred Collaborative Practice
Goal: to ensure delivery right care, by the right provider, in the right setting, requires a clear understanding of providers roles
Client-centred or Client-focused care
– focus on client needs rather than staff needs
– necessary care & services are decentralized & brought to clients
– Staff close to patients in decentralized workstations
– care teams are established for a group of clients
– disciplines collaborate to ensure appropriate care is received
Length of Stay (LOS)
are opportunities to reduce costs & two strategies to accomplish decreased LOS include:
1.Clinical pathways
(outline expected clinical course & outcomes for a specific client type
Pathways by days– each day expected outcomes are articulated
client progress is measured against the expected outcomes)
2.Case management
Care Delivery Management Tools:
Clinical Practice Guidelines
Evidence based best practice in prevention, diagnosis or management of a symptom, disease or condition for a client or group of clients
Canadian Medical Association (CMA) integrated in quality care program
Care Delivery Management Tools:
Case management
- strategy to improve patient care & reduce hospital costs through coordination of care
- Case Manager: responsible for coordinating care & establishing goals from preadmission through discharge
Care Delivery Management Tools;
Case Manager
Has a data function to improve care
Collects aggregate data on client variances from clinical pathways
Shared with members of health care team in effort to explore opportunities for improvement in pathway or in system
Organizational Purpose, Mission, Philosophy, Values
Mission statement: formal expression of the purpose or reason for existence of the organization
Philosophy: value statement of principles & beliefs that direct the organization’s behaviour
Vision: provides a clear picture of what the future will look like, it defines the key results achieved & goals that are to be accomplished
Values: may be formally stated & explicit, or may be implicit & part of the organizational culture
Shared governance:
Framework grounded in the decentralization of leadership that fosters autonomous decision making and professional nursing practice
Benner’s Novice to Expert
1) Novice – task oriented, focused
2) Advanced beginner – somewhat independent
3) Competent – 2/3 years
4) Proficient – plan of care
5) Expert - ++ experience
Difference Between QA and AI:
Quality Assurance QA
Assessing/measuring performance
Determining whether performance conforms to standards
Improving performance when standards are not met
Continuous Quality Improvement CQI
Meeting needs of customer
Building quality performance into the work process
Assessing the work process to identify opportunities for improved performance
Employing a scientific approach to assessment and problem solving
Improving performance continuously as a management strategy (not just when standards are not met)
Comprehensive unit-based continuous quality improvement program consists of four outcomes from four domains:
Access
Service
Cost
Clinical quality
Primary Benefits of QI (QUALITIY IMPROVEMENT)
Ability to discover performance issues quickly and efficiently
Improve staff satisfaction by involving staff in the developing and implementing the work process
Empowering staff to identify and implement change
Demonstrate to clients that you care about meeting their clients needs
Decrease unnecessary costs from waste and rework, lost time and meeting provincial standards
Regulatory Requirements
- Accreditation Canada (AC) assists health organizations across the country to examine & improve the quality of care & service they provide
- new accreditation program in 2008 called Qmentum, which emphasizes health system performance, risk prevention planning, client safety, performance measurement, and governance
Sentinel Events/ Critical Incident
- Is an unexpected incident (related to a system or process deficiency) that results in a major & enduring loss to the client
- Sentinel events require immediate investigation & response
Organizational culture –
basic pattern of shared assumptions, values, & beliefs that govern behaviour within a organization
3 Functions of Organizational Culture
- Deeply embedded form of social control
- The “social glue” bonds people together & makes them feel part of the organizational experience
- Corporate culture helps employees make sense of the workplace
Interdisciplinary Team
Composed of members with a variety of clinical expertise
Five stages that groups progress through
1) Forming
2) Storming- DIALOGUE
3) Norming- HOW YOU PRESENT IT
4) Performing-
5) Adjourning- ACCOPLISH THE GOAL
Functional roles
– Initiator- WHO IS BRINGING IT ALL TOGETHER
– Coordinator- WHATS GUNNA HAPPEN WHEN
– Mobilizer- ACTIONS
– Questioner- ALLOW TO RELOOK AT THINGS
– Antagonist- ASSHOLE THAT ALLOWS YOU TO THINK OF OTHER SHIT
– Recorder - DOCUMENTATION
Dysfunctional roles
Criticizer- I TOLD YOU, THEY DIDN’T DO THIS OR THAT
Passive observer- SOMEONE WHO DOESN’T SAY SHIT
Detailer- SPEND TOO MUCH TIME ON SHIT
Controller- AUTOCRATIC
Pleaser-
