ORGANIZING PATIENT CARE| NCM 119 | TOPIC 06

UNIT 4 (CHAPTER 14) LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS BY MARQUIS & HUSTON
LESSON OUTLINE FUNCTIONAL METHOD
1. Characteristics of effective health care delivery
systems
2. Traditional modes of organizing patient care
a) Total patient care or case method nursing
b) Functional method
c) Team nursing
d) Multidisciplinary team leader role
e) Modular nursing
f) Primary nursing v Evolved as a result of World War II
g) Case management v Uses relatively unskilled workers who have been trained to
3. Disease management
4. Selecting the optimum mode complete certain tasks
5. New role for changing health care arena v Care is assigned by task rather than by patient
a) Nurse navigators v Use of ancillary personnel- trained to do simple tasks & gained
b) Clinical nurse leader
c) Patient and family centered care proficiency by repetition.
v Functional Nursing task were checking BP, administering
medication, bathing patients, changing linens.
CHARACTERISTICS OF EFFECTIVE v Economical means of providing patient care
HEALTH CARE DELIVERY v Efficient- tasks are completed quickly with little confusion
v Facilitate meeting the goals of the organization
regarding responsibilities
v Cost-effective
v Low Job Satisfaction
v Satisfy the patient
v Major advantage: is its efficiency; tasks are completed
v Provide role satisfaction to nurses
quickly, with little confusion regarding responsibilities.
v Allow implementation of the nursing process
v Provide for adequate communication among health-care TEAM NURSING
providers

TRADITIONAL MODES OF ORGANIZING

v There is no one best mode for organizing patient care

TOTAL PATIENT CARE OR CASE MEDTHOD

NURSING

v Ancillary personnel collaborate to provide care to patients

under the direction of a professional nurse.
v Requires extensive team communication and regular team
planning conferences
v Allows members to contribute their own special expertise or

v The oldest mode of organizing patient care skills

v Nurses assume total responsibility for meeting the needs of all v Team Leader is responsible for knowing the condition of all

assigned patients during their time on duty. patients assigned to the team and for planning of individual

v Case method care

• It provides nurses with high autonomy and responsibility v Consists of not more than 5 people, allowing each member to

of their assigned patients. contribute their own expertise.

• Lines of responsibility and accountability is clear. MULTIDISCIPILNARY TEAM LEADER ROLE

v To lead and diffuse collaborative improvement efforts with
• The patient has a different nurse each shift, requiring
physicians and other members of the health care team to
highly skilled personnel and may cost more than some
improve practice environments
other forms.
v Require an efficient means of communication about patient
DISADVANATGES OF TOTAL PATIENT CARE
goals progress and problems
v The greatest disadvantage of total patient care delivery occurs
when the nurse is inadequately prepared to provide total care MODULAR NURSING
v Pairs professional nurses with ancillary staff to deliver care to
to the patient.
groups of patients
v Used frequently during the 1980s and 1990s

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Organizing Patient Care
PRIMARY/ RELATIONSHIP BASED NURISNG
v During work hours, the primary nurse provides total direct care
for that patient.
v When the primary nurse is off duty, associate nurses follow the
care plan established by the primary nurse and provide care.
v Brings nurse back to the bedside to provide clinical care
v Can succeed with a diverse skill mix or an all-RN staff
v Job satisfaction is high
v Disadvantages lie primarily in improper implementation
v their performance, either for self-evaluation or by others?
CASE MANAGEMENT
v Collaborative process that assesses, plans, implements,
coordinates, monitors, and evaluates options and services to
meet an individual’s health needs through communication and
available resources to promote quality, cost-effective outcomes.
v Case managers often manage care using critical pathways and
multidisciplinary action plans (MAPs) to plan patient care.
v The care MAP is a combination of a critical pathway and a
nursing care plan.
v All health-care providers follow the care MAP to facilitate
expected outcomes.
v If a patient deviates from the normal plan, a variance is
indicated.
DISEASE MANAGEMENT
v Provide a comprehensive, integrated approach to the care and
reimbursement of common, high-cost, chronic illnesses.
v Target population groups (population based) rather than
individuals.
v Use standardized clinical guidelines—clinical pathway
reflecting best practice to guide providers.
v Use integrated data management systems to track patient
progress across care settings and allow continuous and
ongoing improvement of treatment algorithms.
ILLNESS OFTEN MANAGED WITH DISEASE
MANAGEMENT PROTOCOLS
v Cancer
v Acute otitis media
v Diabetes
v Hyperlipidemia
v Asthma
v Hypertension
v COPD
v Hormone replacement therapy
v AIDS
v Stroke
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NCM 119
SELECTING THE OPTIMUM MODE
v The mode should be based on patient acuity and not
economics alone.
v The knowledge and skill required for particular activities with
specific populations should always be the true driver in
determining appropriate care delivery models
CHANGING THE PATIENT CARE DELIVERY MODE
Questions the change agent must ask
v How will the reorganization alter autonomy and individual and
group decision making?
v How will social interactions and interpersonal relationships
change?
v Will employees view their unit of work differently?
v Will the change require a wider or more restricted range of
skills and abilities on the part of the caregiver?
v Will the redesign change how employees receive feedback on
v Will communication patterns change?
FACTORS IN CHOOSING APPROPRIATE MODE
OF PATIENT CARE
v skill and expertise of the staff,
v the availability of registered professional nurses,
v the economic resources of the organization,
v the acuity of the patients,
v the complexity of the tasks to be completed.
EMERGING CARE DELLIVERY MODELS
v Elevating the role of nurses and transitioning from caregivers to
“care integrators”
v Taking a team approach to interdisciplinary care
v Targeting high users of care, especially older adults
v Sharpening focus on the patient,
v Leveraging technology
v Improving satisfaction, quality, and cost
NURSE NAVIGATORS
v Assists patients and families to navigate the complex health-
care system by providing information and support as they
traverse their illness.
CLINICAL NURSE LEADER
v Is an experienced nurse possessing a graduate degree who
provides clinical leadership in all health care settings
implements OBP and quality improvement strategies, engages
in clinical practice, and creates and manages microsystems of
care that are responsive to the health care needs of individuals
and families
PATIENT AND FAMILY CENTERED CARE
v Patient care is organized around the needs of patients.
v Patient and family perspectives are sought out and their
choices are honored.
v The voice of the patient and family are represented at both the
organizational and policy levels as well as in the health
system’s strategic planning.