The relationship between healthcare costs and quality is likely one of the most discussed and controversial topics in health policy. In the United States, the healthcare industry is challenged with providing high quality care that is affordable, efficient and equitable. The quality of healthcare in comparison to the cost has yet to be accurately defined. Quality healthcare is described as “uniquely intangible, variable and inseparable characteristics.” (Al-Rashdi, 2001).

As well, affordability and quality both are viewed differently in importance and definition depending on the particular stakeholder in question. This makes it increasingly difficult to find a one-size fits all solution.  It is however, in order for healthcare to be both affordable and high quality, organizations need to focus on providing cost effective care, while maximizing the current resources available while exploring opportunities for further improvements.

In light of the recent and on-going COVID-19 pandemic, challenges to provide affordable and high-quality patient care have become increasingly challenging.  The American healthcare system has and continues to experience staffing and supply chain shortages that are unprecedented, as well as increased costs.  In many services areas, besides healthcare, the effect inflation results in rising costs for the consumer.  The increased cost, however, does not necessarily reflect an increase in quality.

Health care costs are associated with high quality and others with poor quality, but the actual result depends on where the focus is placed within the organizational policy and practice (Hussey, Wertheimer & Mehrotra, 2013).  According to Rivers and Glover (2008), through quality and process improvements organization can decrease costs, which in turn results in increased customer satisfaction while maintaining quality.

Reference:

Al Rashdi I. (2011). How much the quality of healthcare costs? A challenging question!. Oman medical journal, 26(5), 301–302. https://doi.org/10.5001/omj.2001.76

Hussey, P. S., Wertheimer, S., & Mehrotra, A. (2013). The association between health care quality and cost: a systematic review. Annals of internal medicine, 158(1), 27–34. https://doi.org/10.7326/0003-4819-158-1-201301010-00006

Rivers, P. A., & Glover, S. H. (2008). Health care competition, strategic mission, and patient satisfaction: research model and propositions. Journal of health organization and management, 22(6), 627–641. https://doi.org/10.1108/14777260810916597

Discussion: Organizational Policies and Practices to Support Healthcare Issues

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.

To Prepare:

• Review the Resources and think about the national healthcare issue/stressor you previously selected for study in Module 1.
• Reflect on the competing needs in healthcare delivery as they pertain to the national healthcare issue/stressor you previously examined.

By Day 3 of Week 3

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

The competing needs of the workforce, resources, and patients directly impacts the development of policy in the Emergency Department. Policy development is needed to prevent the impact that nurse burnout has on turnover rates in the Emergency Department. Specifically, policies regarding self-scheduling should be established by organizations to help Emergency Department nurses achieve a healthy work-life balance.

While there may be different variables on the organizational level regarding high turnover rates, a common theme in the research points to the fact that turnover rates are directly related to job satisfaction. One example is a study that showed that nurses viewed self-scheduling as a way of enabling them to have the work-life balance they need to have a more exceptional feel of job satisfaction (Armstrong-Stassen, Schlosser, 2010).

Policy development regarding self-scheduling is beneficial in that it empowers nursing staff to feel that they have more control over their time spent at work and their time spent with their families. To reduce nurse burnout and turnover rates, a policy development that enables nurses to self-schedule shifts helps nurses to establish a healthy work-life balance (Wright, McCartt, Raines & Oermann, 2017). Active policy development is vital in implementing self-scheduling for nurses. In an article by Bailyn, Collins, and Song (2007), it detailed how ineffective policy development led to adverse effects associated with self-scheduling. The scheduling policies were not adhered to by management and staff, which failed the attempted implementation of self-scheduling.

My personal experience of self-scheduling has been both positive and negative. My previous employer was an example of ineffective self-scheduling and was the primary reason that I left that position. We were required to self-schedule half daylight shifts and half night shifts per six-week schedule rotation. My nurse leader would change all of my self-schedule requests to different days and also put me on a steady night shift for many consecutive schedule rotations in a row. This action led to job dissatisfaction for me. However, the benefit of self-scheduling with a properly developed and utilized policy at my current position creates a higher level of job satisfaction for me.

It is evident by the research that self-scheduling for nurses leads to increased levels of job satisfaction and decreased turnover rates. Policy development needs to ensure that management and staff are adhering to the policy guidelines for self-scheduling. By developing and adhering to self-scheduling policies, organizations may see a drop in nurse turnover rates.

Armstrong-Stassen M., Schlosser F. (2010). When hospitals provide HR practices tailored to older nurses, will older nurses stay? It may depend on their supervisor. Human Resource Management Journal, 20(4), 375-390. doi:10.1111/j.1748-8583.2010.00143.x

Bailyn L., Collins R., Song Y. (2007). Self-scheduling for hospital nurses: An attempt and its difficulties. Journal of Nursing Management, 15(1), 72-77. doi:10.1111/j.1365-2934.2006.00633.x

Wright, C., McCartt, P., Raines, D., & Oermann, M. H. (2017). Implementation and Evaluation of Self-Scheduling in a Hospital System. Journal for nurses in professional development, 33(1), 19–24. https://doi.org/10.1097/NND.0000000000000324

By Day 6 of Week 3

Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.

Great insights! True to your statements, while there may be different variables on the organizational level regarding high turnover rates, a common theme in the research points to the fact that turnover rates are directly related to job satisfaction.

One on-going healthcare policy that nurses have played a role in is The Registered Nurse Safe Staffing Act of 2018 (HR 50552 S2246). Under the proposed Registered Nurse Safe Staffing Act, Medicare participating hospitals would be required to establish and publicly report unit-by-unit staffing plans which includes self-scheduling

The Safe Staffing for Nurse and Patient Safety Act of 2018 not only considers the complexity and stability of patients, but also nurse experience, available technology, resources and unit workflow such as numbers of admission, discharges and transfers.

The goal of the bipartisan legislation, according to the American Nurses Association, is to shorten hospital stays; lower infection rates; and prevent medication errors, falls, injuries, and deaths. At each hospital, a committee, 55% of whom should be RNs involved in direct care will determine staffing levels for specific units. The plan includes procedures for investigating complaints and protection for whistle-blowers.

The importance of having a safe working environment, is a fundamental concept that  is a growing concern for nurses. Each time we step onto our unit and begin a work shift, their licenses are on the line. The healthcare system demands high quality, patient centered nursing care, this is only possible if nurses have the resources and support. Great post!