Strategies to effectively manage health care resources and in leading

LEADERSHIP STRATEGY

As a nurse, you serve an important role in identifying strategies to effectively manage health care resources and in leading health care quality improvement. You must be able to decide what leadership style or strategy to apply in a given situation to achieve an effective resolution of the issue. Read the following two scenarios and select one to focus on in this Discussion. Consider the leadership style or strategy that might be most effective in the scenario you selected.

SCENARIO 1

You work in a for-profit nursing home, with about 100 beds, on a 20-bed unit that is largely patients with Alzheimer’s disease. Your patient mix is predominantly Medicare and Medicaid patients. Your nursing home is part of a larger system that includes a major medical center, as well as VNA, outpatient dialysis, and a fully integrated network. Your nurse manager is getting feedback from the hospital that your nursing home is sending too many patients to the ED who really don’t need to go. How would you go about figuring out what could be done at the nursing home to prevent avoidable ED visits?

SCENARIO 2

You’ve been associated with an outpatient cardiology clinic that is part of a large academic medical center. Your patients are mostly charity care and managed Medicaid. Most have a prescription plan, but none have a “family doctor” and use the clinic (and the ED) regularly. Most are unfamiliar with their medications and do not have the resources for care coordination in their family/social network. About 25 CHF patients have been “lovingly,” but inappropriately, called “frequent fliers” because of their inability to manage their own care, their frequent visits to the ED, and their “one night stays” paid at the observation rate. As a staff nurse in this clinic, describe the strategies you could devise for you and your fellow staff nurses targeting these 25 patients. Find at least one article from the professional literature to corroborate your recommendations.

Select one of the scenarios, and 
post the following:

Describe the most appropriate leadership style and/or strategy to apply in the scenario you chose in order to implement the recommendations successfully. Justify your selection.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level.

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use 
evidenceLinks to an external site. from the readings and include 

in-text citationsLinks to an external site.
. Utilize 

essay-levelLinks to an external site.
 writing practice and skills, including the use of 

transitional materialLinks to an external site.
 and 

organizational framesLinks to an external site.
. Avoid quotes; 
paraphraseLinks to an external site. to incorporate evidence into your own writing. A 

reference listLinks to an external site.
 is required. Use the most 

current evidenceLinks to an external site.
 (usually ≤ 5 years old).

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Tina Marie Beltz

Main Discussion Post Week 5

Effective leadership of healthcare professionals is critical for improving quality, care, and cost reduction.   As a staff nurse at an outpatient cardiology clinic, there are a few strategies we can implement to assist our patient population group. The strategy or approach I like the most so far is the Quadruple Aim or Triple Aim. (Patricia S. Yoder-Wise, 2019) The Quadruple Aim focuses on improving the patient’s experience of care, improving the health of the population, and reducing the cost of health care, as well as improving the work life of the health care provider. ( Institute for Healthcare Improvement., 2023)

The American Heart Association has programs for underprivileged,  under-resourced community populations.  This would be a great resource to introduce to patients that need assistance with several aspects of their care.  A very interesting item I discovered when researching this is that the American Heart Association has a telemedicine program that connects healthcare facilities with volunteer cardiologists at no cost to patients. (No-cost cardiology consultations for under-resourced communities: Doctors With Heart, 2021) This is actually a superb resource to get out to patients.   Most of the population now has access to a cell phone so getting connected with resources is much easier than it used to be.  American Heart Association also has a lot of information regarding cardiovascular education, diets, receipts, stress management, fitness, and exercise, and much more. (American Heart Association, 2023)  There is also a way to look up local events near you.

As a staff nurse at an outpatient cardiology clinic, I would advocate putting in place an area to connect with an online cardiologist.  Not only that but provides a place for patients to search, learn, and review information about their specific diagnoses.  I would provide pamphlets and information leaflets.  A learning center of sorts.  On the American Heart Association’s site, there is also a section where you can download Cardiac Rehab Tools and Resources. 

References

Institute for Healthcare Improvement. (2023). 
The IHI Triple Aim. Retrieved from Institute for Healthcare Improvement.: https://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

American Heart Association. (2023). 
American Heart Association. Retrieved from American Heart Association: https://www.heart.org/

No-cost cardiology consultations for under-resourced communities: Doctors With Heart. (2021, June 17). Retrieved from American Heart Association: https://newsroom.heart.org/news/no-cost-cardiology-consultations-for-under-resourced-communities-doctors-with-heart

Patricia S. Yoder-Wise, R. E.-B. (2019). Leading, Managing, and Following. In R. E.-B. Patricia S. Yoder-Wise, 
Leading and Managing in Nursing, 7th Edition (p. 2). Elsevier.

Jasmine Leakes

Reducing the number of unnecessary emergency room visits should be the goal of all working in the medical field. Working in a 100-bed nursing home with most patients diagnosed with Alzheimer’s Disease, it may be difficult to differentiate between what warrants an emergency room visit, versus what can be treated in the home/nursing facility setting. This can lead to many unnecessary and avoidable ER visits, overutilization of the emergency room, and costly bills to insurance and patients. Emergency department/room visits for nursing home residents lead to higher morbidity and mortality; therefore, inappropriate visits or potentially avoidable visits must be minimized (Zuniga, et al, 2022). ER visits not only include the risks of harm to the resident, but they also increase healthcare costs and use of resources when not necessary. ER visits are traditionally for acute care needs. When we are sending patients unnecessarily to an ED, we are blocking the chances for other serious cases that could arise. These visits burden the health care system. Selection, evaluation, and decision-making are very important factors to address prior to sending a patient to the emergency room.

To proactively address the issue above at hand, the facility should take steps to better understand its patient population and anticipate some of the reasons why these patients may report to the ER. It is important for the nursing and medical staff to identify and evaluate potentially high utilizers of the emergency room within the nursing home. Understanding why these patients are often sent to the ER can help to formulate a plan to reduce the number of times these residents are sent to the emergency department. Being a nursing home with patients primarily diagnosed with Alzheimer’s Disease, many caregivers can confuse symptoms of dementia/Alzheimer’s Disease with delirium. Delirium is a state in which a person is confused, disoriented, and not able to think or remember clearly. This usually starts suddenly and is often temporary and treatable. In contrast, dementia/Alzheimer’s symptoms typically develop slowly and become progressively worse. Proper education of the medical staff and caregivers is necessary to differentiate between what is a part of the chronic condition and what is acute. This can help to avoid ER visits when possible.

The use of the quality improvement tool titled INTERACT can also be useful in reducing emergency room visits. INTERACT was adopted and started in long-term care facilities to assist with reducing hospitalizations and high rates of ER visits. INTERACT stands for Interventions to Reduce Acute Care Transfers (Lamb, et al, 2011). This quality improvement tool focuses on preventing conditions from becoming severe enough to require emergency room visits, managing acute conditions in the nursing home, and improving advance care planning for residents for whom palliative or comfort care is appropriate (Lamb, et al, 2011). This is a tool that could be utilized in the nursing home setting to avoid unnecessary trips to the hospital.

In conclusion, preventive strategies focusing on high-quality ambulatory care might further reduce potentially inappropriate emergency room visits and admissions. To ensure that ER visits are utilized when necessary, evaluation protocols are essential to have in facility settings.

Lamb, G., Tappen, R., Diaz, S., Herndon, L., & Ouslander, J. G. (2011). Avoidability of Hospital Transfers of Nursing Home Residents: Perspectives of Frontline Staff. Journal of the American Geriatrics Society, 59(9), 1665–1672. https://doi.org/10.1111/j.1532-5415.2011.03556.x

Zúñiga, F., Gaertner, K., Weber-Schuh, S. K., Löw, B., Simon, M., & Müller, M. (2022). Inappropriate and potentially avoidable emergency department visits of Swiss nursing home residents and their resource use: a retrospective chart-review. BMC Geriatrics, 22(1), 659. https://doi.org/10.1