Organizational Outcomes For Providers

This work will review factors affecting patient safety in ICU and what to do to reach a proper patient outcome.Organizational Outcomes For Providers And Patients Essay

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Patients in Intensive Care Units are at risk of unsafe care because of the complex environment, also a patient may sustain an injury as a direct result of daily care. This makes nurses uniquely poised to have a tremendous impact on patient safety as professional caregivers in direct contact with patients and their families. Quality care and patient safety require a focused commitment from all level of an organization, yet nurses serve as the bedside safety advocate with the opportunity to put theory into practice. The challenges are: What is the right thing to do? Is the right thing being done? Is it being done right?

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Factors that play a role in patient safety in ICU environment

The critical care setting is one of the most complex environments in a health care facility. Critical care units must manage the intersecting challenges of maintaining a high-tech environment and ensuring staff competency in operating the equipments, providing high-quality care to the sickest patients of a health facility and attending to the needs of staff members working in a very stressful environment (Chang et al, 2005).Organizational Outcomes For Providers And Patients Essay

Before building initiatives to enhance patient safety, the extent of patient injuries and events in ICUs must be well explained. Critically ill patients are at high risk for complications due to the severity of their medical conditions, the complex and invasive nature if intensive care treatments and procedures and the use of drugs and technology that carry risks as well as benefits (Chang et al, 2005).

What to do?

The first step of patient safety improvement process is to gain the support and engaging leadership.Risk managers, patient safety officers and critical care physicians start working together to make a business case to executives for patient safety investments. In short; implementing ICU patient safety plane becomes a team effort (Rainey and Combs, 2003).

An improvement initiative will be more successful if a culture of patient safety prevails. This should create an ICU environment in which all members of ICU team understand how to exchange patient information in a meaningful and respectful way. A starting point in creating such a culture is to conduct an assessment of the current climate in the ICU whether and how it affects patient care (Rainey and Combs, 2003).Organizational Outcomes For Providers And Patients Essay

A facility’s approach to provide safe critical care services will depend mainly on the ICU is organized, staffed and designed i.e. ICU staffing, structure and work environment. Generally, there are three organizational models for ICUs; the open model which allows different members of the medical staff to mange patients in the ICU. The closed model is limited to ICU certified physicians managing all cases. The hybrid model, it combines aspects of the previous two models on referral basis (Chang et al 2005, Rainey and Combs 2003 and Pronovost et al 2003).

Work environment within the ICU is characterized by being high work load and fatigue; both have been identified as major negative contributors to patient safety. Staffing an adequate number of critical care educated nurses is essential to the delivery of high quality ICU care (Chang et al 2006).

ICU equipment, technology and systems should be assessed from the perspective of patient safety before acquisition and implementation. When devices do not undergo a rigorous evaluation for appropriateness during acquisition or when they are not used properly or badly maintained, they can contribute seriously to patient safety (Pronovost et al 2003).Organizational Outcomes For Providers And Patients Essay

Quality indicators: Savitz, Cheryl and Shulamit, conducted a meta-analysis on quality indicators sensitive to nurse staffing in acute care settings and their results did not to specific indicators that should necessarily be examined in monitoring performance and examining trends in safety as related to nursing staff.

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What is needed?

The shortage of critical care nurses has increased concerns for patient safety. Programs must retain experienced critical care nurses and maintain nursing staff competency with medial equipments and procedures. Continuing education must not be neglected on the assumption that the nurse can not be spared (Trossman 2000). Closer cooperation and understanding is always needed for the ICU staff members. Having a clear program for ICU patient safety should make the job easier.Organizational Outcomes For Providers And Patients Essay


Recognizing the critical linkage between nursing workforce and safe and effective outcome for patients, both health provider and professional organizations are committed to work together to accelerate the adoption of evidence based practices known to improve the working nursing environment, patient safety and quality outcomes for patients.

This necessitates having a culture that supports patients safety, operating the ICUs as a dedicated team managed by intensive care specialists with specialized training. Finally, to ensure that the work environments can support the caregivers to interact productively, make proper level titrated vital decisions, perform medical intervention and operate medical equipments safely.

Healthcare organizations operate in uncertain times of healthcare reform. Therefore, strong, ethical and professional leadership can guide organizations to act in the best interest of the staff and patients. Ethical culture, with its expected input of virtuousness and emotional wellbeing, can positively enhance outcomes independently of individual employee’s specific value and ethics, as a result, managerial efforts should be heavily focused on creating an ethical culture (Ruiz-Palomine, Martinez-Canas, & Fontrodona, 2013). Improving employee’s perceptions of ethics in the organization, such as fairness, clarity of expectations, accountability, and leadership prioritization, could impact healthcare organizational outcomes (Cohen, Foglia, Kwong, Pearlman & Fox, 2015). In the current health care arena, the level of patient satisfaction depends on clinical leadership and nurses’ ability to communicate effectively during the delivery of care (Moore et al., 2016).Organizational Outcomes For Providers And Patients Essay

The drive to provide effective communication to the patient stems from new financial sanctions implemented by CMS, which can withhold two percent of hospitals’ inpatient payments (CMS, 2016). The consequence of the new financial sanctions is that acute care hospitals focus on increasing patient satisfaction and organizational performance through improving communication (Mazurenko et al., 2016). Recent studies on hospital communication indicate that an open dialogue between patients and nurses positively influences the patients’ experiences and satisfaction assessments (Ford, Huerta, Diana, Kazley, & Menachemi, 2013). These links between organizational ethical culture and outcome verifies the importance of organizational ethical culture and its impact on productivity and customer satisfaction.Organizational Outcomes For Providers And Patients Essay

There is very limited empirical research on the relationship between an organizational ethical culture and patient satisfaction in health care organizations. According to Riivari and Lasma, (2014), organizational ethical culture influences innovation and they have concluded that strong ethical culture has a direct impact on organizational culture and innovation. Nevertheless, this study did not include other aspects of an organization’s outcome such as financial outcome, productivity, efficiency, commitment, and work satisfaction. Riivari and Lasma, (2014), recommended further research to include these outcomes. Ethical leadership behavior is related to the perception of ethical climate, and ethical climate mediates the influence of the managers on individual ethical behavior outcome (Demirtas & Akdogan, 2015). However, findings of this study cannot be generalized to other industries and they suggested further research should include other variables and outcomes as counter-production and group level behaviors.Organizational Outcomes For Providers And Patients Essay

The aim of this research is to address the gap in literature and explore healthcare organizational ethical culture’s impact on patient satisfaction. Improving patient satisfaction and organizational performance has been a challenge for healthcare organizations. In the past, research on organizational ethical culture and performance has yielded limited results on ethical culture influence on the healthcare industry, in particular, its effect on patient satisfaction (Cohen et al., 2015). Hence, when healthcare organizations possess high level of ethical culture they experience less staff turnover, more productivity, increased patient safety, cost effectiveness, and a high level of patient satisfaction. Effective leadership in healthcare is important for the achievement of optimal patient outcomes (Wong, Cummings, & Ducharme, 2013). Recent studies on hospital communication indicate that an open dialogue between patients and nurses positively influences the patients’ experiences and patients’ satisfaction assessments (Ford, Huerta, Diana, Kazley, & Menachemi, 2013). Nursing care has the most substantial impact on the HCAHPS overall rating top-box percentage with measuring patient satisfaction and can have implications on hospitals reimbursements (Wolosin, Ayala, & Fulton, 2012).Organizational Outcomes For Providers And Patients Essay

There are a number of studies that have identified the relationship between ethical culture, climate and moral distress in healthcare (Atabay et al., 2015; Oh & Gastmans, 2015). Other studies explored the correlation between ethical climate and organizations’ effectiveness including job satisfaction turnover and commitment (Demirtas & Akdogan, 2015; Huang, You &Tsi, 2011; Ebtisam Aly, 2017). However, the proposed study will offer new insight into the application of corporate ethical virtues on patient care delivery and patient satisfaction regarding nursing communication. The findings of this study will contribute to the body of knowledge concerning ethical theory and model, as well as its relationship to patient satisfaction. The specific focus of this study lies in the examination of a relationship between organizational ethical virtues in nursing and patient satisfaction in a large academic hospital.Organizational Outcomes For Providers And Patients Essay

The researcher will use a quantitative methodology to examine the relationship between nursing ethical culture and patient satisfaction at a large academic center in North East United States. The primary foundation of this study is the Corporate Ethical Virtues (CEV) model as it formulates normative and multi-dimensional measures for evaluating the ethical culture of an organization (Kaptein, 2008). This study seeks to investigate the relationship between nursing ethics as perceived by frontline nursing and patient satisfaction. The researcher will collect data using the corporate ethical virtues model (CEV) to measure ethical culture (Kaptein, 2013), facilitated by using Survey Monkey, a web-based survey tool. The Opinion Meter, which is based on the questions on the Hospital-Consumer Assessment of Healthcare Providers and Systems (HCAHPS; CMS, 2015), will be used to measure patient rating of nurses’ communication during their hospitalization. The Opinion Meter survey will be administered directly to the patient that is assigned to the same nurse (Appendix G).Organizational Outcomes For Providers And Patients Essay

The remainder of this chapter will focus on the background of the study, statement of the problem, purpose of the study, the proposed research questions and hypotheses, how this research will advance scientific knowledge, and the significance of the study. Moreover, this chapter contains a brief overview of ethical leadership, organization’s ethical culture, patient satisfaction, as well as rationale for using quantitative research methodology and the research design. This chapter will conclude with a list of the definition of terms, assumptions, limitations, delimitations, and a summary organization of the rest of the study.

As nurse practitioners continue to expand their role in delivering health care, it is imperative for NPs to provide the data and evidence to demonstrate the impact of NP care on patient outcomes. There are several challenges that advanced practice nurses face to provide quality care and meet productivity goals of an organization. This week it is important to explore the connection of quality care and performance measures. Some questions to consider as we discuss this topic are:Organizational Outcomes For Providers And Patients Essay
• Why are quality measures important?
• What is the difference between quality measures and performance indicators?
• What performance measures are used for NP productivity?
• Why are incentive plans used in clinical organizations?
To prepare:
• Read the article, An Incentive Plan for Advanced Practice Registered Nurses: Impact on Provider and Organizational Outcomes, by Catherine A. Rhodes, Mavis Bechtle, and Molly McNett (2015)
• Explore quality measures and identify at least one clinical performance measure, such as the Agency for Healthcare Research and Quality (AHRQ)
Post an explanation of the importance of quality measures using the clinical performance measure you identified as an example.
Then, identify the performance measures used for NP productivity in Rhodes, Bechtle, and McNett (2015) article.
Finally, share your opinion on incentive payment for care, including external motivators and at least one business model.Organizational Outcomes For Providers And Patients Essay

Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors. Studies conducted during the past three decades show that the clinician’s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care.


Patients’ perceptions of the quality of the healthcare they received are highly dependent on the quality of their interactions with their healthcare clinician and team 2,3. There is a wealth of research data that supports the benefits of effective communication and health outcomes for patients and healthcare teams. The connection that a patient feels with his or her clinician can ultimately improve their health mediated through participation in their care, adherence to treatment, and patient self-management. Organizational Outcomes For Providers And Patients Essay

Yet, it is estimated that one-third of adults with chronic illnesses underused their prescription medication due to cost concerns; yet they fail to communicate this information to their physician 10. Another study found that less than half of hospitalized patients could identify their diagnoses or the names of their medication(s) at discharge, an indication of ineffective communication with their physicians. 11

The Institute of Medicine (IOM) Report on Health Professions and Training 12 has identified that doctors and other health professionals lack adequate training in providing high quality healthcare to patients. The IOM 12 called upon educators and licensing organizations to strengthen health professional training requirements in the delivery of patient-centered care. The patient-centered care model 13 underscores the essential features of healthcare communication which relies heavily on core communication skills, such as open-ended inquiry, reflective listening and empathy, as a way to respond to the unique needs, values and preference of individual patients 14.

Healthcare Communication Outcomes
A clinician may conduct as many as 150,000 patient interviews during a typical career. If viewed as a healthcare procedure, the patient interview is the most commonly used procedure that the clinician will employ. Yet communication training for clinicians and other healthcare professionals historically has received far less attention throughout the training process than have other clinical tasks.Organizational Outcomes For Providers And Patients Essay

This is so even as evidence continues to mount that a structured approach to communication measurably improves healthcare delivery.

Diagnostic Accuracy
Most diagnostic decisions come from the history-taking component of the interview 15.. Yet, studies of clinician-patient visits reveal that patients are often not provided the opportunity or time to tell their story / history, often due to interruptions, which compromise diagnostic accuracy. Incomplete stories /history leads to incomplete data upon which clinical decisions are made.
When interruptions occur, the patient may perceive that what they are saying is not important and leads to patients being reticent to offer additional information.
The bottom line is that when patients are interrupted, it is a deterrent to collecting essential information and it hinders the relationship.
Adherence is defined as the extent to which a patient’s behavior corresponds with agreed upon recommendations from a healthcare provider 16. Certainly, we are all aware of the huge problem of non-adherence in health care. For instance, a Health Care Quality Survey 17 conducted by the Commonwealth fund found that 25% of Americans report they did not follow their clinician’s advice and provides the reasons cited in this survey:Organizational Outcomes For Providers And Patients Essay

39% disagreed with what the clinician wanted to do (in terms of recommended treatment)
27% were concerned about cost
25% found the instructions too difficult to follow
20% felt it was against their personal beliefs
And 7% reported they did not understand what they were suppose to do
Patient Satisfaction
The core elements comprising patient satisfaction 18 include:

Expectations: Providing an opportunity for the patient to tell their story.
Communication: patient satisfaction increased when members of the healthcare team took the problem seriously, explained information clearly, and tried to understand the patient’s experience, and provided viable options.
Control: Patient satisfaction is improved when patients are encouraged to express their ideas, concerns and expectations.
Decision-making: Patient satisfaction increased when the importance of their social and mental functioning as much as their physical functioning was acknowledged.
Time spent: Patient satisfaction rates improved as the length of the healthcare visit increases.
Clinical team: Although it is clear that the patient first concern is their clinician, they also value the team for which the clinician works.Organizational Outcomes For Providers And Patients Essay
Referrals: Patient satisfaction increases when their healthcare team initiates referrals relieving the patient of this responsibility.
Continuity of care: Patient satisfaction increases when they receive continuing care from the same healthcare provider(s).
Dignity: As expected, patients who are treated with respect and who are invited to partner in their healthcare decisions report greater satisfaction.
Patient Safety
An estimated one-third of adverse events are attributed to human error and system errors 19.
Research conducted during the 10 year period of 1995-2005 has demonstrated that ineffective team communication is the root cause for nearly 66 percent of all medical errors during that period.
This means that when health care team members do not communicate effectively, patient care often suffers.
Further, medical error vulnerability is increased when healthcare team members are under stress, are in high-task situations, and when they are not communicating clearly or effectively 19.
Team Satisfaction
Why is team satisfaction important?Organizational Outcomes For Providers And Patients Essay

Communication among healthcare team members influences the quality of working relationships, job satisfaction and profound impacts patient safety 19.
When communication about tasks and responsibilities are done well, research evidence has shown significant reduction in nurse turnover 20 and improved job satisfaction because it facilitates a culture of mutual support 21 .
Larson and Yao 22 found a direct relationship between clinicians’ level of satisfaction and their ability to build rapport and express care and warmth with patients.
What are the elements that contribute to healthcare team satisfaction: Feeling supported, e.g., administratively and inter-personally, respected, valued, understood, listened to, having a clear understanding of role, work equity and fair compensation.Organizational Outcomes For Providers And Patients Essay

Malpractice Risk
According to Huntington and Kuhn 23, the “root cause” of malpractice claims is a breakdown in communication between physician and patient.
Previous research 24 that examined plaintiff depositions found that 71% of the malpractice claims were initiated as a result of a physician-patient relationship problem. Closer inspection found that most litigious patients perceived their physician as uncaring 24. The same researchers found that one out of four plaintiffs in malpractice cases reported poor delivery of medical information, with 13% citing poor listening on the part of the physician 24.
Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors. Studies show that the clinician’s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care. Further, communication among healthcare team members influences the quality of working relationships, job satisfaction and has a profound impact on patient safety.

Clinicians and other members of the healthcare team conduct thousands of patient interactions during their career. The call to action from the Institute of Medicine (IOM) Report on Health Professions and Training 12 underscores the importance of communication training for clinicians and members of the healthcare team. Similar to other healthcare procedures, communication skills can be learned and improved upon. Improvement in communication skills requires commitment and practice.Organizational Outcomes For Providers And Patients Essay

Given the wealth of evidence linking ineffective clinician-patient communication with increased malpractice risk, nonadherence, patient and clinician dissatisfaction, and poor patient health outcomes, the necessity of addressing communication skill deficits is of the utmost importance. Organizational Outcomes For Providers And Patients Essay

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