Creating a future worth experiencing: nursing strategic planning in an integrated healthcare delivery system

The application of a strategic planning methodology for the discipline of nursing is described in use by a large, nonprofit integrated healthcare system. The methodology uses a transformational leadership assessment tool, quality planning methods, and large group intervention to engage nurses in the implementation of strategies. Based on systems theory, the methodology outlined by the author has application at any level in an organization, from an entire delivery network, to a patient care unit. The author discusses getting started on a strategic planning journey, tools that are useful in the process, integrating already existing business plans into the strategies for nursing, preliminary measures to monitor progress, and lessons learned along the journey.     

Achieving breakthrough performance in an integrated delivery system

The challenges facing Blue Cross and Blue Shield of Massachusetts were considerable. Its products were largely indemnity-oriented. Its cost structure was high compared to the newer managed care industry. Its service culture was more internally directed than the competition. Its financing and payment systems were not well integrated into the delivery system. The ultimate challenge in the face of an increasingly competitive environment was to reengineer the company.     

Care delivery innovation in an integrated health system

In an environment marked by continuous change, organizations that develop a capacity for innovation have a distinct competitive advantage. In today's health care environment, moreover, innovative care delivery increasingly is recognized as essential for organizational stability and success.     

High-resource hospital users in an integrated delivery system.

OBJECTIVES: With decreasing healthcare reimbursement, nurse administrators need to aggressively manage care for high-resource users of hospital services to ensure the viability of their healthcare organization. The objective of this study was to (1) investigate frequent Medicare inpatient admission and emergency department users, (2) investigate Medicare day outliers, and (3) examine Medicare reimbursement/charge ratios. BACKGROUND: Although much research has focused on patients who have been readmitted frequently to the hospital, little research has examined patients who are frequent users of both emergency departments and inpatient services. METHODS: In this study, all 4,920 elderly Medicare inpatient admissions and emergency department visits for 1 year in a 222-bed general hospital were included. Patient profiles of two categories of high resource users were created. RESULTS: Results showed the frequent high user group (n = 75), who had six or more combined emergency department and inpatient admissions per year, had cardiac, diabetic, and chronic respiratory conditions, and came to the hospital from their homes. The day outlier profile (n = 148) consisted of older patients who have neoplasms, and respiratory and circulatory diseases. The mean Medicare reimbursement/charge ratio varied for high volume diagnosis-related groups (DRGS.) IMPLICATIONS: From the study, implications include refining case management, monitoring high-resource patients by computer tracking, analyzing high-user trends by several different methods, incorporating many facets of an integrated healthcare delivery into their care, expanding patient, outpatient, and community support programs, and continually monitoring revenue for organizational viability.     

Clinical leadership in nursing development units

There is an expectation for Nursing Development Units (NDUs) to explore and develop the clinical leadership role. This paper describes how 28 Department of Health funded NDUs in England sought to meet this objective. We describe the personal and professional characteristics of NDU clinical leaders (CLs) and their perceived responsibilities. We identify 10 elements which appear to be central to the CL role and together form a core role set of the leader which is applicable, to some extent, across clinical specialties and settings. The position of the CL in the organizational hierarchy emerges as crucial to his/her ability to act on these responsibilities and fulfil a leadership role.     

A case for conceptual competency in an integrated delivery system

Integrated delivery systems come in more than one shape--vertical, horizontal, or a combination of both. Leadership competencies vary according to the type of system. The most complicated is the combination; this and horizontal requires that the leader has the competency in the conceptual area. The business and health care model are highly congruent, with useful applications from industry. The skill and aptitudes required for conceptual competency are discussed in relation to a combined vertical and horizontal system complicated by academia and city politics.     

Developing a patient care model for an integrated delivery system.

An integrated healthcare delivery system requires a consistent patient care delivery model. The authors describe the process used to define common elements of the patient care model. These elements include the roles of chief nurse executives, first-line managers, staff registered nurses, and unlicensed assistive personnel. In addition, the philosophy of nursing and support functions (staff education and nursing dashboard for quality measurement) in place across the system are discussed.     

护理综合目标管理体系的构建

目的:建立护理综合目标管理体系,提高护理质量。方法:构建由三级质控网络组成的组织体系,注重持续质量改进的考核体系及综合评价体系。结果:加强了质量管理的内涵建设,强化了全面参与质量管理的意识,促进了护理队伍整体水平的提高。结论:护理综合目标管理体系适应于护理质量管理,是提高护理管理水平的一个完整的管理体系。     

Developing an integrated nursing team approach

Nursing Standard recently published a literature search that explored different models of integrated nursing and more traditional models of community nursing in primary care (Baileff 2000). Models of change for implementing integrated nursing were also examined. This article aims to explore the development of an integrated nursing team in a healthcare centre in Northampton.     

Management and leadership in nursing: an Australian educational perspective

dignam d., duffield c., stasa h., gray j., jackson d. & daly j. (2012) Journal of Nursing Management 20, 65–71
Management and leadership in nursing: an Australian educational perspective Aim In this article, we present an Australian perspective on issues influencing management and leadership education in nursing. Background Nurse leaders and managers work in a context of high pressure, uncertainty and rapid change, and face unprecedented challenges on a daily basis. Evaluation and Key Issues In the present paper, we reflect on the issues and challenges facing providers of management education for nursing, and consider these challenges in relationship to current trends and imperatives. Conclusions Collaborative approaches between educational and clinical settings are needed to ensure quality, relevant educational support for managers and leaders, and enhance curriculum integrity. Implications for Nursing Management There is a need for contemporaneous and relevant research to inform innovative models of collaborative education.     

疤痕子宫产妇的临床护理

目的探讨疤痕子宫产妇分娩前后的护理对策。方法选择有疤痕子宫并足月妊娠的产妇52例为研究对象,根据其病史,心理,前次分娩情况等采取不同的护理方式,阴道分娩者注意"导乐"过程,剖宫产者去除恐惧及做好配合等,阴道分娩失败再次剖宫产者加强心理护理及配合。结果 44例再次行子宫下段剖宫产术,8例顺利阴道分娩,产后及术后恢复良好,新生儿健康。结论对于疤痕子宫患者,针对不同的分娩情况,须采取合适的护理对策,加强心理护理,结局满意。