Tomorrow's Healthcare Research Articles

“Acute caring” in the emergency department

The aim of this essay was to discuss the ways in which the dynamics of interprofessional communication and collaboration among healthcare providers ultimately affect patient quality of care in the acute setting. Interprofessionalism describes a care model whereby health providers use complementary skills, knowledge and competencies to provide quality care to a group of patients. These interactions are characterized by trust, respect and an understanding of each other's skill and knowledge. At its best, the interprofessional care model has made great strides in the amelioration of patient outcomes, including reduction in negative outcomes, decreased health access needs and increased patient satisfaction. However, challenges with regard to communication and implementation have translated to a steep learning curve for healthcare providers. As such, a new-found emphasis has been placed on interprofessional education for today's healthcare students with the goal of promoting a more efficient and collaborative philosophy for tomorrow's healthcare teams.

Developing health care management skills in times of crisis: A review from Baltic region

Health care is now under pressure to change related to new situations in demand side (demographics, pattern of diseases, public expectations), supply side (technology and clinical knowledge, health care workforce), and wider societal changes (financial pressure, internationalization of health care systems, global market for research and development). The increase of health expenditure in most of the middle- and high-income countries exceeds GDP growth rate and threatens further competitive capacity of economies tight in bearing the burden of social costs. A period of economic slowdown is challenging for health care systems in many countries. It is also the case for countries in Baltic region now looking for ways to bring more value for money spent on health care. Several factors are listed as causes for rising health care costs. Some of them (e.g. aging and unhealthy lifestyles of individuals) are out of the sphere of direct influence of doctors, managers of health care organizations, and even ministries of health. However, other causes (e.g. introduction of new costly technologies, utilization of expensive medications, organization of care processes) are in their direct domain. There is growing evidence that organizations will benefit from additional non-clinical competencies acquired by doctors – the key persons in control of resources in health care. The goal of the study is to evaluate current practice of medical education in several universities of different countries regarding amount and content of courses aimed to develop contextual organizational, leadership, and management competencies. The study is based on analysis of content of selected undergraduate studies of medicine programs in all three Baltic countries and other selected countries in Europe. The results of this study showed wide variation in the defining courses aimed to develop non-technical core competencies and the lack of dedicated courses for developing elements of entrepreneurship in most of the analyzed programs. This study demonstrates the lack of collaboration that exists between governments, health providers, and universities with regard to adaptation of professional education programs to the needs of changing health care systems. The author suggests that further research is needed to prove the hypothesis that integration of entrepreneurship, economics, and management education into curricula of medical studies will add the systemic view and inter-professional competencies needed by all future physicians and will support development of leadership of tomorrow's health care managers.

Building a Safety and Quality Culture in Healthcare: Where It Starts

Healthcare in Canada underachieves stakeholders' expectations for safe, high-quality care. The authors maintain that a common understanding of, and vision for, what is required to achieve improved outcomes for patients is missing. Educating tomorrow's healthcare professionals is paramount to address this critical shortfall. However, healthcare educational institutions must themselves break out of a 20th-century paradigm of viewing healthcare safety and quality as functions of individual healthcare providers rather than as properties of the clinical micro- and meso-systems within which they function and are a part. Canadian healthcare systems are ailing; like treating a sick patient, interventions should be grounded on a solid understanding of anatomy (structure) and physiology (function). The Healthcare Encounter Safety and Quality Model (HESQM) highlights the structures underlying healthcare delivery and the key system functions required to achieve safe, high-quality care. The model has been used to frame the University of Calgary Faculty of Medicine's educational strategy for achieving safer, higher-quality care. The HESQM is based on leadership - leaders whose decisions and actions are guided by core safety and quality principles. Today's and especially tomorrow's healthcare leaders require a common understanding of how to achieve higher-performing healthcare systems; it is the responsibility of Canada's post-secondary institutions to deliver it.

Different Roles, Same Goal: Students Learn about Interprofessional Practice in a Clinical Setting

The Shriners Hospitals for Children-Canada has developed an innovative Interprofessional Education Program to help tomorrow's healthcare professionals gain the skills and knowledge they need to work effectively in teams to provide efficient, collaborative and family-centred care. Undergraduate students in nursing, physiotherapy and occupational therapy participated in group discussions, seminars by staff members and group presentations. Students reported increased understanding of their own and others' roles and a more holistic view of patients and families, and demonstrated their ability to work in teams to create collaborative care plans. Facilitating factors were a strong existing interprofessional team, administrative buy-in and support, consistent clinical nurse specialist involvement and strong, enthusiastic students. Challenges included logistics, time taken away from students' regular clinical time, time required of staff for program planning and implementation, and the difficulty of evaluating effects on patient care. The program shows promise as a way of introducing students to interprofessional practice and giving them a chance to practise their newly acquired skills in a clinical setting. It also has the potential to enhance staff awareness of interprofessional issues and facilitate staff development.

The Undergraduate Education of Nurses: Looking to the Future

Societal change historically has presented many challenges for nursing. The challenge to nurse educators is to ensure that professional education remains relevant and keeps abreast of both societal and healthcare changes. These challenges include globalization, changing patient characteristics, science and information technology advancements, the increasing complexities of healthcare, and recent policy and economic developments. The aim of this paper is to consider possible future societal and healthcare changes and how these may impact the preparation of future graduates in general nursing. A clear understanding of these factors is essential if nursing is to meet the challenges presented by tomorrow's healthcare environment within a global context.

The ethics of tomorrow's health care

The ethics of tomorrow's health care

Standard & Poor's Healthcare Economics and Policy Advisor, Industry Leader

As global healthcare systems begin to reevaluate the healthcare needs of its citizens, social entrepreneurs are playing increasingly vital roles by leveraging the sophisticated business skills and global networks of the private sector to solve healthcare problems in the public sector. These public-private partnership models for entrepreneurial collaboration are unique in history. They create sustainable businesses which do not rely on traditional philanthropy, but instead align the interests of traditional competitors and empower citizens by building foundations of economically sound revenue generating clusters that can organically grow and adapt to solve today's and tomorrow's healthcare problems. In our increasingly interdependent world the challenges we face to improve healthcare cannot be solved by government, corporations, or individuals working alone. To effectively solve our global healthcare crisis it is essential to develop an integrated decision making chain by engaging national and world community leaders, inspiring them with strategic insights, and, enabling them with creative synchronized strategic plans developed in collaboration with a multidisciplinary team from industry, the private sector, government and entrepreneurs.

Status Check: Are We Managing Performance or Managing Performance Data?

MORE THAN A DECADE AGO, I conducted an extensive review of the literature on external reporting of hospital performance data. Key takeaways from that review included the following: (i) there is a lack of consensus about to measure and report, (2) existing information resources and databases are inadequate and inaccurate with regard to constructing desired measures, (3) there are concerns about the validity and reliability of available indicators, and (4) high costs are associated with measuring performance and preparing reports (Slovensky 1996; Slovensky, Fotder and Houser 1998). My naive belief was that these issues would be resolved in a very few years. I expected healthcare executives to address the operational issues of technology and expense, health services researchers to conquer the statistical challenges, and one or more regulatory or advocacy groups to establish a standardized reporting framework. Subsequently, healthcare organizations would achieve strategic benefits from making performance data available to purchasers and consumers of healthcare services. In turn, purchasers and consumers would be empowered with information to make better healthcare decisions. Unfortunately, as Patrice Spath's current literature review suggests, none of these issues has been resolved. In fact, the pessimists among us might conclude that only moderate progress has been made in any category. Nevertheless, extraordinary resources have been expended systemwide in pursuit of the best (or at least good) indicators of provider performance, in building robust information management capabilities, and in establishing communication forums to connect providers, purchasers, and consumers. Seemingly, none of the players questions the inherent value in measuring and reporting performance data, but the what and remain problematic. This issue's lead articles provide a status report on performance and management from two useful perspectives: a recommendation for we should be doing based on current knowledge and an example of we are doing and how it's working for us. As is her wont, Spath provides practical advice for healthcare executives, discussing rational decision criteria for investing organizational resources to create a system to meet internal and external needs. The report by Ron Anderson, Ruben Amarasingham, and S. Sue Pickens of how clinical quality is managed at Parkland Hospital & Health System is consistent with Spath's recommendations, but adds rich contextual information to the big picture. WHAT TO MEASURE AND (MAYBE) REPORT Tomorrow's healthcare leaders, that is, current students and recent graduates of academic programs, are taught to establish performance indicators to measure achievement of strategic goals (Swayne, Duncan, and Ginter 2006), some of which will articulate the organization's quality positioning. From a market perspective, the ability to benchmark or compare one's performance against that of competitors may be essential. Our lead authors agree that performance must meet regulatory, purchaser, and accreditation requirements, in addition to supporting the organization's strategic agenda. Healthcare executives truly are faced with a measurement if all these information needs differ. All too often we feed the monster by trying to meet the needs of all rather than making deliberate decisions about key stakeholders and negotiating information sharing with strategic partners. And in doing so, we relearn that measurement, like quality, is an unending journey. Not only are robust measures difficult to construct, but issues of data availability and data quality further complicate the design process. In addition, the number of external reporting initiatives to which organizations can subscribe is legion and ever changing, and a significant number are mandated. In fact, for smaller organizations with limited resources, complying with mandates may preclude, or severely limit, any facility initiatives. …

Leading Tomorrow's Healthcare Organizations

Hospitals and health systems today are challenged by the lack of consistent workforce planning which has resulted in a significant dearth of effective succession planning strategies and tactics for the executive suite as well as middle management. This article discusses how the healthcare industry lags behind other corporate organizations in creating a succession plan and in retaining top leadership talent. It also provides practical approaches for succession planning in healthcare and identifies the key elements of succession planning for the chief executive officer and other senior leaders.

Improving Tomorrow's Health Care With Today's Tools: A Conversation With Larry C. Glasscock

The chairman and CEO of WellPoint Inc. provides some factual background on one of the nation's largest health insurers, which covers 34.2 million lives. Its own employees are offered the opportunity to join a consumer-directed health plan, which gives the company some real-life data on which to base its strategies in the marketplace. Glasscock believes that future reform efforts in his company and at the national level must focus on improving quality and affordability, reducing the number of uninsured Americans, and improving the health of those insured by WellPoint and everyone else.

Berwick, Escape Fire , and tomorrow's health care system. Berwick DM. Escape Fire: Designs for the Future of Health Care. Jossey-Bass/A Wiley Imprint. San Francisco (CA): John Wiley & Sons, Inc., 2003

Berwick, Escape Fire , and tomorrow's health care system. Berwick DM. Escape Fire: Designs for the Future of Health Care. Jossey-Bass/A Wiley Imprint. San Francisco (CA): John Wiley & Sons, Inc., 2003

Twenty-first-century primary care: new partnerships between nurses and doctors.

What role will advanced practice nurses (APNs) play in tomorrow's health care system? The author shares her answer to this question by first looking at the history of APNs and nurse practitioners (APNs whose focus is primary care), explaining what they do, and tracing their increasing success in overcoming long-standing barriers to full acceptance as providers of care. The author emphasizes that while APNs' advancement has usually been based on demonstrating sameness of practice processes and outcomes with those of physicians, in actuality, APNs-whose advanced primary care is delivered with full accountability and is indistinguishable from such care delivered by physicians-offer a different style of practice, which involves caring, nurturing, support, engagement with patients, attention to illness prevention and health promotion, and patient education. It is this difference on which APNs' survival rests. The author then discusses the educational training, economic, marketplace, and other questions that must be answered if APNs and physicians are to achieve a non-competitive, richer future, one in which both work together as partners rather than as members of a hierarchical team. Ultimately, such a future will be possible only when APNs have the same independence, access to patients, and voice in the treatment plan that physicians do.

Des voies pour réaliser le changement dans le système de santé en France

The report on the future of the health care system in France focuses on the challenges facing the system and the changes needed to implement new policies. These challenges are similar to those faced by other O E C D countries. However, the implicit operating model of the health care system that structures the «Horizon 2020» report does not provide insight into the underlying dynamics of this system. The four main logics driving any health care system and providing the framework for actors' decisions and practices are professional, technocratic, market and democratic. The predominant role given to the technocratic approach does not reflect the complexity of phenomena nor does it recognize the importance of the professional logic. However, it is renewed tension between the various forces influencing the regulation of the French system that will open new avenues for implementing changes. The motors of change can be summarized as follows: the production of a mobilizing vision of tomorrow's health care system; the emergence of a new leadership which will be able to rely on health care professionals; the definition of new forms of incentives that attribute an important role to values and knowledge; and, finally, the development of strategies for experimenting with new types of organization and practice.

Creating a Vision for the Twenty-First Century Healthcare Organization

Management approaches used by healthcare organizations have often lagged behind other businesses in more competitive industries. Companies operating in such dynamic environments have found that to cope with the rapid pace of change they must have an articulated understanding of their organization's capabilities and consensus on where the organization is headed based on predictions about the future operating environment. This statement of identity and strategic direction takes the form of a vision statement that serves as the compass for the organization's decisions for a five- to ten-year period. This article discusses the importance of vision statements in tomorrow's healthcare organizations, presents an overview of future scenarios that may provide context for organizational visions, and suggests a process for developing a vision statement. A case study is presented to illustrate how a vision statement is created. Following the guidelines presented in this article and reviewing the case study should assist healthcare executives and their boards in crafting better visions of their organizations' futures, developing more effective strategies to realize these visions, and adapting to more frequent and more significant change.

Preparation for practice in the new millennium: a discussion of the moral implications of multifetal pregnancy reduction.

This article approaches the problem of multifetal pregnancy reduction from a moral perspective. It is one of many complex moral issues arising from reproductive technology and is one with which midwives and nurses are faced more frequently with advancing technology. The work is intended to be used as an educational tool for those who prepare tomorrow's nurses and midwives. The subject is discussed from three perspectives, the pregnant woman and her partner (clients), a midwife, and from a philosophical ethical perspective. In an attempt to introduce a degree of reality, the perspective of the clients is presented as a dialogue. The midwife's moral position and her professional difficulties are also discussed. The dialogue and discussion are supplemented with notes in which the issues raised by the characters are critically analysed and discussed. This article is designed to encourage reflection and critical thinking in tomorrow's health care professionals, and in those who have the responsibility of educating them for a future where reproductive technology is posed to generate more major moral quandaries.

Today's Communications Technology--Tomorrow's Health Care

Today's Communications Technology--Tomorrow's Health Care

Advanced practice roles for nurses in tomorrow's healthcare systems.

Advanced practice nurses (APNs) have traditionally been a diverse group in terms of titles, education, credentials, and roles. The classification of APN usually encompasses the nurse practitioner (NP), certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). NP, CRNA, and CNM roles have been more clearly delineated than the CNS roles. In light of healthcare reform, the CNS roles have been critically reviewed and analyzed. Attempts have been made to clarify responsibilities and outcomes, and to quantify the financial impact of this role. In this article, seven APN roles clearly defined in terms of minimal qualifications and competencies critical to accomplishment of the duties, responsibilities, and expected outcomes are presented. Comparison of competency requirements are also presented. The roles presented are designed to facilitate healthcare institutions in meeting the demands for serving patients with increasingly complex needs, as well as cost-containment goals.

Nurse Practitioners in a Teaching Hospital

The development of a model of care using acute care nurse practitioners in a teaching hospital and the integration of the nurse practitioner into an alternative model of care delivery are discussed. Issues in implementation include lack of understanding about the nurse practitioner role on the part of other members of the health care team, legislative constraints, and the administrative restrictions of teaching hospitals. Education of nurses and physicians regarding the scope of practice of the nurse practitioner role, departmental policy changes, and the development of protocols facilitate the efficiency and utilization of the nurse practitioner in this setting. Specific concerns surrounding costs of a nurse practitioner service and practice differences between the clinical nurse specialist and the acute care nurse practitioner are addressed. Nurse practitioner models of care delivery, which address quality, cost-effective care are on the forefront of tomorrow's health care.

Building a data foundation for tomorrow's healthcare information management systems.

Accurate, timely data are a necessary foundation for an effective healthcare information management system. Today's systems do not achieve their potential because they lack this essential ingredient. Technology can reduce the problem by making the data entry task easier, but a complete solution will require new strategies for system implementation and use. Functions must be implemented in a sequence that allows the initial functions to establish a data foundation for subsequent functions. Each atomic data item must be collected separately, with a consistent definition. Data capture strategies must permit data to be collected once, at the source. Finally, the data must be used, reused, and corrected by all members of the healthcare team.

Health reform planning models. The case of veterans hospitals.

As part of the national effort to reform healthcare, the Department of Veterans Affairs is undergoing a major reassessment of its healthcare mission. As Veterans Affairs prepares to meet the challenges of the twenty-first century, one underlying issue of critical importance is which planning assumptions will be selected and employed. Will historical patterns of veterans' use be interpreted as indicators of the market demand for Veterans Affairs healthcare services, or will estimates of disease prevalence among veterans be used as indicators of future healthcare need? If Veterans Affairs is to continue as a critical component of the nation's healthcare delivery system, its selection of a planning basis will have major implications for tomorrow's healthcare system.